Healthcare & Intercultural Communication

I imagine that you as myself would like to think that we all receive the best possible Health Care in every situation and that we as humans would just naturally just look out for one another and and do the best we can to care for one another and provide each other with the best um you know healthiest life that we possibly can and that may be in principle um what we're shooting for but we know in reality that that's just not the case that that people from different cultures when they come to this culture or we go to their culture I mean we receive different levels of care often times we receive different access to care and all kinds of things and it's not just patients it's also culture influencing the the doctors and the and the and the healthcare field in general in that culture so it's it's you know all of these things um in which we see the impact and influence of of culture on Healthcare that we have as humans so um I want to spend just a minute in this video talking about that intersection the influence of of culture on Healthcare and some of the challenges that we see in that field specifically related to culture so let's just start right there let's start with some of the cultural challenges that we see in healthcare some of the things that that commonly come up from you know a cultural perspective in healthcare um we start with language issues that's I mean we're going to talk about two primary categories here but there's lots of things within those that we could talk about and number one is language issues um so you know first of all translation could be an issue I mean if you're just if you're in a country where you don't speak the primary language if you come to the United States and you speak a different language and your doctor only speaks English or conversely if you we traveled out of the country recently and one of my my concerns was what if we end up in a hospital and nobody can understand what we're saying the translation would be so I mean just primarily are you speaking the same language literally as far as you know having that shared language to to start with the shared primary language but also then within that you have language issues with things like medical terminology I mean I have become more well versed in this over time because I have a series of medical issues so I know more than I did you know 20 years ago about medical terminology but certainly my my wife who's worked in the healthcare for number of years you know has some training in health care there knows all the stuff and I don't even understand most so she has to come along a lot of times to translate for me um to say what the doctor says even though we speak the same literal language the same primary language I often times need somebody to translate what all that terminology means just um just just in general um and then beyond that you have not only just medical terminology you know the basic medical terminology but then within that you have all this jargon that doctors use I mean that and and not just doctors but in the healthcare institution all these abbreviations and this is true in every institution uh we have it you know in in higher red as well but every every um career and every um organization really has these this jargon that you use so then you combine all of that together and it just can make it really difficult to understand what the doctor saying or what the instructions are and and so um so those are challenges cultural challenges with language in healthcare another cultural challenge we have it's really related to language really centers on um ethnocentrism okay so um just this idea that we have differing ways in different cultures of commun communicating about Healthcare so um for example um in cultures that are more um typically collectivistic cultures and uh and have you know Less Direct ways of communicating than we do in some of the western cultures where it's just very abrupt somebody asks you how you're feeling what your pain level is you're probably going to tell them and it's if anything it's probably going to be higher than it may actually be relatively speaking but in collectivistic cultures and and where with the goals like you know not to upset the the fruit card so much it's they tend to undermine you know score lower than these so they may be feeling an intense amount of pain but only say that it's at a three and if you're you know somebody from a western culture who just takes people of face value when they say it's a three you believe it's a three you don't understand that for them a three really is a seven um so I mean it requires that kind of mental gymnastics too but we have this ethnocentrism in terms of the way that we communicate the way that we approach Healthcare and communicating about Healthcare and about our own health um that that is just very very different can can really create some some significant challenges um and then also language issues related to um legal issues and the laws surrounding Health Care practices and and the way that we communicate about Healthcare just starting basically with here in the United States we have the we we call Hippa right which governs patients rights and and information what can and can not be released to other people and discussed in the open and private information and things like that so I mean there's laws regarding that with language issues there's laws regarding you know just what a patient has to understand and different things so um so understanding kind of the legal ins and outs as well from both sides is is is a challenge creates a lot of uh cultural issues and language issues and those are unique for for different cultures as well you go to a different country they may not have those same kind of u rules and the same kind of laws and so people may not understand what they are here may not be comfortable talking here because they don't understand that that information is private and uh and and can't be revealed by that doctor without you know meeting certain criteria so lots of different language issues ranging from just you