Communicating Across Cultures Requires More Than Language

I recently visited Oakland, California to attend Diversity Rx's Eighth National Conference on Quality Health Care for Culturally Diverse Populations (more on that in a moment). When traveling, I like to treat my tastebuds to new experiences, so I popped into a Japanese restaurant, seated myself at a table by the window, and tried to order a simple glass of water.

The conversation went something like this:

Waitress: "What would you like to drink?"

Erin: "Water"

Waitress: "You want tea?"

Erin: "No, just water."

Waitress: "Hot water?"

Erin: "No, just plain water, please."

Waitress: (Probably thinking: 'There's something this lady isn't understanding about my question.') "Maybe you would like a cup of tea?"

Erin: (Thinking: 'I must not be communicating clearly. The words I'm using to describe the picture of 'water' I have in my head are not creating the same picture of 'water' in the waitress's head. I need to describe my picture better…') "No tea. Just a cup of water with ice, please."

Bingo! "Ohhh! Okay!" the waitress affirmed with a smile.

The waitress relaxed, I relaxed. A moment later she brought be a lovely cup of tea. Just kidding! It was a tall glass of perfectly iced water.

There's more to communicating across cultures than finding a shared language (or interpreter). It is also necessary to develop skills and strategies that allow you to communicate effectively across cultures.

The Diversity Rx Conference offered workshops focused on developing skills to communicate effectively in cross-cultural encounters. One of these workshops was "Using a Skill-Based Approach to Get the Most Out Of Cultural Competence: The ASCN Model (Ask, Share, Compare, Negotiate)" (presented by John Bormanis, PhD, and Randa Hutob, MD, MPH.) As stated in the session description:

"The main premise of the ASCN model is that you only understand a patient's culture if you ask about it; futhermore, unless you have a great deal of self-knowledge about your own culture(s), you are less likely to be able to deliver culturally competent care."

The ASCN Model is one communication model that promotes effective communication between providers and their patients:

  • Ask the patient about his or her health beliefs and behaviors
  • Share your medical view
  • Compare both views
  • Negotiate a treatment plan

By using the ASCN Model, you have the opportunity to better understand the patient's perspective regarding the health concerns. You are able to establish rapport by showing interest in and respect for the patient's experience. You can take what you learn about the patient's perspective, share your medical perspective, make recommendations and negotiate a plan of action.

Just to clarify: "negotiating" doesn't mean acting in a way that would jeopardize a license to practice medicine or the patient's wellbeing. On the contrary; it is about communicating with patients in a way that builds relationships and fosters exchange of information, which, in turn, allows the theraputic relationship to work toward the best possible outcome. Or, as one of the session participants put it:

"Instead of me (doctor) fixing you (patient), we work together to fight diabetes."

Wouldn't it be so much easier to just tell the patient what to do and be done with it? Yes. Would it be effective? Almost certainly not.

The aforementioned waitress could have brushed off my desire for ice water and simply brought me tea. She even could have explained that it was a tasty beverage that would complement my meal well and facilitate proper digestion. I would have agreed with her completely, yet left the tea untouched.

You see, I do enjoy tea and would have very much liked to have drunk tea with my meal, but it was the Lenten Season, and I had made a commitment to abstain from tea as part of my observance of Lent.

To the waitress, I might have seemed like a picky customer. To me, I was just trying to practice my faith, in a way that is common in my culture. Without effective communication, though, there was no way to for the waitress to know the underlying forces that were driving my actions (or inactions, in this case).

How often could simple cultural misunderstandings lead to patient non-compliance, or a medical provider missing the reason behind, for example, a dietary change?

Understanding that these cultural differences exist is the basis for a more thorough and mutually-beneficial conversation between provider and patient, which, in turn, leads to better healthcare outcomes.

Interested in learning more about communication models that help facilitate effective cross-cultural communication?

Here are links to the L.E.A.R.N. Model (Berlin and Fowkes, 1983), and the R.E.S.P.E.C.T. Model (Welch, M., 1998), to get you started.

What successes have you had in communicating within culturally diverse communities?

Are there other communication models / techniques that you have found to be effective?


Posted on April 12, 2013 and filed under Medical Team.