In Montgomery County, Maryland, Wendy Friar, Holy Cross Hospital’s Director of Community Health, has used foreign medical school graduates to lecture recent immigrants regarding appropriate use of the American medical system. Every aspect of this interaction must be considered. Immigrants need to understand how to find a primary physician instead of simply using the emergency department. They need to know the importance of preventive care and how to get it. Friar’s system helps this new wave of people integrate into the system more effectively. Physicians have colleagues from many cultures who can serve as resources to help better understand their patients; they should take advantage of this bounty that is available to them.
Misunderstandings regarding cultural differences can be found in misconstrued words and in nonverbal communications that convey something we never intended to say. It is worth the physician’s time to get to know about their patient’s culture. As an added benefit, the patient usually warms to the fact that the doctor is interested in them as individuals and as people of a specific background. If the physician knows a little of the patient’s language, they may also want to use a few words in conversation, but it is not a good idea to depend on it. Again, this shows respect for the patient as a person and is appreciated, even if the words are not pronounced perfectly!
Nonverbal communication is important in every culture, but it is interpreted differently by each. In some cultures, people are comfortable being in close proximity to each other; but other groups require a polite distance. Types of physical bearing, facial expressions, and hand and arm gestures all can be inappropriate or uncomfortable for some cultures. The use of humor or calling a patient by their first name may be offensive to some. Even touching the head of a child is inappropriate in some cultures; and direct eye contact is acceptable in a number of societies, not in others. Pages can be devoted to the details of this issue. Since it is important to treat each patient with respect, it will be important for each physician to take the training that is offered, and to learn from both his or her colleagues and their patients.
Verbal misunderstandings can be reduced by several means. If the patient and/or family have some understanding of English, speaking slowly and pausing periodically will allow them to do most of the necessary mental translations. An increased understanding can be obtained by using pictures and diagrams; writing simple instructions in large, easy-to-read print will also help. Periodically asking questions about the patient’s understanding of explanations and instructions, and rephrasing the questions can be helpful. The same thing can be done with the instructions themselves. They should be repeated in different words so that they are more likely to be understood. Ask the patient if their lifestyle and their schedule will allow them to follow the directions they have been given; for instance, will they be allowed to take fifteen minutes every three hours to apply ice to an injury while they are at work?
It is also a good idea to use interpreters and use other experts, like the pharmacist who speaks the patient’s language. A recent study, published in the 2008 Journal of the American Board of Family Medicine stressed that patients prefer physician-patient communications in which they are asked about their understanding, and the physician also acknowledges the challenge of understanding all the information presented. This creates a more comfortable, shame-free environment for the patient.
Few people feel comfortable admitting that they don’t understand something that has just been explained to them. In a physician’s office, when cultural, language, and simple communication differences are often in play, it becomes the physician’s responsibility to bridge those gaps so that their patients are given a chance at a better health outcome.
While interpreters can solve many communication problems, cultural barriers can still surface. For instance, when family members are used as interpreters, children may be raised to a position of power over their parents, and that may make both them and their parents uncomfortable. This situation may go beyond mere discomfort in cultures where the patriarch is the only person with authority in the family; the translation simply will not be accurate or will not occur at all.
Matters of sexual or reproductive health are often just too uncomfortable or inappropriate for family members to translate, and in these cases, the discomfort may be compounded by the translator’s misunderstanding and mistranslating of anatomical terms.
Satyanarayana, Megha. “Breaching Barriers of Culture and Understanding: Holy Cross Links Imigrants With Health Professionals Who Speak Their Language.” Special to The Washington Post. Tuesday, February 5, 2008. http://www.washingtonpost.com. © The Washington Post Company. 2/7/2008.
Desmond, Joanne and Lanny R. Copeland, M.D. “Communicating with Today’s Patient: Essentials to Save Time, Decrease Risk, and Increase Patient Compliance.” Jossey-Bass, San Francisco. Page 205.
xi Kemp, Evelyn C., PsyD, RN, Floyd, Michael R., EdD, McCord-Duncan, Elizabeth, MD and Forrest Lang, MD. “Patients Prefer the Method of ‘Tell Back-Collaborative Inquiry’ to Assess Understanding of Medical Information.” Journal of the American Board of Family Medicine. 2008;21(1):24-30. 4/08/2008. ©2008 American Board of Family Medicine. http://www.medscape.com. 4/16/08.