know speaking the same primary language all the way up through this the challenges of ethnocentrism and and legal issues and things so anyway language and and uh and verbal communication creates a lot of challenges cultural challenges in healthcare one of the significant challenges in healthc care that is related to culture is what we would Define as the historical treatment of cultural groups um different groups have always um you know have reasons to um be concerned about or mistrust Health Care Systems and and wonder if they're getting appropriate care and uh and having access to appropriate care you know and these are not you know without rationale or without justification but look at things like for example the German SS um prior to and during World War II did a lot of experimenting on people primarily um Jewish people but also you know people that they just considered undesirable that were in the concentration camps they just tested them for tested all kinds of stuff out on them right tested a nerve gas out on them tested on different diseases to see about you know both for biological warfare and just you know for medical research but they just you know grab well hey we need to test this so we're just going to grab this person they're not really a person so it's no wonder that that you know that those people may have concerns about you know visiting doctors or about the kind of healthc care that they're getting because they've they're they're you culturally have historically been treated poorly in those situations another example around that same time frame Japan's Unit 731 this is a little lesser known um than like the SS and the concentration camps but not very different to be honest Japan during that time had what they called Unit at 731 which conducted biological warfare and medical testing on Chinese civilians during the 1930s and 1940s um so again kind of the same idea they just didn't see them as real people and uh didn't have a concern about testing the stuff out on them and did so liberally and I'm really kind of you know very very sad obviously um but and and a tragic part of of history there but we're not obviously we're not uh immune from this in the United States we're not excused from this in the united stat States um famously you know there are a variety of examples we could probably point to but famously the uh Tuskegee syphilis project right the Tuskegee syphilis project which ran for 40 years by the way 40 years from 1932 to 1972 the uh the American government was was running um a tasks of deceived African-American men during that time told them they they were doing um basically tests on Bad Blood what they call bad blood so a variety of things but what they were really doing is testing active syphilis they were they were they were giving these people syphilis so they could test and see what the um results of untreated syphilis were um just totally despicable and uh and that happened again for 40 years here in the United States that Tuskegee syphilis project was was going on and so is it really then any wonder if you look more recently we fast forward to uh to the co outbreak Co pandemic is it any wonder that African-American people in general but but specifically African-American men were skeptical about getting the the vaccination about the co vaccination of course that's not limited to just people of African-American descent lots of people were skeptical about that um but you know certainly the people who had reason to be concerned about that you know if you just look at the Tuskegee cus project which is not that long ago 1972 seems like a long time it was not that long ago those people had concerns and they had right had a right to be concerned had reason to be concerned because people of their culture their ethnicity had been tested on mercilessly for 40 years so um so it's not really a Wonder um that they had questions about that uh just one other quick example currently we we we've seen statistics recently that demonstrate that African-American women are more likely to receive poor treatment um during their pregnancy and lose more children in to child birth and and child birth related incidents and things than um than people of Caucasian descent um totally inexcusable and uh and so is you know is a wonder that they're seeking out alternative methods of child birth when they can't trust the hospitals and the doctors a lot of times to give them the care that they need culturally speaking that's that's me statistics have worn that out so so we know that there's reason for a lot of this concern and and the because of this historical treatment of of cultural groups that can create challenges though again for for example trying to get convince African-American men that it was safe to take the vaccine after they'd been testing on for 40 years with the syphilis I mean that's totally understandable to me I can totally understand why that would be the case so um do we have to understand and recognize that that's a cultural challenge in healthcare though is that historically there are groups that have not been treated well through through the healthc care system and and so um have concerns and and and very real issues about that for a broader cultural perspective on Healthcare I mean we've talked in another video in previous videos about some of the different types of uh Dimensions cultural Dimensions um primarily from from hofste research and things things like individualism collectivism power distance time that kind of thing and those certainly are at work here in healthcare we could go through lots of different examples of those things but uh but we've spent a lot of time in other videos talking about those Dimensions I think you can probably draw those conclusion so not going to spend a lot of time on those but I would like to spend a little time on some of the other uh maybe uh ones we haven't discussed as much that maybe have a a a specific connection to healthcare as well here so uh I'm not going to gloss over these don't want to gloss over these completely but uh but I'm going to focus on a few others that we haven't