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  • Define cross-cultural communication.

  • Review evidence for the need to improve cross-cultural communication.

  • Describe challenges to effective cross-cultural communication and how they have an impact on clinical care.

  • Describe strategies for effective cross-cultural communication.

Ms. Jones is a 56-year-old African-American classroom assistant who was hospitalized with a stroke. Her course rapidly deteriorated and her physicians determined that aggressive treatment would be futile. They approached her family with the recommendation that life support be removed. The doctors explained that Ms. Jones had multiorgan failure and little hope of recovery. Her family, a daughter and two sisters, were shocked by this recommendation and accused the physicians, all of whom were white, of substandard care.


When patients and physicians interact, cross-cultural communication is a common occurrence as patients and clinicians differ in many important ways. Patients from vulnerable populations (including persons from racial and ethnic minority populations, immigrants, low-income persons, and persons with low educational attainment) and health-care providers face unique challenges to effective communication. These challenges are borne of the differences in life experiences, cultural norms, assumptions, expectations, and barriers inherent in a health-care system in which the biomedical model of health predominates. While this chapter takes an example of an African-American family interacting within the US health-care system, cross-cultural communication is observed in every country, and, to a certain extent, in every clinical encounter. Patients and physicians may share a common background and have similar expectations of the clinical encounter, yet still differ radically in their level of knowledge or in their personal values. Navigating cross-cultural communication is the norm in most medical encounters.

Culture is a coherent system of beliefs, values, and lifestyles held by individuals, their communities, and the larger sociopolitical structure in which they live. Culture is a dynamic entity and is responsive to changes such as socioeconomic position, immigration, and other factors (Figure 14-1).

Figure 14-1.

Culture is a coherent system of beliefs, values, and lifestyles. Individuals' culture is influenced not only by their personal circumstances but also of their families and extended families' cultures, the culture of their communities, and the culture of the larger social political environment. Individuals, families, communities, and societal cultural systems are dynamic and responsive to multiple forces such as socioeconomic conditions.

Cross-cultural communication in the context of health care is both complicated and complex because of these multiple determinants of culture and the inherent complexities of medical care. Effective cross-cultural communication acknowledges the interplay of multiple factors, including race, ethnicity, cultural norms, religion, socioeconomic position, and education to achieve a common understanding or aim. Effective cross-cultural clinical communication also results in sharing of key information and demonstration of caring. This chapter discusses common barriers to effective cross-cultural communication and how to overcome them. (For a discussion of the ...

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