(7) communicating with patients from different cultural background.ppt

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  • 8/14/2019 (7) Communicating with Patients From Different Cultural Background.ppt

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    Communicating with patientsfrom different cultural

    backgrounds

    I Gde Raka Widiana

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    The importance of cross-culturaland racial issues

    The great divisions among humankind and the dominatingsources of conflict will be cultural (Huntington)The people of different civilizations have different views onthe relations between:

    God and man,

    the individual and the group,the citizen and the state,parents and children,husband and wife,rights and responsibilities

    liberty and authority,equality and hierarchy.

    Intercultural communication have contributed to increasedinternational contacts .

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    Definition of Culture ideas , values, beliefs, customs and

    behaviors based on different people'supbringing and personal experiences .

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    cultural changes affects health services.

    cross border movement and seeking for health services abroad

    Patients new and unfamiliar country, unfamiliar hospitalenvironment.

    The hospital may represent a different set of cultural values andexpectations, as well as a different language.

    Foreign environment can make the whole experience extremelyalienating.

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    S c e n a r i o :

    Imagine that you are physically unwell and don'tknow what is wrong.

    You know that you need to consult a doctor andyou go to the nearest hospital.

    You walk into an unfamiliar building and don'tknow where you should go; all the signs are inanother language.

    You hear this language being spoken and do notunderstand it, but you know you must makecontact with someone urgently.

    How would you feel? What would you do?

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    The role of culture in the doctor-patient relationship

    In every medical encounter you need tounderstand the patient's culture in order to begin

    to communicate effectively in some aspects.

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    Naming:

    Find out the patient's full name . Ask if they have a surname different from the

    one usually used. The names of other family members may be

    different, so do not use the husband's surname to refer to the wife, and vice versa.

    Address people by their surnames unless afamiliarity with the patient has been established.In some cultures, elders may expect to beaddressed formally as a sign of respect .

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    Significant others:

    Ask who are the significant people who haveaccompanied the patient to the hospital.

    Find out if they wish to accompany the patientduring the medical interview . For example, in thecase study, Mr Shah felt it was his duty, as headof the household, to be with his wife in order toexplain her problem to the doctor and be directlyinformed about her condition.

    How many people can join the patient during themedical interview?

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    Food and diet:

    Are there dietary rules that the patient wishes tofollow? For example, a Muslim patient will noteat pork as it is considered impure.

    Is the patient vegetarian or vegan ? Do patients have a preference about the manner

    in which food is served ? For example, Muslimpatients will not eat food offered with the lefthand -because only the right hand is consideredto be pure and clean.

    Can relatives bring in food for the patient ?

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    Religion:

    Ask if the patient has a religion and if they

    practice it. Ask if the patient wishes to worship whilst

    in hospital.

    Where appropriate, explore the patient'sreligious views that may have a bearing onblood transfusions, abortions, etc.

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    Hygiene and grooming:

    Are there particular wishes about bathing ? Forexample, in Sikh culture a deceased person

    must be washed by someone of the same sex . How does the patient feel about getting

    undressed in front of a doctor or nurse of theopposite sex?

    Does the patient object to the shaving of thehead or body?

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    Dress:

    Are there areas of the body that have to remaincovered? For example, it is vital that orthodoxMuslim women keep all parts of their body covered, except for their hands.

    Do jewellery and head coverings have religioussignificance?

    Are there items of clothing which are particularlysignificant?

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    Case example.

    Mrs Shah, an Indian woman attending a hospital clinic.Mrs Shah was referred to the outpatient clinic by her GP.She arrived with her husband, and the nurse called her to

    see the doctor. Her husband got up to go with her, butthe nurse told him this was not necessary.

    Mr Shah was angry and insisted on talking to the doctorhimself.The doctor could see that they were dressed in traditional

    clothes, and that their spoken English was poor.

    He wondered why Mr Shah was so angry and why hewanted to accompany his wife.He often felt uncomfortable dealing with patients from other

    cultures.