discussed as much so for example belief systems you know culturally we have different belief systems and it comes out through Healthcare in one way in the in the um instance of Eastern versus Western medicine what we broadly Define as Eastern medicine and Western medicine so these these are just two different philosophies two different belief systems about the um medical about Healthcare in general about how we should be caring for our bodies and and and the rest of us as well the rest of our our persons and uh so Eastern medicine tends to operate under the what's known as the biophysical model um which is that uh in general that disease is a signal that the body is out of balance in some way and that uh then we want to use natural remedies to work with the inherent physiological processes right so we want to find a way to get the body Back in Balance by using some of the things that is provided for us and by nature in nature right so we're using these natural remedies to try and bring the body back into balance uh and and get it back into those natural inherent physiological processes that's the you know again the biophysical model that that you know generally speaking is what we refer to as Eastern medicine as opposed to Western medicine which if you're from the United States is going to be something that's much more familiar with you or for you Western medicine is driven by what's known as the biomedical model OKAY Eastern is biophysical model Western medicine is the biomedical model um which focuses on the scientific understanding of what causes illness so trying to get to the root cause of those illnesses and understand what is causing those so that then we can use medicine uh of of whatever kind use medicine to kind of fix or correct whatever mechanical so to speak issue we're having with the body thinking of the body as as an engine or a machine this medicine is intended to reset or to fix or to correct whatever issue there is because we then understand the root cause of that illness that's the idea of the the biomedical model anyway that we use in Western medicine so um that's what we see frequently here when we go to the doctor our our primary you know healthc care system is based on that that system and that model so there's just different belief systems though right again this is not to say that one is better or worse than the other both see different results good results in some ways and and it's so it's not a matter of right or wrong that uh that necessarily we should come to that conclusion it's just a different approach to how we're doing it and what we're supporting and what we're funding what we're pursuing and and uh so we have this you know different belief systems though for eastern and western medicine and we're seeing much more of each of these as we um integrate other cultures into ours okay so again primarily in the United States we have this Western medicine but we're seeing um you know with with immigration with with different people coming here now from different cultures we see an influx of Eastern medicine and uh and it's not just this strange thing that you see in movies now it's it's you know a lot of people that operate under this biophysical model and and and have a strong belief in that so we need to recognize that within our healthc care system and understand that there's more than one viewpoint point to these things another cultural perspective that influences Healthcare is this idea of alternative medicine right um and so alternative medicine what is just a general term or broad term to say whatever other people are doing whatever you know is not normal so to speak or not the norm for us so in our bio biomedical model we we tend to focus on manufactured medications right from pharmaceutical companies that are can kind of correct or fix whatever's going on but but so we use these these man-made manufactured um remedies these these medications that come to us so that's the norm here but so really anything other than that would be considered an alternative medicine from our perspective okay so we use that term alternative medicine for anything that's not kind of the standard or the norm for our system so alternative medicine includes things like mindbody medicine so the idea here is that the Mind influences the body things that would fall into this category include things like patient support groups meditation prayer but all these things indicate that you know our mind has some sway some influence over our body and we can we can certainly use that to contribute to our health and and uh to to find that you know so to speak balance between the mind and the body or whatever it is but our mind influences our body and so we can use those things like sport groups or or individual meditation prayer those types of things as part of a a medical treatment another in addition to mind body medicine we have biologically based practices um these are simply products that are found in nature so again thinking about Eastern medicine they use lots of natural products so biologically based practices are just products that are found in nature things like herbal therapies dietary supplements uh even I suppose you can make a case for marijuana right in a medical sense of being a biologically based practice because it is you know it's grown naturally I mean there's a naturally grown marijuana again there's also synthetic and those are different things and I'm not an expert in this area but I'm just talking about you know things you things that are grown things that are found in nature your biologically based practices are things that are found in nature naturally you have body- based practices so biologically based practices but now we have body based practices here we're talking about things like uh massage and Chiropractic manipulation maybe even yoga depending on again how you're utilizing it and things but um body based practices basically just have to do with using you know with adjusting our body and maneuvering manipulating our body in a particular way that provides some health benefit or health relief then finally we have what we call