Cultural differences in medical communication: a review of the literature.

OBJECTIVE Culture and ethnicity have often been cited as barriers in establishing an effective and satisfying doctor-patient relationship. The aim of this paper is to gain more insight in intercultural medical communication difficulties by reviewing observational studies on intercultural doctor-patient communication. In addition, a research model for studying this topic in future research is proposed. METHODS A literature review using online databases (Pubmed, Psychlit) was performed. RESULTS Findings reveal major differences in doctor-patient communication as a consequence of patients' ethnic backgrounds. Doctors behave less affectively when interacting with ethnic minority patients compared to White patients. Ethnic minority patients themselves are also less verbally expressive; they seem to be less assertive and affective during the medical encounter than White patients. CONCLUSION Most reviewed studies did not relate communication behaviour to possible antecedent culture-related variables, nor did they assess the effect of cultural variations in doctor-patient communication on outcomes, leaving us in the dark about reasons for and consequences of differences in intercultural medical communication. Five key predictors of culture-related communication problems are identified in the literature: (1) cultural differences in explanatory models of health and illness; (2) differences in cultural values; (3) cultural differences in patients' preferences for doctor-patient relationships; (4) racism/perceptual biases; (5) linguistic barriers. It is concluded that by incorporating these variables into a research model future research on this topic can be enhanced, both from a theoretical and a methodological perspective. PRACTICE IMPLICATIONS Using a cultural sensitive approach in medical communication is recommended.

[1]  Carolyn M. Brown,et al.  Ethnic differences in temporal orientation and its implications for hypertension management. , 1996, Journal of health and social behavior.

[2]  M. Maclachlan.  Cultivating Pluralism in Health Psychology , 2000, Journal of health psychology.

[3]  D. R. Levy.  White doctors and black patients: influence of race on the doctor-patient relationship. , 1985, Pediatrics.

[4]  S. Murphy,et al.  Ethnicity and attitudes toward patient autonomy. , 1995, JAMA.

[5]  T. Koepsell,et al.  Patient-physician racial concordance and the perceived quality and use of health care. , 1999, Archives of internal medicine.

[6]  J. Scarpaci.  Help-seeking behavior, use, and satisfaction among frequent primary care users in Santiago de Chile. , 1988, Journal of health and social behavior.

[7]  R. Nisbett.  The geography of thought : how Asians and Westerners think differently--and why , 2003 .

[8]  D. Roter.  The enduring and evolving nature of the patient-physician relationship. , 2000, Patient education and counseling.

[9]  S. Ibrahim,et al.  Racial/ethnic variations in physician recommendations for cardiac revascularization. , 2003, American journal of public health.

[10]  G. Hofstede.  Culture′s Consequences: Comparing Values, Behaviors, Institutions and Organizations Across Nations , 2001 .

[11]  T. Singelis,et al.  The Measurement of Independent and Interdependent Self-Construals , 1994 .

[12]  A. Krumeich,et al.  The future of intercultural mediation in Belgium. , 2002, Patient education and counseling.

[13]  J. Brown,et al.  Intercultural consultations: investigation of factors that deter non-English speaking women from attending their general practitioners for cervical screening. , 1994, BMJ.

[14]  A. Ramirez.  Consumer-provider communication research with special populations. , 2003, Patient education and counseling.

[15]  J. Gilmartin,et al.  Barriers to communication between health practitioners and service users who are not fluent in English. , 2002, Nurse education today.

[16]  D. Trafimow,et al.  Culture and its Implications for Intergroup Behavior , 2008 .

[17]  E. Jacobs,et al.  Patient centeredness in medical encounters requiring an interpreter. , 2000, The American journal of medicine.

[18]  M. van Ryn,et al.  The effect of patient race and socio-economic status on physicians' perceptions of patients. , 2000, Social science & medicine.

[19]  S. Erzinger,et al.  Communication between Spanish-speaking patients and their doctors in medical encounters , 1991, Culture, medicine and psychiatry.

[20]  T. Schofield.  Patient-Centered Medicine: Transforming the Clinical Method , 1995 .

[21]  J. Bensing,et al.  Doctor-patient communication in different European health care systems: relevance and performance from the patients' perspective. , 2000, Patient education and counseling.

[22]  H. D. de Haes,et al.  Patient centered decision making in palliative cancer treatment: a world of paradoxes. , 2003, Patient education and counseling.

[23]  Rosa Seijo,et al.  Language as a Communication Barrier in Medical Care for Hispanic Patients , 1991 .

[24]  J. Feinglass,et al.  Explaining racial variation in lower extremity amputation: a 5-year retrospective claims data and medical record review at an urban teaching hospital. , 2003, Archives of surgery.

[25]  Ron D. Hays,et al.  Are latinos less satisfied with communication by health care providers? , 1999, Journal of General Internal Medicine.

[26]  P. Thoits,et al.  The impact of culture on the cognitive structure of illness , 1987, Culture, medicine and psychiatry.

[27]  B. Sleath,et al.  Hispanic ethnicity, physician-patient communication, and antidepressant adherence. , 2003, Comprehensive psychiatry.