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    In the case example, the doctor needs to establish : if it is more acceptable in her culture that she be joined

    by her husband rather than left alone with a male doctor if her hesitancy may be caused by reasons that are not

    related to her culture. The doctor could invite both of them into a private room

    to discuss whether her husband should be present:

    Doctor: Would you both like to join me? Mrs Shah: My husband must come with me so that he

    can explain to me what I have to do. I mustn't be left onmy own after all, it is my husband who has broughtme here.

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    Reasons why patients present cross-culturalissues in a covert way , or might avoid them

    They may fear that the doctor might become angry or judgmental

    They do not know how much the doctor knows abouttheir culture

    They may fear that showing a preference for their ownpractices will insult the doctor's culture and worry thatthis might interfere with their treatment .

    In some cultures, the doctor is a figure of very highstatus whose authority should not be challenged .

    Some patients may be angry at having to travel fromabroad to seek treatment in an alien culture, and theymay be afraid to show their anger to the doctor .

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    Dealing with barriers in cross-cultural communication

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    Advice on cross-culturalcommunication with patients

    Do not impose your own values on the patient Learn about the cultural background of your patients,

    particularly if they constitute a large group in yourcommunity

    Learn which cultural differences might affect treatment Show the patient that you respect the differences betweenyou and the patient

    Find out if there are similarities in ideas and expectations and build on them whenever possible

    Be open-minded about cultural practices unfamiliar to you Accommodate cultural ideas in the treatment without

    compromising the quality of care provided for the patient Explain that you will try to give the best medical care

    possible, but that you are not an expert on their culture

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    Do's and Don't's in cross-culturalcommunication

    Do1. Use open questions2. Explore the racial and cultural background only if necessary3. Be honest about anything that may be unclear to you4. Show respect for cultural differences

    Don't1. Pretend to understand cultural patterns you are unclear about2. Be judgmental about cultural patterns3. Make assumptions about how the patient's cultural patterns might

    relate to the onset of illness or to the outcome of treatment4. Assume that cultural issues are unimportant if they don't appear inthe initial interview, for they may become pertinent at any stage of themedical encounter

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    Consult relatives

    In dealing with emotive areas such as death in the family,the relatives need to be consulted on culturallyappropriate practices.

    For example, in Judaism, the deceased must be buried as soon as

    possible, and usually within 24 hours: mutilation of thebody is not allowed unless there is a legal requirementfor a post-mortem.

    In Hindus, the dying patient is usually read passagesfrom the Holy Book, and once the person has died theirbody must be left uncovered . The rituals surroundingdeath are emotive ones for the relatives, and to makedecisions without consulting them could be viewed asoffensive and disrespectful.

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    The use of interpreters

    The use of interpreters is commonplace in mosthealth care settings (If the patient or their

    relatives speak little or no English) to make surethe relatives understand the nature of the illnessand the treatment planned .

    Interpreter from the patient's own culture canidentify crucial issues and give comfort andsupport.

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    Some problems in usinginterpreters

    Possibility of bias when communication is dependent ona third party.

    Meanings can be changed in the process of translation. Interpreters are often lay people and are not usually

    familiar with medical terminology An interpreter's presence may embarrass the patient

    when the problem is perceived as a taboo subject (e.g. a

    sexual problem) An interpreter might reinterpret the patient's ideas , or

    abbreviate responses. This can annoy doctors.

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    Consult colleagues

    Sometimes it may be necessary to consultcolleagues in order to find the most effective way

    of bridging cross-cultural differences and thehospital practices. Colleagues of the same cultural background as

    the patient may be particularly helpful in

    suggesting ways to ensure that the patient feelssupported (e.g. they can provide the presence ofsomeone who speaks the patient's language).

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    Key Points It is important to allow the patient to explain their

    cultural background, values, beliefs andexpectations when these may be relevant to theconsultation.

    Heightened awareness of cultural issues canhelp you to make a more accurate assessmentof the patient's behavior, to improve thetherapeutic relationship and to enhancetreatment.

    The doctor needs to accept other people'scultural and racial ideas as different, but equallyimportant.

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    Key Points (contd) Important issues can be overlooked if

    either the doctor or the patient fearmisunderstanding and rejection of cultural

    values. The patient may be part of a particular

    culture, but they will have adopted someaspects of it and rejected others.

    Matching patient and doctor according torace or culture is not always helpful.