Energy Medicine right so Energy Medicine includes things like acupuncture Reiki um certain kinds of massage would be considered Energy Medicine um so just different types of medicine that's what we again alternative medicine is just medicine that's used by uh you know other types of medicine outside of our Norm of the manufactured Pharmaceuticals that we would normally use so um sometimes these are used instead of those sometimes are used in combination with one another um so but just understanding that different cultures will have different perspectives on um the utility and the value of these alternative medicines then finally we could talk about the social implications of illness a cultural perspective here on the on the the um social implications of illness of which there are many the way that we view these types of you know the way that we view health and illness socially and the way that it impacts us from a social standpoint so we could start with things here we're talking about things like emotional stigma right the stigma of having it an illness it may make you feel isolated may make you feel like you're worried about not being around other people may add additional stress there's all kinds of emotional stigma stigma that that comes from an illness that would impact us socially right there's also you know um think about the the if you remember the case of Ryan White which was again something very close to home for me and in my age range um Ryan White was a a a young guy a young man who was diagnosed with AIDS back in very early days of that arum and um notably was was diagnos he he he contracted um HIV and then AIDS through a blood transfusion right when he was young he had a medical issue and and contracted it through a blood transfusion but then a lot of stigma associated with it he received a he was the butt of a lot of jokes um Nationwide really and and I can tell you somebody who lived in a community near where he was from and and um there was a lot of concern at that time we didn't really understand HIV and AIDS and there's a lot of concern of you know should we basically ship them off somewhere else should should we should we have them around are we in danger are we we putting ourselves in danger and others in danger by having can you imagine the impact that would have on a young boy somebody who just wants to go to school somebody who's done nothing wrong not that anybody who contracts a disease has done anything wrong but but somebody who I mean you know innocent and all this just wants to go to school wants to live his life such as he can but has all this emotional stigma really impacted his life his ability to to just live life the way he could have and should have we also think about the cost Associated as a social implication um the cost of healthare which can be really burdensome for many many people uh particularly if you're not insured and you have this these major illnesses or whatever and that could be a reason that you don't seek treatment which could just compound the issue and so I mean these costs when when people go bankrupt over over um not being able to pay their health bills healthc care bills and things creates a huge um has huge social implications and the way that people view them the impact on what they're able to do and the way you know again the way they live their lives can have a big impact on your family when there's illness it impacts really the entire family and somebody's old or you know whether you're elderly or younger it doesn't matter it really you know we are interdependent with these folks so what happens that one person impacts the rest of us and um it can really have a strong impact on the family uh so there social implications there and then just our community interactions in general um when you have an illness or when you have a propensity for illness you you become oftentimes more isolated and so you find yourself not able to enjoy the social interaction we saw this on a a large scale during the pandemic we were all very much isol ated and it was such a a relief for many people when they could go back to engaging in their usual activities and things but uh for many people that that has created even more issues with with Community interaction because they are more susceptible to these things and and so it has continued to be an isolating experience for for those folks even more so um than maybe some others so um just think about you know thinking about the community interaction as a social implication but all these are really cultural perspect you know cultural related cultur related issues that will impact Healthcare and somebody's willingness to seek health care and their ability to receive healthare all these different types of things related to that general area so there are a few additional uh considerations when we think about Healthcare that I want to that I want to um throw out here for a minute and uh and discuss um so um one is uh religion is an additional cultural consideration for a variety of reasons and when we think about religion it could impact the types of treatment you're you're willing or able to receive could affect your views of modesty your willingness to you know be seen or or to to uh you know show your body to to a doctor for whatever reason there issues modesty may have issues with the you know a doctor of the opposite sex um or dietary restrictions views on medication and the use of different medications um views on the um uh the appropriateness of life- sustaining therapies you know should you put on a ventilator and so forth blood and organ donation and then death practices if you were to pass away what should be done the you know religions view that differently so religion has a lot of impact on Health Care considerations and even you know again we don't like to think about it but considerations for um what to do when a person passes and someone dies what how do we how should we handle that most appropriately so religion will impact all of those things as well um Power it's not you know nice to think about but Power has a significant impact on on Healthcare