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Over the past two decades, people have migrated to and from various places in the world at an unprecedented pace,1 leading to a heterogeneous mix of cultures within each country that requires healthcare providers to sensitively navigate cultural nuances in order to effectively deliver medical care.2 Today, there are about 272 million migrants worldwide—51 million more than just 10 years ago—which is approximately 3.5% of the world’s population.3 This means that healthcare providers now are working in a superdiverse society, with patients and clients who come from very different sociocultural backgrounds. Furthermore, many countries, such as the United States and much of Europe, are already highly diverse due to their historical development. For the local healthcare system, and in particular primary healthcare services, which are often the first point of contact in the healthcare system, this social and cultural mixture of people entails many challenges and has direct implications when it comes to effectively navigating emotional communication during patient encounters.4

Recognizing and responding effectively to patients’ emotions has proven difficult for many providers,5,6 even when they share a similar cultural background with their patient. Addressing emotions in an ethnically and/or culturally discordant context is an even greater challenge in practice.7 Therefore, the focus of this chapter will be on strategies for successfully identifying, engaging with, and appropriately responding to cultural barriers that affect emotional communication during medical encounters.

Cultural Distance in Clinical Encounters

Although the term “culture” is typically ascribed to geographic regions or countries of origin, a person’s culture can be defined by many aspects of their lives, such as their age, religion, socioeconomic class, race/ethnicity, gender, sexual orientation, gender identity, disability, or immigration status. These multiple influences have a broad impact on one’s life—including aspects of life that are relevant for healthcare practices and communication—such as traditions and customs, spirituality, style of communication, attitudes and beliefs about medicine and healthcare, attitudes toward personal autonomy, and family dynamics.8

All persons, clinicians and patients alike, have their own personal culture. In addition to the culture within which one grows up, health professionals are often acculturated in a Western medical tradition that embraces a scientific tradition with particular models of health and disease and places a high value on objectivity. With this training, clinicians take on their own “medical culture” that can create differences between their perspectives and those of the “lay culture” of patients they serve. This social or cultural distance between clinicians and patients can often create challenges for effective communication.9–11


Clearly, individuals vary in their personal tendencies regarding emotional experience, expression, and reaction to the emotional expressions of others. While such individual differences exist, these personal experiences and behaviors also develop from absorbing the values, norms, beliefs, and habits of their cultural or ethnic ...

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