CROSS CULTURAL MEDICAL COMMUNICATION

CROSS CULTURAL MEDICAL COMMUNICATION

Yati SoenartoCenter for Bioethics & Humanities, Faculty of Medicine, UGM,Indonesia

CULTURE; DEFINITION

• Taylor (1871): That complex whole which includes knowledge, belief, art, morals, law, custom and any other capabilities & habits acquired by man as a member of society.

• Keesing(1981): System of shared ideas system of concepts, rules & meanings that underline and are expressed in the ways that human beings live

MEDICAL COMMUNICATION• Doctor-patient communication: cornerstone of good

medical practice (Doherty,1990, Rotter, 1995)

• Interactional skills difference to a wide range of desirable patient outcomes: accuracy of diagnosing psychiatric disturbance patient, compliance with prescribed medication, recovery from medical interventions, smoking cessation, weight loss and Aids-related risk behaviors (Doherty, 1990, Mrks, 1979. Cockburn,1987, Mumford,1982, Slama, 1990, Stunkard,1985, Coates, 1990).

HOW ARE COMMUNICATION PROBLEMS IN CLINICAL PRACTICE?

• Common (Simpson,1991)• Late 1980th, few doctors has sufficient information

for patients to effectively comply with their doctor’s recommendations (Cockburn, 1987, Horne, 1987).

• Several recent studies of communication skills training have drawn positive conclusions regarding it’s impact

WHAT TO BE TAUGHT?

• WHO (1993): Things to be taught need to be relevant to particular culture.

• Ask: 1). A group of doctors & other relevant professionals to identify particular behaviors that constitute good practice-core communication skills for the particular culture,2).A group of people representing consumers of health services-identify aspects of a desirable consultation.

Definition : The process of understanding and sharing meaning

KEYWORDS

Understanding: Perceiving, interpreting,and comprehending the meaning of the verbal & non verbal behavior of others

Sharing: An interaction between people in order to exchange meaning

Meaning: The shared understanding of the message (constructed in the minds of the communications).

Jason, Hillard Md. 2000. A practical guide to communication skills in clinical practice. Education for Health.

Pearson,Judy C & Nelson, Paul E. 2000. An Introduction to Human Communication. 8th Ed. Mc Graw-Hill Higher Education. Boston

WHO. 2000. Health Ethics in South-East Asia. Vol 3. New Delhi

PATIENT-DOCTOR RELATIONSHIP

BASIC COMMUNICATION

Patient-Doctor (P-D)INTERACTION & COMMUNICATION

Effective P-D interaction & comm. Is: central to P&D satisfaction, to the clinical competence of D, & to the health outcomes of their patients

Indicators show many doctors don’t comm. effectively , & training in interactional & relationship skills is important & low cost -- investment considering the high rewards that can be gained for P, D, medical schools & health care.

COMMUNICATION

Definition (Pearson & Nelson, 2000): The process of understanding and sharing meaning.

Notes: Communicare (Latin word): to share A process : dynamic, ongoing, always changing,

continuous

Definition : The process of understanding & sharing meaning

KEYWORDS

Understanding: Perceiving, interpreting,and comprehending the meaning of the verbal & non verbal behavior of others

Sharing: An interaction between people in order to exchange meaning

Meaning: The shared understanding of the message (constructed in the minds of the communications).

Learning & sustaining trust, Listening actively, Mastering timing, Formulating ideas clearly & succinctly, Conveying a sense of sincere caring, Transmitting sympathy or empathy as needed

Full Communication Involves: (Jason, 2000)

Full Communication Involves: (Jason, 2000)

HEALTH PROFESSIONALS (Physician,PH,nurse,mid-wife, dentist, pharmacist)

NON-HEALTH PROFESSIONALS

(administrative, finance)

HOSPITAL (others)HOSPITAL (others)

PATIENTS

How to make money(competitors)

How to serve the community(colleagues/team members)

PATIENT’S AUTONOMY vs DOCTOR’S RESPONSIBILITY on PATIENT’S VALUE vs HEALTH PROFESSIONALISM THE ROLE OF PATIENT - IN MEDICAL DECISIONS MAKING PROCESS CONFLICT?

