Culture shock in health care

Our culture code applies to our relation to health, too. Let’s take a surgery or hospital consultation: the patient will have certain expectations when it comes to encounters with a doctor, while the doctor, on the other hand, will expect certain behaviours from the patient. To name only a few: the doctor’s bedside manner, use of terminology, the way the patients are being addressed (Mr Brown vs. Bobby) and the on-going relationship with the patient. What are the cultural considerations when dealing in these situations? Let’s use examples from British-German-Polish using both perspectives.

Cultural considerations

I am currently delivering some German for medics courses at the University of Cambridge attended by fourth year British medical students. They are greatly motivated to improve their German and hence increase their chance of getting a work placement in Germany. Whatever their level of German, all of them will have noticed by now that communication is more than the language…

 

Medical consultations

We were looking at a typical German doctor-patient conversation; suddenly, I heard giggling, followed by a great outburst of laughter. ‘But surely, I can’t just say ‘Good morning’ to my patient and start examining them straight away?’.

Well… Yes, actually you can. In Germany or Poland, the literal translation would go:

DOCTOR:      Good morning, Herr Schmidt. How are you today?

PATIENT:      Good morning doctor, well, I’m actually bad. I’ve got a terrible pain in my chest.

DOCTOR:      OK, now I am going to examine you. Please take your shirt off.

The physical examination will of course trigger further questioning, but the doctor would certainly not be seen as rude or abrupt when he starts the consultation in this way. This scenario would be unthinkable for British doctors, whereas is typical in Germany, or in fact Poland, where a very direct style is used compared to British English.

The British style demands either small talk, or social oiling, even in accidental emergency. My British students found the German approach very hard to accept because they were had been taught not to do this in their UK communication training.

 

The attitude towards patients and illnesses

This is an area in which I can draw heavily from my own experience from living in the UK, Germany and Poland. I used to get frustrated when my British GP wouldn’t use medical terminology when talking to me, because this would make me feel that I was not being taken seriously.

It is nothing unusual in consulting your doctor when you have a bad cold in Poland or Germany. The difference there would be, that the Polish doctor is likely to give you antibiotics and the German a vitamin booster, but essentially, a cold is seen as an illness.

If it’s about children, in Poland you are likely to be told to wrap them up in blankets and keep home for about a week. In the winter, you should also forget about swimming for a couple of months… By contrast, UK doctors will probably advise you to give the child appropriate pain killers and fluids, but will give you a strange look if you mention keeping your child home. I was terrified when my GP told my to take my new-born with a chest infection for regular walks to help her breathing!

 

Conclusion

Our expectations are pre-programmed culturally and will affect our perception in every situation and can lead to misunderstandings. I see intercultural training as a vital tool not only in the private, but also in the public health, education and civil service sector. Just as business people need to learn how to do business abroad, British doctors, wherever they are working, have to be sensitive to cultural differences represented by their patients.

So whatever sector you work in, consider how you should approach intercultural communication.

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