Cultural competence in medical communication

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Cultural competence in medical communication

• Conny Seeleman
• Academic Medical Center, dept. Social Medicine
• 10th February 2006

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Cultural competence in medical communication

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

Academic Medical Center, dept. Social Medicine
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Introduction (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

Academic Medical Center, dept. Social Medicine
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Introduction (2)

• 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

Academic Medical Center, dept. Social Medicine
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Introduction (4)

• 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)

Academic Medical Center, dept. Social Medicine
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Introduction (5)

• Cultural competences, some examples
• Knowledge epidemiological aspects
• Awareness of influence of patients 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

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• Cultural Dimensions
• Geert Hofstede

Academic Medical Center, dept. Social Medicine
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Cultural dimensions - Hofstede (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

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Cultural dimensions - Hofstede (2)

• Method
• Research project into national cultural
  differences at IBM
• 53 countries / 74
• In 1967 1973 and later
• Survey to compare culturally determined values

Academic Medical Center, dept. Social Medicine
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Cultural dimensions - Hofstede (3)

• Five dimensions
• Power distance
• Individualism
• Masculinity
• Uncertainty avoidance
• Long term orientation
• How about our countries?

Academic Medical Center, dept. Social Medicine
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Power distance (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

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Power distance (2)

• Power distance in medical practice
• Power difference between physician and patient
• Initiative for communication
• Expecting participation

Academic Medical Center, dept. Social Medicine
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Power distance (3)

• Power distance how about our countries?
• High power distance Low power distance

Academic Medical Center, dept. Social Medicine
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Power distance (4)

• Power distance how about our countries?
• High power distance Low power distance

MAR
Academic Medical Center, dept. Social Medicine
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Individualism (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

Academic Medical Center, dept. Social Medicine
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Individualism (2)

• Individualism in medical practice
• Importance group/family in decision making
• Meaning of yes and no
• Dependence vs. own responsibility

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Individualism (3)

• Individualism vs. collectivism
• how about our countries?
• Individualism Collectivism

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Individualism (4)

• Individualism vs. collectivism
• how about our countries?
• Individualism Collectivism

GB
Academic Medical Center, dept. Social Medicine
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Masculinity (1)

• 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

• 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

Academic Medical Center, dept. Social Medicine
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Masculinity (2)

• Masculinity vs. femininity in medical practice
• Different ideas about good doctors
• Aggression
• Sexuality issues

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Masculinity (3)

• Masculinity vs. femininity
• how about our countries?
• Masculinity Femininity

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Masculinity (4)

• Masculinity vs. femininity
• how about our countries?
• Masculinity Femininity

IT
Academic Medical Center, dept. Social Medicine
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Uncertainty avoidance (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

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Uncertainty avoidance (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

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Uncertainty avoidance (3)

• Uncertainty avoidance
• how about our countries?
• High uncertainty Low uncertainty
  
• avoidance avoidance

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Uncertainty avoidance (4)

• Uncertainty avoidance
• how about our countries?
• High uncertainty Low uncertainty
  
• avoidance avoidance

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Time orientation (1)

• Long term orientation
• Perseverance leads to gradual results
• Thrift, deal with means sparsely
• Old age is a happy phase that starts relatively
  early

• Short term orientation
• Short efforts with quick results
• Aggression and emotions are not expressed
• Old age is an unhappy phase, fortunately is
  starts late

Academic Medical Center, dept. Social Medicine
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Time orientation (2)

• Long term orientation in medical practice
• Logic of preventive measures
• ?

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Time orientation (3)

• Time orientation
• how about our countries?
• Long term orientation short term
  orientation

Academic Medical Center, dept. Social Medicine
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Time orientation (4)

• Time orientation
• how about our countries?
• Long term orientation short term
  orientation

GB
Academic Medical Center, dept. Social Medicine
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Cultural dimensions - Hofstede

• Discussion
• What attracted your attention? What amazed you?
• Can such a theory as Hofstedes be helpful in
  medical practice?

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• case-study
• A dialogue with a Moroccan man and woman

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Case-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?

Academic Medical Center, dept. Social Medicine
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Case-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

Academic Medical Center, dept. Social Medicine