I've touched on this a little bit but we have inequalities in uh maybe the you in the knowledge of different doctors um that that may be available to certain um populations right so they may or may not be as qualified or have the experience or knowledge of other doctors that may be available to you know more wealthy frankly um individuals so inequality in Access whether or not you have access to the appropriate doctors and the kind of doctors that you need a hesitance to ask questions or challenge authority especially if you're from a culture that has a has a high power distance culture and not accustomed to challenging Authority you may not want to challenge your doctor if your doctor tells you to do something you're not comfortable doing you may have trouble expressing that if you're from that kind of culture so um maybe an outsized influence of the the outsized influence of insurance providers and government agencies that insert themselves here uh and so um that's a a power issue that creates a lot of um Health inequalities as well and then finally the power of of you know ethical power so ethical issues would fall under this category things like youth in Asia for example what responsibilities does a healthc care provider have in terms when it comes to assisted suicide or euthanasia those types of things right so power is a is a cultural Factor here information sharing is an important one um there are different types of information sharing different categories of what is and what is not allowed what is normal what is what is considered appropriate here in the United States we have they we fall in the category of what we call unmitigated honesty meaning the doctor it really has a requirement to uh communicate the entire diagnosis to the patient tell them exactly what's happening even if it's bad news even if it's you know if there's nothing they can do about it they still have an obligation or requirement to share that with the patient because we that's you know again we're very um very direct very low context um culture we're just going to tell it as it is and and give it to you straight right um For Better or For Worse again whether that's good or not other cultures have different views on that and they may believe that it's best um to to provide misinformation if uh if if they believe it's in the best interest of the patient or they could choose to only communicate part of that diagnosis right or those types of things so in different cultures that would be the norm that would be what's permissible but not in this culture we need to understand that there are differences in the way that we approach those things as well and then finally identity um we're not talking about identity in the sense of gender necessarily and things like that which is kind of how this term is come to be uh what what it's come to be associated with we're really talking here about the communication Theory What's called the communication theory of identity um where people make assumptions about each other based on their backgrounds so we're making assumptions about other you know healthcare providers in this instance are making assumptions about people based on their background and we do the same about people providing that care as patients we do that um there are two concepts related to this one is called identity salience which is the uh the way that people view their cultural identity as an important part of who they are and then identity intensity which has to do with the level of importance that people place on that identity so not only do you how do you see yourself but how strongly do you feel about that or how what prominence does that have that identity have for you so this may lead to questions about things like is your doctor from the same culture you know if they're from the same culture you're more likely to be comfortable with them and and accept their information accept their diagnosis but if they're not then you may be more skeptical about that may have questions about that or at the very least do they do they show respect for your cultural identity if you're C if your doctor or Healthcare Providers is from a different culture do they at least show respect respect for your cultural identity and uh instead of just asserting their own and assuming that that yours is the same and that you will follow theirs and so but those are just some additional cultural considerations that we you know we do pretty quickly there but but some things to think about as it relates to culture and Healthcare okay so lots of lots to think about here as well this is a huge topic culture is an enormous influence on Healthcare something we ought to be aware of both again as patients and as Healthcare Providers and as just as people involved in this Health Care system that uh that we are a multicultural um um Society in the United States in particular now we're a multi Multicultural Society not everybody will have the same views on on Healthcare we need to acknowledge that and respect the uh the um Health Care desires of that individual but also we have to understand that we are in a particular healthc care system where you know for example if you're here in a western culture then it's going to be easier to follow find Western medication and and and be and receive treatment in you know in in that vein of of of medicine then it is through Eastern medicine that's going to be more of a challenge because it's not the norm here we got to recognize that too that you know it's not not the home field here so to speak right that uh um so we have a lot to think about when it comes to culture and comes to healthcare and the intersection of that just like we do in in every other U part of life really I hope this has been helpful for you in understanding the that intersection of healthcare and culture if you have any questions please feel free to email me I'd love to hear from you there in the meantime I hope that you will have a new appreciation for the different impacts and the different ways that that culture does influence and impact uh the Health Care System here and wherever you happen to be