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Effective clinician–patient communication involves verbal and nonverbal sharing of information across cultural and linguistic boundaries. In the medical arena, these boundaries are populated on the one side by clinicians who represent the esoteric world of biomedicine, and on the other side by patients and families who often lack familiarity with biomedical concepts and procedures and may have their own strongly held beliefs about illness—what it means, how it should be diagnosed, and how it should be treated. The goals of effective cross-cultural communication (or "cultural competency," as it is sometimes called) are threefold: (1) to understand illness from the perspective of the patient; (2) to assist patients in understanding diseases and treatments from the perspective of biomedicine; and (3) to help patients and their families navigate, express themselves, and feel comfortable within large, complex, and often impersonal health care organizations. These activities require some awareness of the wider context of patients' lives, and of how the worlds of biomedicine and the lay public interact and, at times, conflict and misunderstand each other.

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Cross-cultural communication skills are best developed through practice, reflection, and reading about and interacting with diverse patient populations. Knowing a few facts about the illness beliefs of an immigrant group or ethnic minority is not enough. It is important to develop ways of perceiving and interpreting what individual patients say and do in the context of their previous experiences with illness, structural positions within society, and membership within particular ethnic and religious communities. True cultural awareness also involves understanding how biomedicine is itself a cultural system, and how it is likely to be perceived and (mis)understood by patients.

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As the dominant form of health care in the United States, biomedicine is practiced by highly specialized professionals and relies on detailed, scientific information about the human body and the use of pharmaceutical and surgical interventions to prevent or treat anatomic and physiologic disorders and their associated symptoms. It has a definite body of knowledge, set of practices, strengths, non-evidence-based biases, and inherent limitations. Each of its many specialties and subspecialties has unique conventions, systems of knowledge, and ways of making sense of people and events. To patients of all backgrounds, much about biomedicine is obscure; difficulties agreeing with and accepting medical explanations and recommendations are commonplace. Therefore, the perspective that orients the discussion in this chapter is that although cross-cultural communication is especially important and challenging for immigrant and minority patients, it has relevance to all patients.

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Culture

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Culture refers to beliefs, values, rituals, customs, institutions, social roles, and relationships that are shared among identifiable groups of people. Typically, one's own culture is taken for granted; it feels entirely natural, consisting of those assumptions and routines that make the world what it is "supposed" to be. Unconscious learning and modeling play important roles in the acquisition of cultural assumptions and routines. Within the family, one of the most influential cultural systems, ...

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