Intercultural Communication and Identity in Health Care

Identity and intercultural communication are crucial aspects when dealing with health care. As explained in Experiencing Intercultural Communication (EIC), as the world becomes more culturally diverse, so does the necessity to effectively communicate with other cultures and identities and acclimate with some form of affirmation (Martin, Nakayama, 2011, p. 365). A major issue in health care in the respect of differing cultures is that of mistrust. For example, the Tuskegee Syphilis Project that was conducted by the U.S. Public Health Service on people from the African-American ethnic identity over a 40 year period created a dramatic health care barrier. Black patients who sought aid for syphilis were given a placebo so that the government could study how the illness spreads in the patient’s body and in the community (Martin, Nakayama, 2011, p. 371). Given that history of medical mistreatment one can understand that some of the black community would be reluctant to seek health care, especially in a Caucasian majority society. Ethnic identities reflect the sets of ideas about one’s own ethnic group membership. Understanding the history of the treatment of specific ethnic identities is an important factor in this situation because you effectively have to try and amend the situation by doing community outreach, and maintaining strict transparent ethically prudent medical practices to try and create a foundation of trust. Otherwise there may be no communication at all.

Another example is how health care can affect those from a particular sexual identity. Sexual identity is what determined by your gender is and what your sexual orientation is. With the rise of AIDS and HIV in the late 20th century many people in the gay and minority communities had fears about poor preferential treatment. Since there is a stereotype that AIDS and HIV largely affect gay people and people who are colored, use drugs, or are poor, there was a thought that they would not receive adequate attention. A slow response did, in fact, occur to this problem which resulted in a separate health system within the gay community (Martin, Nakayama, 2011, p. 372). Finding a way to approach and communicate about these issues and understanding cultural identities would have saved lives in both of these scenarios.

Verbal and non-verbal communication also play critical roles when dealing with intercultural communication in health care. The obvious example here is if you don’t speak the same language. On a personal level I would be concerned about how adequate my diagnosis would be if I was not able to effectively communicate my problem. Often in the medical field patients who do not speak the native language of where they are hospitalized have to rely on their bilingual children (children who can speak two languages) to relay information between doctor and patient. This can lead to complications when things are lost in translation because both doctor and patient have no way to verify what has been communicated.

However, beyond the obvious, there are subtleties in communication that should be addressed. One issue that can arise is variations in communication styles. Communication styles combine verbal and non-verbal elements. It refers to the way people use language, and it helps listeners understand how to interpret verbal messages. In the medical field, dealing with high or low context style communication can greatly effect a diagnosis. High context style refers to where most of the information being relayed by a person is mostly in the physical context or internalized. Low context is when most of the meaning comes in the form of the verbal message. One can see that as a doctor or physician, knowing what culture you are dealing with will allow you to make better contextual preparation in order to make an adequate analysis.

Another example of how communication styles differ is with other various approaches. Some people have a very direct style of communication. This makes things easier for a practitioner, but knowing how to deal with people that have an indirect communication style suits the purpose of having a better understanding of how everyone communicates and how they will want to be treated socially and physically. Some cultures, Japanese for example, have a very understated communication style. Sometimes people from this culture will down-play their ailment as a show of strength when they are actually quite ill. As a doctor being able to read non-verbal cues is helpful when dealing with this and other cross cultural situations because often times these bridge the language barrier.

Knowing how to deal with different types of conflict styles is a key element in the medical sector. Medical practitioners often have to assert some form of mediation. People and their family/companions coming in with emergencies all have differing conflict styles and are often in some form of emotional distress. Knowing which angle to take with each particular patient makes a doctor a form of strategist. Certain conflict styles work well in the health care industry for both doctor and patient. Using an accommodating conflict style is beneficial for both parties especially because you are attempting to thwart any type of incompatibility for the sake of their interdependency in this situation. The doctor is reliant on the patient to relay information to them that is viable for diagnosis, and the patient is reliant on the doctor to understand and treat their ailment. Both parties are reliant on their communication to ensure the success of the transaction. Employing a discussion style is also necessary because both parties have to communicate to achieve some form of resolution to whatever ailment or problem the patient is having. As a doctor, one must also take care when dealing with religious conflict as well. Certain patients aren’t allowed food or drink during the daytime because of religious fasting periods. As a physician, knowing this allows you to prescribe a once a day medication that can be taken after nightfall as opposed to a four times a day medication that may be been completely excluded.