[28]  D. Rowland,et al.  Race, Ethnicity, and the Health Care System: Public Perceptions and Experiences , 2000, Medical care research and review : MCRR.

[29]  A. Kleinman.  The cultural meanings and social uses of illness. A role for medical anthropology and clinically oriented social science in the development of primary care theory and research. , 1983, The Journal of family practice.

[30]  A. Nuru-Jeter,et al.  Is doctor-patient race concordance associated with greater satisfaction with care? , 2002, Journal of health and social behavior.

[31]  Judith A. Hall,et al.  Doctors Talking With Patients/Patients Talking With Doctors: Improving Communication in Medical Visits , 1992 .

[32]  William B. Gudykunst.  Cultural Variability in Communication , 1997 .

[33]  Rupert Brown,et al.  Blackwell handbook of social psychology: intergroup processes , 2002 .

[34]  T. Laveist,et al.  Race/ethnicity, the social environment, and health. , 1996, Social science & medicine.

[35]  M. Hecht,et al.  A Mexican American perspective on interethnic communication , 1990 .

[36]  A. Kleinman,et al.  Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. , 1983 .

[37]  C. M. Brown,et al.  The effects of health and treatment perceptions on the use of prescribed medication and home remedies among African American and white American hypertensives. , 1996, Social science & medicine.

[38]  M. Stone,et al.  Reasons for non-compliance with screening for infection with Helicobacter pylori, in a multi-ethnic community in Leicester, UK. , 1998, Public health.

[39]  Richard L Street,et al.  Racial and ethnic disparities in the use of health services: bias, preferences, or poor communication? , 2003, Journal of general internal medicine.

[40]  W. Ferguson,et al.  Culture, language, and the doctor-patient relationship. , 2002, Family medicine.

[41]  R. Zambrana,et al.  Panel VI: Ethnic Minorities, Health Care Systems, and Behavior , 1995 .

[42]  J. Selby,et al.  Racial and ethnic differences in a patient survey: patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. , 2000, Medical care.

[43]  T. Laveist,et al.  Attitudes about Racism, Medical Mistrust, and Satisfaction with Care among African American and White Cardiac Patients , 2000, Medical care research and review : MCRR.

[44]  J. Moreno,et al.  Informed consent: Patient autonomy and physician beneficence within clinical medicine , 1992 .

[45]  S. Sue,et al.  Asian-American assertion: A social learning analysis of cultural differences. , 1991 .

[46]  E. Saltzer,et al.  Cross-cultural aspects of physician-patient communications patterns. , 1981, Urban health.

[47]  S. Syme.  The social environment and health , 1994 .

[48]  Nikolas Coupland,et al.  ′Miscommunication′ and Problematic Talk , 1991 .

[49]  B. Sleath,et al.  Physician expression of empathy and positiveness to Hispanic and non-Hispanic white patients during medical encounters. , 2000, Family medicine.

[50]  Deborah A. Cai,et al.  A test of a cultural model of patients' motivation for verbal communication in patient‐doctor interactions , 2000 .

[51]  Dee G. Appley.  Beyond Culture , 1977 .

[52]  T. Holtgraves.  Styles of language use : Individual and cultural variability in conversational indirectness , 1997 .

[53]  B. Sleath,et al.  Gender, ethnicity, and physician-patient communication about depression and anxiety in primary care. , 2002, Patient education and counseling.

[54]  The influence of Hispanic ethnicity on patients' expression of complaints about and problems with adherence to antidepressant therapy. , 2003, Clinical therapeutics.

[55]  Héctor Betancourt,et al.  The Study of Culture, Ethnicity, and Race in American Psychology , 1993 .

[56]  L. Meeuwesen,et al.  When cultures meet in general practice: intercultural differences between GPs and parents of child patients. , 2003, Patient education and counseling.

[57]  Debra L Roter,et al.  Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race , 2003, Annals of Internal Medicine.

[58]  N. Powe,et al.  Patient race/ethnicity and quality of patient-physician communication during medical visits. , 2004, American journal of public health.

[59]  J. Brown.  Patient-centred medicine: Transforming the clinical method , 1998 .

[60]  R. S. Klingle,et al.  Silent partners in medical care: a cross-cultural study of patient participation. , 1996, Health communication.

[61]  A. Kleinman.  Clinical relevance of anthropological and cross-cultural research: concepts and strategies. , 1978, The American journal of psychiatry.

[62]  M. Bruijnzeels,et al.  Intercultural communication in general practice. , 2002, European journal of public health.

[63]  William B. Gudykunst,et al.  The Influence of Cultural Individualism-Collectivism, Self Construals, and Individual Values on Communication Styles Across Cultures , 1996 .

[64]  R. Gomez,et al.  Patient personality predicts preference for relationships with doctors , 2004 .

[65]  J. Goodwin,et al.  Patient Characteristics That Influence Physician Behavior , 1982, Medical care.

[66]  H. Markus,et al.  Culture and the self: Implications for cognition, emotion, and motivation. , 1991 .

[67]  M. Christie,et al.  Sharing the true stories: improving communication between Aboriginal patients and healthcare workers , 2002, The Medical journal of Australia.