From What Language Does Your Patient
Hurt In?: A Practical Guide to Culturally Competent Care.
Diversity Resources, Inc. Amherst, MA. 2000.
1. Everyone likes to feel special!
Check your records. What cultural groups did you serve last month ? Decide to learn a little about one of those cultures every week.
Hint: Start with the calendar. Are there any festivals or holidays that your patients will observe this month? Ask the first patient you see from each cultural group if there is any specific greeting that is used for that occasion. Write it down and learn to say it in the patient's language. Even if you mispronounce it, the patient will be really pleased with your effort!
2. When speaking to patients who are not proficient in English, avoid too much "small talk."
Keep your language simple and not cluttered with extraneous questions or information.
Hint: "Friendly chatter" is not considered friendly in many cultures even if the person does understand you. It may be considered "inappropriate" to disclose personal information about yourself or "prying" to ask people about their job or their family.
3. Smile and look at the patient when greeting him or her but don't feel offended if the patient doesn't smile back or establish eye contact.
Hint: In some cultures, it's considered rude to smile at strangers and impolite to look directly at anyone who is older or in a position of authority.
4. When taking patient information, use questions that begin with when, where, why, who, which, how.
If the answer is vague or inappropriate, rephrase the question and start again!
Hint: These questions require a basic understanding of the question itself in order to supply the necessary information. If the patient is unable to answer, there is a great possibility that he or she hasn't understood the question!
5. If a patient says "What?" or "Sorry" or "Could you repeat that?" in response to something you have said or asked, it probably means that the patient doesn't understand, not that he or she doesn't hear.
Rephrase your question or information in other words.
Hint: In general, it is a very good idea to give the same information or ask the same question in at least two or three different ways. Use different words and expressions each time.
6. Don't make any assumptions about the patient's basic beliefs about how to best maintain health or cure illness.
Hint: Adopt a line of questioning that will help you learn some of the patient's beliefs: "Many of our X (name country or culture) patients believe (visit, do…) "Do you?"
7. Don't be angry or disturbed if a patient is accompanied by one or even a group of friends or family when visiting a hospital or clinic or medical office.
Try to accommodate them.
Hint: In many cultures, health decisions are not individual, but family decisions. You can save time, frustration, and gain support for your medical advice if family members are included in the consultation should the patient request that they be present.
8. Be aware that patients may be reluctant to make health care choices or decisions.
Wanting to be part of the decision-making process is a uniquely Caucasian-American cultural trait. Be sensitive to the possibility that asking the opinions of patients who belong to a culture in which the physician is viewed as the "knower" who will make the best choices and take "full charge" of the patient's cure may destroy the patient's faith and trust in the physician or medical facility.
Hint: The patient may turn the question back to you, saying, "I don't know. What do you want me to do?" At this point, it is best to say something like, "Well, if it were me (my mother, my sister, my son…) I would do/choose X but I'm required by law to have you make the final decision."
9. Don't discount or ridicule the power of the belief in the supernatural!
You may not believe in those things, but if your patient does, it will affect his/her health and compliance and satisfaction with treatment.
Hint: If the patient believes that he or she has been hexed, or bewitched, or punished for past sins, he or she is likely to take little responsibility for participating in treatment and may have little faith in your ability to cure this illness.
10. Make your practice or facility "patient friendly."
Learn what colors, images, and reading matter will appeal to diverse segments of your patient population. Make sure your waiting room looks and feels like a secure, comfortable place for all patients!
Hint: If many of your patients are from Asia or the Middle East, you might have tea available. Make sure you have magazines and/or newspapers in the languages of your patients. Are health signs and posters meaningful to the cultures you serve?
11. Be aware that cultural factors affect how to best relate bad news or to explain in detail the nature of a disease or complications that might result from a course of treatment to the patient.
Hint: In many cultures, a poor prognosis is never given to the patient and certain words, such as cancer, are never used. Talk to the family first. Follow their advice about how much to disclose to the patient.
12. A gesture or facial expression is worth a thousand words!
When communicating through an interpreter, face and direct your comments to the patient, not the interpreter.
Hint: Observe the patient's body language and facial expressions carefully. They may tell you much more than the interpreter can! When the words and expressions don't match, rephrase your questions or information.