An OB-GYN and I were talking about a recent presentation she’d seen from a leader in her field. I heard in her voice how much she’d enjoyed the presentation, and we spent some significant time talking about it.
She was encouraged by this physician’s thoughtful comments on some of the complexities in physician/patient communication. She was especially interested in issues he’d raised around empathy, being present, and the emotional contexts around communication.
One observation she made stood out to me, as we were discussing her thoughts:
“Any conversation about care is also a conversation about culture.”
I would like to take some time to consider this statement, in light of the attention being paid the last several years to various issues of cultural difference and diversity.
And as usual, I’ll end with something you can do today: two ways you can take that important first step toward speaking respectfully and connecting meaningfully with all patients–including those who don’t look, sound, or see the world like you do.
The case for cross cultural communication
According to PubMed, an average of more than 3300 articles per year, over the last ten years, have been written on cross cultural issues such as communication, care, interaction, adaptability and measurement.
How do you communicate with patients with whom it seems you have little in common? This isn’t a problem unique to medicine, of course. Talking across difference happens in any human relationship.
It might go without saying that cross-cultural communication training is helpful. Physicians who are trained in specialty-specific conversations benefit when cross-cultural communication is added in, as found in this study in pediatric hematology/oncology fellows and this study on primary care physicians and pediatric asthma .
When cultural differences are missed or ignored in communication, outcomes suffer. As this recent study points out, “Ineffective cross-cultural communication contributes to adverse outcomes for minority patients.” Similarly, this article on cross cultural communication for pharmacists asserts that “failure to recognize these [cultural] differences may contribute to misunderstanding or miscommunication that may affect treatment.”
What’s being done
Providers like you are noticing that cross-cultural communication matters. And you’re asking for support.
There are some popular models for cross-cultural communication, with new ones being developed for in-person and online formats. Health professions educators also merit support in facilitating cross-cultural communication education in their programs, as this study confirmed.
One study at an aged care facility found that the wide range of care providers who participated demonstrated being “already sympathetic and sensitive to cross-cultural issues.” Another study in oncology found that providers had “a high level of interest in all aspects of cross-cultural training.”
Challenges to cross-cultural communication
The broad agreement and enthusiasm around cultural issues in communication is essential, in the face of the many challenges to cross-cultural communication in the health sector.
Even from my position, I have sensed the tension in engaging in talk about difference, when medicine is focused, perhaps necessarily, on standardization.
It does not help that many providers interact with patients in situations where they are the only provider present. So these cross-cultural conversations are unintentionally hidden from view. Among other things, this can make them difficult to talk about, and easy to sideline in favor of more visible issues.
There is also enormous pressure, as many physicians have told me, to be entirely error-free, self-sufficient, and—as one physician put it–nearly “superhuman.” It’s possible that providers are not encouraged to talk about their communication ‘failures,’ or ask critical questions of themselves or others.
I’d like to help by drawing your attention to the crucial first step in communicating across difference. One step that can be easy to overlook. And it’s one you can do on your own.
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Missing half of the picture
As I’ve talked with health care professionals about communication and culture, it’s been great to hear a high level of awareness about the importance of seeing the patient’s perspective. This is essential.
But that would be missing half of the picture.
Cross-cultural communication implies there’s at least two sets of cultures going on here, right? The patient’s, and…yours.
Yes, where you’re going matters. So does where you’re coming from.
You can’t help but speak from your own position. From the blend of the personal and professional cultures you’re a part of. (I won’t open the huge and contested issue of what culture means. It’s enough for right now to say we all belong to multiple cultures.)
Where do you stand?
Our understandings of the world – including our inaccurate or inadequate ones – are based on a lifetime of our own experience, and our membership in different social groups. We’re all always pulling on the collective knowledge and experiences of our ‘cultures’ to inform our words and actions.
These are cultural norms that we may or may not be aware of.
As I’ve noted before, our language reveals our perspective on what linguist James Gee calls “being ‘normal,’ ‘acceptable,’ ‘right,’ ‘real,’ ‘the way things are,’ or ‘the ways things ought to be.’” Language thus becomes a marker for what’s important to us, or for what we take for granted. And this often happens without our notice.
For example, I explored in a recent podcast the different–and entirely context-appropriate–uses of the terms “pee pee,” “pee” and “urinate.” Depending on who you are, and what your situation is, one of those terms works for you. The others would be…a bit off.
This is just a quick reminder that being aware of our language, and the sometimes-invisible influences on it, is important.
Awareness isn’t enough
Being conscious of our language is important, but this alone is not enough.
Language is tied to culture, and both language and culture are tied to power—for instance, power to make decisions, access resources, or make changes. About health, or anything else.
The relationships among language, culture, and power also tend to escape notice. Noticing them is a first step, but again, not enough.
Communicating across cultures, I suggest, involves asking pointed questions about much of what is usually taken for granted about culture, language, and power.
You yourself can begin this process–by examining some assumptions about your own communication with patients. And not only patients where there’s a cultural difference; patients of all kinds of backgrounds. Because this communication, as I’ve pointed out, has been shaped by your history, and the various personal and professional cultures you belong to.
Make the familiar strange
If you’re ready and willing to step back and look at your own language, and the assumptions beneath it, bravo! But how?
Here are two prompts to get you started:
- Which patients do you typically find it easy to talk to, get along with, or reach? What do you think it is about these patients, that makes those interactions easy for you? What might this tell you about your attitudes and assumptions regarding patient communication?
- Which patients you find it difficult to get along with, or relate to, or reach? What do you think it is about these patients, that makes those interactions difficult for you? What might this tell you about your attitudes and assumptions regarding patient communication?
(I’ve adapted these from an earlier article about reflective practice you can check out here.)
Every encounter is a cultural encounter
As my physician friend at the start said, “Any conversation about care is also a conversation about culture.”
She, and many other providers I have met, see their responsibilities to all patients, as well as the challenges and promises of culturally-responsive communication. And they want to grasp their opportunities to grow in this arena.
I’ll assert that no one, including me, can ‘empower’ you to respond appropriately to the myriad cultural differences between you and the patients you encounter across your professional career.
Rather, I argue that only you yourself can interrogate your communication—including the assumptions underneath your words—and then choose the appropriate words and actions for your specific context.
This process can be aided and supported with expert help, outside information, and additional resources. And, I highly recommend, a community of practice.
Effective Patient Education Audiobook Bundle
This bundle of audiobook, eBook, and supplementary materials will help make your life easier. And it might change the way you think about patient education, no matter your specialization or patient population. You get practical, culturally and linguistically relevant advice and research-based tools, in an unfussy, conversational format. All sales support this podcast series.
$19.99
Buy Now
