cultural competence in medical communication conny seeleman academic medical center, dept. social...
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Cultural competence Cultural competence
in in
medical communicationmedical communication
Conny Seeleman
Academic Medical Center, dept. Social Medicine
10th February 2006
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Cultural competence in medical Cultural competence in medical communicationcommunication
Program:• Introduction • Cultural dimensions – Hofstede• Discussing a case-study
Academic Medical Center, dept. Social Medicine
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Introduction Introduction (1)(1)
Why our project?• 2001: Inventory study medical faculties• Need for educational material
Aim of our project:• Developing a book of case-studies about
ethnic diversity
Academic Medical Center, dept. Social Medicine
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Introduction Introduction (2)(2)
What did we do?• Identify problems in literature
– Epidemiology– Migration history and contextual factors– Cultural differences– Communication
• Medical practice– Interviews with physicians– Interviews with patients
Academic Medical Center, dept. Social Medicine
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Introduction Introduction (4)(4)
Determine learning objectives cultural competences
Cultural competences:• The attitudes, knowledge and skills a
physician requires in order to adequately take care of migrant* patients
(*migrant: first, second and third generation migrants)
Academic Medical Center, dept. Social Medicine
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Introduction Introduction (5)(5)
Cultural competences, some examples:• Knowledge epidemiological aspects
• Awareness of influence of patient’s background on his/her perspective
• Awareness of own frame of reference
• Awareness of own prejudice, stereotyping
• Being able to transfer information in an ‘understandable’ manner
• Knowledge of legal rules and procedures
Academic Medical Center, dept. Social Medicine
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Cultural DimensionsCultural Dimensions
Geert HofstedeGeert Hofstede
Academic Medical Center, dept. Social Medicine
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Cultural dimensions - HofstedeCultural dimensions - Hofstede (1)(1)
Hofstede:• Culture as mental programming: ‘software of the
mind’• Cultural dimension:
“a dimensions is an aspect at which a culture can be compared to other cultures”
Academic Medical Center, dept. Social Medicine
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Cultural dimensions - HofstedeCultural dimensions - Hofstede (2)(2)
Method:
• Research project into national cultural differences at IBM
• 53 countries / 74
• In 1967 – 1973 and later
• Survey to compare culturally determined values
Academic Medical Center, dept. Social Medicine
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Cultural dimensions - HofstedeCultural dimensions - Hofstede (3)(3)
Five dimensions• Power distance• Individualism• Masculinity• Uncertainty avoidance• Long term orientation
How about our countries?
Academic Medical Center, dept. Social Medicine
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Power distancePower distance (1)(1)
Low power distance
• Inequality should be as
small as possible
• Parents treat children as
equal
• Teachers expect students’
initiative
• Subordinates expect to be
consulted
Academic Medical Center, dept. Social Medicine
High power distance
• Inequality is wanted and
expected
• Parents teach children to
obey
• Teachers have all initiative
• Subordinates expect to be
directed
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Power distance Power distance (2)(2)
Power distance in medical practice
• Power difference between physician and patient– Initiative for communication– Expecting participation
Academic Medical Center, dept. Social Medicine
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Power distance Power distance (3)(3)
Power distance: how about our countries?
High power distance Low power distance
Academic Medical Center, dept. Social Medicine
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Power distance Power distance (4)(4)
Power distance: how about our countries?
High power distance Low power distance
Academic Medical Center, dept. Social Medicine
MAR T IT NL GB
GER
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IndividualismIndividualism (1)(1)
Individualism• Consider oneself as ‘I’
• Personal opinion is
expected
• Virtue to be totally honest;
confrontation can be
beneficial
• Low context communication
• Guilt
Academic Medical Center, dept. Social Medicine
Collectivism• Consider oneself as ‘we’
• Opinions determined by
group
• Harmony should be kept;
confrontation avoided
• High context communication
• Shame
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IndividualismIndividualism (2)(2)
Individualism in medical practice
• Importance group/family in decision making• Meaning of ‘yes’ and ‘no’
• Dependence vs. own responsibility
Academic Medical Center, dept. Social Medicine
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Individualism Individualism (3)(3)
Individualism vs. collectivism:
how about our countries?
Individualism Collectivism
Academic Medical Center, dept. Social Medicine
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Individualism Individualism (4)(4)
Individualism vs. collectivism:
how about our countries?
