Cultural competence in medical communication Conny Seeleman Academic Medical Center, dept. Social...

Cultural competence Cultural competence

in in

medical communicationmedical communication

Conny Seeleman

Academic Medical Center, dept. Social Medicine

10th February 2006

Cultural competence in medical Cultural competence in medical communicationcommunication

Program:• Introduction • Cultural dimensions – Hofstede• Discussing a case-study


Introduction Introduction (1)(1)

Why our project?• 2001: Inventory study medical faculties• Need for educational material

Aim of our project:• Developing a book of case-studies about

ethnic diversity



What did we do?• Identify problems in literature

– Epidemiology– Migration history and contextual factors– Cultural differences– Communication

• Medical practice– Interviews with physicians– Interviews with patients



Determine learning objectives cultural competences

Cultural competences:• The attitudes, knowledge and skills a

physician requires in order to adequately take care of migrant* patients

(*migrant: first, second and third generation migrants)



Cultural competences, some examples:• Knowledge epidemiological aspects

• Awareness of influence of patient’s background on his/her perspective

• Awareness of own frame of reference

• Awareness of own prejudice, stereotyping

• Being able to transfer information in an ‘understandable’ manner

• Knowledge of legal rules and procedures


Cultural DimensionsCultural Dimensions

Geert HofstedeGeert Hofstede


Cultural dimensions - HofstedeCultural dimensions - Hofstede (1)(1)

Hofstede:• Culture as mental programming: ‘software of the

mind’• Cultural dimension:

“a dimensions is an aspect at which a culture can be compared to other cultures”



Method:

• Research project into national cultural differences at IBM

• 53 countries / 74

• In 1967 – 1973 and later

• Survey to compare culturally determined values



Five dimensions• Power distance• Individualism• Masculinity• Uncertainty avoidance• Long term orientation

How about our countries?


Power distancePower distance (1)(1)

Low power distance

• Inequality should be as

small as possible

• Parents treat children as

equal

• Teachers expect students’

initiative

• Subordinates expect to be

consulted


High power distance

• Inequality is wanted and

expected

• Parents teach children to

obey

• Teachers have all initiative

• Subordinates expect to be

directed

Power distance Power distance (2)(2)

Power distance in medical practice

• Power difference between physician and patient– Initiative for communication– Expecting participation



Power distance: how about our countries?

High power distance Low power distance



Power distance: how about our countries?

High power distance Low power distance


MAR T IT NL GB

GER

IndividualismIndividualism (1)(1)

Individualism• Consider oneself as ‘I’

• Personal opinion is

expected

• Virtue to be totally honest;

confrontation can be

beneficial

• Low context communication

• Guilt


Collectivism• Consider oneself as ‘we’

• Opinions determined by

group

• Harmony should be kept;

confrontation avoided

• High context communication

• Shame

IndividualismIndividualism (2)(2)

Individualism in medical practice

• Importance group/family in decision making• Meaning of ‘yes’ and ‘no’

• Dependence vs. own responsibility


Individualism Individualism (3)(3)

Individualism vs. collectivism:

how about our countries?

Individualism Collectivism


Individualism Individualism (4)(4)

Individualism vs. collectivism:


Individualism Collectivism


GB NL IT GER MAR T

Masculinity Masculinity (1)(1)

Masculine

• Fathers handle facts, mothers

handle feelings

• Girls may cry, boys should

fight back

• Best student is norm

• Feminism: women get same

opportunities as men

• Taboo on speaking about sex,

more implicit symbolism

• Migrants should assimilate


Feminine

• Fathers and mothers handle

facts and feelings

• Boys and girls may cry, both

should not fight

• Average student is norm

• Feminism: society should

change

• Explicitness about sex, less

implicit symbolism

• Migrants should integrate


Masculinity vs. femininity in medical practice

• Different ideas about good doctors• Aggression

• Sexuality issues



Masculinity vs. femininity:


Masculinity Femininity



Masculinity vs. femininity:


Masculinity Femininity


IT GB

GER

MAR T NL

Uncertainty avoidance Uncertainty avoidance (1)(1)

High uncertainty avoidance • Many and precise rules and

regulations• Aggression and emotions can

be expressed if right time and place

• Difference is dangerous• More sorrow about health and

finances• Confidence in specialists and

technical solutions• Prejudice against ethnic

differences


Low uncertainty avoidance• Little and broad rules and

regulations• Aggression and emotions are

not expressed

• Difference is interesting• Less sorrow about health and

finances• Confidence in generalists and

common sense• Tolerance for ethnic differences

Uncertainty avoidanceUncertainty avoidance (2)(2)

Uncertainty avoidance in medical practice

• High Uncertainty avoidance less subjective wellbeing

• Physicians essential for every task?• Emotion expression in consultation• Patients’ confrontation with discrimination



Uncertainty avoidance:


High uncertainty Low uncertainty

avoidance avoidance



Uncertainty avoidance:


High uncertainty Low uncertainty

avoidance avoidance


T NLMAR GERIT GB

Time orientation Time orientation (1)(1)

Short term orientation• Short efforts with quick

results• Aggression and emotions

are not expressed• Old age is an unhappy

phase, fortunately is starts late


Long term orientation • Perseverance leads to

gradual results• Thrift, deal with means

sparsely• Old age is a happy phase

that starts relatively early


Long term orientation in medical practice

• Logic of preventive measures• ?



Time orientation:


Long term orientation short term orientation



Time orientation:


Long term orientation short term orientation


NL IT GER GB

Cultural dimensions - HofstedeCultural dimensions - Hofstede

Discussion

• What attracted your attention? What amazed you?

• Can such a theory as Hofstede’s be helpful in medical practice?


case-study:

A dialogue with a Moroccan man A dialogue with a Moroccan man and womanand woman


Case-studyCase-study

• What problems/difficulties occur in this case?

• What could cause these problems?

• What cultural competences (knowledge,

attitudes, skills) does a physician need to

prevent or reduces these kinds of problems?


Case-studyCase-study

Themes we discuss • Communication:

– exploring lists of concern, points of attention (skill)

– language difficulties and causes of misunderstanding (knowledge)

– leading a conversation, involving a third person

• Background information (knowledge):– contraception and Moroccan women

– virginity and islam

• Awareness:– Influence own frame of reference

– Limits of own competence


Cultural competence in medical communication Conny Seeleman Academic Medical Center, dept. Social...

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