ReviewCultural differences in medical communication: A review of the literature
Introduction
A recent issue in the study of doctor–patient interaction is the relation between patients’ ethnic background and medical communication, and the fundamental question this raises to what extent belonging to an ethnic/cultural group influences the communication process between patients and health care practitioners. To pose this question is of vital importance, because in today's multicultural society health care practitioners are increasingly confronted with patients from different cultural and ethnic backgrounds. For instance, in The Netherlands more than 18% of the population is from other ethnic origin nowadays [1]. Encounters with these patients are likely to differ from meetings between doctors and patients sharing the same cultural or ethnic background, because people from different cultures hold different beliefs about health, illness and communication [2], [3]. These divergent beliefs, as well as linguistic barriers that often exist between members of different cultures, confront health care practitioners with the difficult task to deliver good quality care to a wide diversity of patients, each bringing his own unique background to the medical encounter.
Culture1 and ethnicity have often been cited as barriers in establishing an effective and satisfying doctor–patient relationship [4], [5], [6]. For example, results of a number of survey studies indicate that there is more misunderstanding, less compliance and less satisfaction in intercultural medical consultations compared to intra-cultural medical consultations,2 even after adjusting for socio-economic variables such as education and income [7], [8], [9], [10]. Moreover, health care providers find consultations with ethnic minority patients often emotionally demanding and patients’ reasons for visiting unclear [11], [12]. Furthermore, numerous studies have shown that there are considerable disparities in access to care as well as in health outcomes as a consequence of patients’ ethnic background. For example, ethnic minority patients are less likely to be recommended for certain treatments than White patients [13], [14]. Although these disparities in health (care) are probably partly related to socio-economic variables such as income, gaps in doctor–patient communication are likely to play a crucial role as well, since it is well known that this factor is positively associated with various health-related outcomes [15]. Hence, possible gaps in intercultural medical communication seem to place ethnic minority patients at an increased risk of receiving inferior care.
The overall aim of the present study is to gain more insight into the effects of patients’ and doctors’ cultural/ethnic backgrounds on the medical communication process. Main research question is whether there are any differences in doctors’ and patients’ communicative behaviour between intercultural and intra-cultural consultations, and if so, which differences. A second question concerns how these differences may be explained and what consequences they have for patient outcomes, such as patient satisfaction, compliance and understanding. Because our focus in this review is on communicative behaviour, we will investigate the first research question by reviewing observational studies on intercultural medical communication as this method yields the most reliable data with regard to assessing behaviour. However, with respect to the second research question, the broader literature on intercultural health communication (including other research methods as surveys, focus groups and so on) will be included as this may add relevant findings to the results of our observational review. Combined with our review results, in the second part of this article these findings will be used to design a research model that can be used in future research on this topic.
Section snippets
Methods
We performed a literature review using online databases (Pubmed, Psychlit), and searched for further eligible literature through references in scientific papers and books. The following key words were used, in different combinations: doctor–patient communication, physician–patient communication, culture, ethnicity, race, diversity, non-English speaking, intercultural communication, cross-cultural communication, medicine, language barriers, medical consultation, medical communication and medical
Study design and methods
Table 1 contains an overview of the study design and methods used; 12 studies were quantitative and two studies qualitative in nature. Most studies were carried out in the United States during the last decade within the setting of a family practice or general practice. Participating physicians were mostly residents in their second or third year of medical training (in the US) or general practitioners.
Patients’ age and sex was reported in the quantitative studies and mostly their educational
Discussion and conclusion
In reviewing the literature on intercultural medical communication we only found a handful of observational studies addressing this topic, yielding partly inconsistent results. To some extent, these contradictory findings may have emerged as a consequence of the wide variety of research questions and designs used in the studies. This makes it hard to reach definite conclusions about the cultural variability of doctor–patient communication. Besides, none of the studies under review explained on
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