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Coping with cultural differences in consultations

Dr Bryony Hooper on managing cultural differences in our increasingly diverse and mobile society.

Bridging cultural differences is vital in diverse patient populations (Photograph: Alamy)
Bridging cultural differences is vital in diverse patient populations (Photograph: Alamy)

Have you ever shown a patient the sole of your shoe while sitting at your desk with your legs crossed? In some cultures, this could be seen as highly insulting.

Health-related norms and expectations vary enormously between cultures, and even in the multicultural UK, awareness of such potential problems can sometimes be lacking.

During the 2012 Olympics, millions of extra visitors from all over the world are expected not just in London, but across the UK, so avoiding a cultural clash could be more relevant than ever for GPs.

Language difficulties are legion in terms of problems of mistranslation, but they can also occur when GP and patient have a reasonable understanding of the same language, but use it differently. Even regional accents and variations can give rise to significant miscommunication.

However, more subtle and perhaps less well recognised problems can frequently occur during cross-cultural consultations (see box below).

CROSS-CULTURAL CONUNDRUMS

Some less obvious examples

  • How do you judge the effect of bad news on a patient who is wearing a burka?
  • What will you do when a female patient refuses to answer questions that concern her health, and refers them to her husband, who seems unlikely to know the answer?
  • How do you know whether a patient has understood the advice you have given when they do not make eye contact?
  • How do you judge whether you have done something perceived as offensive and how can you prevent or repair the damage to provide effective healthcare?

Even within Europe, patients' beliefs and priorities can vary considerably. One study has shown that while patients in Portugal believed it was very important for their doctor to take a personal interest in their life situation, this was considered unimportant by patients in Israel and Norway.

Patients in the UK, Norway and Denmark placed a high priority on feeling free to tell their GP their problems - a much lower priority in Israel.

Guidance
GMC guidance says doctors are expected to respect patients' rights to hold religious or other beliefs, and to take these beliefs into account where they are relevant to their care.

The guidance also advises against making assumptions about patients' wishes and recommends using contact groups with specialist knowledge if this might help.

Being adaptable
Suggestions for bridging cultural differences include establishing a trusting relationship, facilitating the involvement of family members, warning patients about the proposed discussion when it is likely to be difficult and involving respected community members or traditional healers if appropriate.

If your practice treats many patients from one particular culture, you will be aware of matters that might cause offence, or unexpected reactions, and these are likely to have been discussed by the staff. Having established, positive doctor/patient relationships makes a big difference.

Being prepared
In less familiar situations or when first meeting a patient, awareness of the potential for misunderstanding is invaluable. Being alert to signs of confusion will flag up problems.

Showing respect for the patient's preferences, for example, choosing not to be examined by a male doctor, is also vital in establishing trust. It is important not to impose your own cultural beliefs on patients.

Sensitivity
Involving family members should be encouraged if the patient finds it helpful and reassuring. If you know or suspect that something you would consider standard practice, such as examining the abdomen, might cause concern or upset, make sure you provide the patient with a clear explanation of what you propose to do and why.

Be flexible about factors that can help the patient to feel comfortable, such as discussing the proposed examination with their family before proceeding. It is vital that you only take steps to which the patient has agreed, whether or not you agree with the patient's reasoning. Acting against their wishes will not only cause great distress, but can also leave you vulnerable to potential allegations.

Open mind
You may be uncomfortable with the concept of traditional healers, but understanding the role they might have in the patient's beliefs, and how you might work together for the patient's health, might be useful in some cases.

Being open-minded and willing to learn and understand can bring unexpected benefits in the relationship with patients.

Doctors regularly adapt their approach to patients and their treatment, depending on a range of factors - age, cognitive abilities and even the patient's mood and outlook during the consultation. Cultural differences are just one more consideration to factor in.

Being flexible and sensitive can help to avoid misunderstandings that often lead to complaints, and make a vital difference to the effectiveness of your care.

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • If your practice has a predominance of patients from a particular cultural background, consider the potential cultural concerns or challenges that could arise and explore these with the practice team.
  • Reflect on any consultations where you feel communication could have been improved. Were cultural matters a factor? If so, consider practice discussion or role play to revisit the scenarios and consider what could have been done differently.
  • Ensure that you are familiar with GMC guidance on personal beliefs and medical practice (www.gmc-uk.org).

Save this article and add notes with your free online CPD organiser at gponline.com/cpd



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