Individualism Collectivism
Academic Medical Center, dept. Social Medicine
GB NL IT GER MAR T
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Masculinity Masculinity (1)(1)
Masculine
• Fathers handle facts, mothers
handle feelings
• Girls may cry, boys should
fight back
• Best student is norm
• Feminism: women get same
opportunities as men
• Taboo on speaking about sex,
more implicit symbolism
• Migrants should assimilate
Academic Medical Center, dept. Social Medicine
Feminine
• Fathers and mothers handle
facts and feelings
• Boys and girls may cry, both
should not fight
• Average student is norm
• Feminism: society should
change
• Explicitness about sex, less
implicit symbolism
• Migrants should integrate
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Masculinity Masculinity (2)(2)
Masculinity vs. femininity in medical practice
• Different ideas about good doctors• Aggression
• Sexuality issues
Academic Medical Center, dept. Social Medicine
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Masculinity Masculinity (3)(3)
Masculinity vs. femininity:
how about our countries?
Masculinity Femininity
Academic Medical Center, dept. Social Medicine
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Masculinity Masculinity (4)(4)
Masculinity vs. femininity:
how about our countries?
Masculinity Femininity
Academic Medical Center, dept. Social Medicine
IT GB
GER
MAR T NL
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Uncertainty avoidance Uncertainty avoidance (1)(1)
High uncertainty avoidance • Many and precise rules and
regulations• Aggression and emotions can
be expressed if right time and place
• Difference is dangerous• More sorrow about health and
finances• Confidence in specialists and
technical solutions• Prejudice against ethnic
differences
Academic Medical Center, dept. Social Medicine
Low uncertainty avoidance• Little and broad rules and
regulations• Aggression and emotions are
not expressed
• Difference is interesting• Less sorrow about health and
finances• Confidence in generalists and
common sense• Tolerance for ethnic differences
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Uncertainty avoidanceUncertainty avoidance (2)(2)
Uncertainty avoidance in medical practice
• High Uncertainty avoidance less subjective wellbeing
• Physicians essential for every task?• Emotion expression in consultation• Patients’ confrontation with discrimination
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Uncertainty avoidanceUncertainty avoidance (3)(3)
Uncertainty avoidance:
how about our countries?
High uncertainty Low uncertainty
avoidance avoidance
Academic Medical Center, dept. Social Medicine
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Uncertainty avoidanceUncertainty avoidance (4)(4)
Uncertainty avoidance:
how about our countries?
High uncertainty Low uncertainty
avoidance avoidance
Academic Medical Center, dept. Social Medicine
T NLMAR GERIT GB
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Time orientation Time orientation (1)(1)
Short term orientation• Short efforts with quick
results• Aggression and emotions
are not expressed• Old age is an unhappy
phase, fortunately is starts late
Academic Medical Center, dept. Social Medicine
Long term orientation • Perseverance leads to
gradual results• Thrift, deal with means
sparsely• Old age is a happy phase
that starts relatively early
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Time orientation Time orientation (2)(2)
Long term orientation in medical practice
• Logic of preventive measures• ?
Academic Medical Center, dept. Social Medicine
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Time orientation Time orientation (3)(3)
Time orientation:
how about our countries?
Long term orientation short term orientation
Academic Medical Center, dept. Social Medicine
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Time orientation Time orientation (4)(4)
Time orientation:
how about our countries?
Long term orientation short term orientation
Academic Medical Center, dept. Social Medicine
NL IT GER GB
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Cultural dimensions - HofstedeCultural dimensions - Hofstede
Discussion
• What attracted your attention? What amazed you?
• Can such a theory as Hofstede’s be helpful in medical practice?
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case-study:
A dialogue with a Moroccan man A dialogue with a Moroccan man and womanand woman
Academic Medical Center, dept. Social Medicine
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Case-studyCase-study
• What problems/difficulties occur in this case?
• What could cause these problems?
• What cultural competences (knowledge,
attitudes, skills) does a physician need to
prevent or reduces these kinds of problems?
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Case-studyCase-study
Themes we discuss • Communication:
– exploring lists of concern, points of attention (skill)
– language difficulties and causes of misunderstanding (knowledge)
– leading a conversation, involving a third person
• Background information (knowledge):– contraception and Moroccan women
– virginity and islam
• Awareness:– Influence own frame of reference
– Limits of own competence
Academic Medical Center, dept. Social Medicine