Closing Cultural Gap Translates into Better Patient Care

Language, social and cultural differences and the assumptions made by clinicians are commonly cited challenges in intercultural communication.

In the years that Marcia Carteret, MEd, has worked as an interculturalist, she has seen many conflicts arise because of differences between Western medicine and the differing cultural norms of patients and their families.

A patient who refuses interpretation services out of pride. A pediatrician who reports child abuse after seeing marks from traditional healing practices like cupping therapy. Parents who stop administering asthma medications after their child’s symptoms subside because their culture has no concept of chronic illness.

“Cross-cultural interactions, especially if there are language barriers, take up so much more time, and doctors are always behind schedule,” Carteret said. “For that reason alone, they are harder patients.”

Marcia Carteret

Carteret trains health care professionals how to communicate across cultural differences. Her primary office is in the department of pediatrics at the University of Colorado, but Carteret travels statewide to work with private practices as well as hospital groups.

Her approach starts by asking health care professionals to take a step back and look at their own cultures, including the culture of the medical world itself.

“They are working in a highly rarified environment with colleagues that share the same the language,” she said. “White lab coats, green scrubs. These are all the markers of culture.”

The expectation of many of Carteret’s workshop participants is that they will be given a how-to guide for each culture they encounter; instead, Carteret said, her training program takes a very different approach.

“You can’t learn how to interact with cultural differences as if cultures have recipe cards and you can carry those around with you and flip to the appropriate card,” she said. “But what you can do is understand some more foundational things about culture and how to compare and look for a kind of framework for comparison, which starts with understanding your own culture.”

Carteret focuses on eight dimensions of culture, which she uses to illustrate the differences between a physician’s own culture and that of his or her patients: time control, task vs. relationship, comfort with change, personal control over destiny, self-sufficiency, status, language, and individualism vs. collectivism.

During her workshop, she explains how each can be understood differently by individual cultures. For example, she describes self-sufficiency as the expectation that patients can be personally responsible for their own care without help from family or community members.

“Our health care system requires an enormous amount of self-sufficiency,” she said. “It’s a complex system of care that those of us who have lived with it our entire lives have a hard time navigating, but for people who come to this country as immigrants and refugees, it’s really hard. They need a lot of help, and they don’t demonstrate the self-sufficiency that we expect.”

Emma Paternotte, MD, PhD, an OB-GYN resident in Utrecht, Netherlands, has found that physicians working internationally are also faced with the challenge of communicating with patients from cultures different from their own.

“I know that in the hospitals in Amsterdam, around 50 percent of the patients have a different cultural background than the doctor has,” said Paternotte, whose doctorate is in intercultural communication. “This does not mean that they always clash, but it can mean that doctors need to be prepared for the conversations with these patients.”

In a 2015 literature review, Paternotte and a team of researchers found that language, social and cultural differences and the assumptions made by physicians were commonly cited challenges in intercultural communication highlighted by previous studies. The researchers suggested that training programs for physicians who practice intercultural communication are an important step to address potential communication barriers.

In her work in Colorado, Carteret has also found training to be an important first step, but she said the real learning happens in the field while delivering care and communicating with patients and their families. Though a patient’s cultural norms may differ from the standards of Western medicine, it is the relationship between the physician and the patient where the potential exists to open patient minds to new ideas.

“It certainly doesn’t happen in one visit,” Carteret said. “It’s when you build a relationship and rapport over time that you can start to make inroads with patients and families.”

Though Carteret said she can’t give a step-by-step guide to physicians about how to approach each individual patient with cultural differences, learning to communicate across cultures always starts with physicians acknowledging cultural biases.

“When you have a patient from a culture that is significantly different from your own, you know right off the bat that you had better step back a bit, slow down, and your antenna needs to go up,” she said. “You start from a place where you know this communication is going to be difference-based.”

Hannah O. Brown is a freelance health care journalist based in Florida.