PATIENT’S & DOCTOR’S NEED ON ETHICAL & LAW STANDARD FOR DOCTOR, INFORMED CONCENT & MALPRACTICE

PATIENT-DOCTOR COMMUNICATION’S CONCEPTPATIENT-DOCTOR COMMUNICATION’S CONCEPT

4 MODELS OF 4 MODELS OF COMMUNICATIONCOMMUNICATION 4 MODELS OF 4 MODELS OF COMMUNICATIONCOMMUNICATION

1. INFORMATIVE

2. INTERPRETIVE

3. DELIBERATIVE

4. PATERNALISTIK

MODELS OF P - P MODELS OF P - P COMMUNICATION; BASED ON:COMMUNICATION; BASED ON:

PATIENT’S VALUE - AUTONOMY CONCEPTDOCTOR’S RESPONSIBILITY -

PROFESSIONALISM

AutonomyAutonomy:: Central concept in health ethics- Respect for person-beneficence (do good), non-malfeasance (do no harm) & justice.

Patient Autonomy:- Autonomy requires: Capable of deliberation-personal goals - treated with respect for capacity for self determination

- Impaired autonomy: Dependent/vulnerable be provided security against harm or abuse

INFORMATIVE MODEL SCIENTIFIC,ENGINEERING,CONSUMERINFORMATIVE MODEL SCIENTIFIC,ENGINEERING,CONSUMER

• PATIENT:

AUTONOMY HIGHCONTROL THE CLINICAL DECISION. PATIENTS’S VALUE HIGH; FACTS LOW

• PHYSICIAN:

PROVIDE RELEVANT INFORMATION. PATIENT CHOSE THE THERAPY; DOCTOR IMPLEMENTS PATIENT’S CHOISE

INTERPRETIVE MODEL INTERPRETIVE MODEL

PATIENT:VALUE :

UNCLEAR/CONFLICTING MANAGEMENT AUTONOMY

SELF UNDERSTANDING RELEVANT TO MEDICAL SERVICE

PHYSICIAN: 1. ROLE:

TO CLARIFY & INTERPRETATE PATIENT’S VALUE, AND IMPLEMENT SELECTED INTERVENTION

2. RESPONSIBILITY GUIDING & COUNSELING MAINTAINING EXPERTIES & REFERRING OR ASKING SECOND OPINION

DELIBERATIVE MODELDELIBERATIVE MODEL

PATIENT:1. VALUE:

OPEN FOR DEVELOPMENT & CORRECTION OF MORAL DISCUSSION

2. AUTONOMY: MORAL SELF DEVELOPMENT WHICH RELEVAN

TO MEDICAL SERVICES.

PHYSICIAN :1. ROLE : AS

A FRIEND/TEACHER

2. RESPONSIBILITYTO ADAPT AND TO PERSUATEPATIENT FOR HAVING BEST MARKS & SELECTED IMPLEMANTATION

PATERNALISTIC / PARENTAL MODELPATERNALISTIC / PARENTAL MODEL

PATIENT:1. VALUE :

OBYECTIVE & DISCUSSED AMONG PHYSICIANS

2. AUTONOMY AGREEMENT OVER OBJECTIVE VALUE

PATERNALISTIC MODELPATERNALISTIC MODEL

PHYSICIAN: 1. ROLE:

TO PROTECT AND TO GUARD

2. RESPONSIBILITY: TO PROMOTE THE BEST INTERVENTION

Traditional• Tradition:

The passing down of elements of a culture from generation to generation, especially by oral communication:- thought or behavior- a set of such custom and usage viewed.Latin: “traditio” – to hand over, deliver, entrust

• TraditionalRelating to or in accordance with tradition

Communication: patient-doctor relationship is compulsory Multidimensional communication is needed Communication models: move from paternalistic (doctor authority to deliberative (patient center) Culture should be thought

CONCLUSIONCONCLUSION