“The good physician treats the disease; the great physician treats the patient who has the disease.” – William Osler

What separates a good practitioner from a bad or even mediocre one is the ability to form a type of friendship or contextually, an intercultural relationship. Being able to identify that people tend to gravitate towards people they are similar to ie: similarity principle, can help with creating a type of complimentary scenario wherein the doctor is sensitive to the patient’s possible reluctance or cultural needs. Building these types of relationships work to increase both party’s cultural awareness and greatly increase the fluidity and success of future intercultural interactions. Often times patients will be reluctant to come in to receive care due to negative stereotypes, anxiety, motivation, and general differences in communication styles and perceptions, and it is up to the practitioner to be aware of these situations and affirm every patient’s cultural identity. That is to not only recognize their differences, but to accept them.

Commercial health care in my immediate family was all but non-existent. My father is a penny pincher and my mom came from an impoverished country where her father was an Igorot witch doctor. The Igorot, or Cordillerans, is the collective name of several Austronesian ethnic groups in The Philippines, who inhabit the mountains of Luzon and have a (distant) history of head hunting and cannibalism. My ethnic history made health care a household issue rather than something we went to a medical professional for. To this date I have only been to a hospital once, when I broke my arm in two places and both of my parents told me that it was just bruised. I had to have it re-broken to set it back into place. This is also due to a family history of poverty as well. And given my cultural identity as a student, up until recently I couldn’t afford to go to the hospital now even had I wanted to.

Last year I was able to get on Medicaid and even though it creates a lot of opportunity for me to get health care there is a part of me that is reluctant. I realize that part of that is how identity is influenced by society and people tend to look down on those who receive government aid. Especially for me as a single young male. Up until the year before last the only way you could get on Medicaid is if you were a female with dependents. As mentioned before this creates anxiety and I’m privy to negative stereotypes which directly affect my motivation to receive health care should I need it. However, should the need arise I am fully equipped to navigate that social interaction. I am driven by logic, and that dictates that I operate under a direct communication style that employs various conflict styles as the situation dictates. Having lived an intercultural life (as we all have regardless of varying complexity of it), and a multi-ethnic life has provided me with the opportunity to be well versed in the art of adaptation.

Adaptability is at the forefront of the skill set of anyone who chooses to succeed in the health care industry (or any walk of life). Knowing that the only pre-conceived perception is that pre-conceived perceptions are often ill-conceived is valuable knowledge. Every patient will present its own unique challenges. If I was to take up health care as a profession, I would do several things. I would research the demographics of where I was stationed and ascertain the appropriate cultures that I would most commonly be treating. After which I would either do personal research and/or attend a cultural competency program. Knowing that every person has a different history, identity, conflict style, set of beliefs and perceptions is absolutely relevant to every single situation in the medical field and in life.

One of the best ways to identify and address these challenges in the health care industry is through education. Companies such as The Cross Cultural Health Care Program serve as a bridge between communities and health care institutions to advance access to quality health care that is culturally and linguistically appropriate. They provide resources and training for individuals and institutions with the goal of systems change. They provide medical interpreter training as well as cultural competency programs and guides to deal with patients (X Culture).

Intercultural communication in the health care industry is reliant upon both parties, not only ability to communicate, but also willingness to accept each other’s differences for the sake of the situation. Creating a safe environment and treating each person as an individual that is in need of care rather than a stereotypical label based upon preconceived notions will alleviate many challenges in this situation.