There are several ways in which clinicians working with multicultural patients & families can contribute to our customers’ positive experience at UMHS. An important first step is to be sensitive to patients’ cultural beliefs and practices and to convey our respect for their cultural values through the manner in which we communicate with them and deliver their healthcare. This may require calling for help in interpreting behavior, either from a provider who is from the same ethnic group as the patient or from an expert familiar with the group’s language, life-style, and value preferences.

It is critical that health care providers recognize individual differences and do not participate in "cultural stereotyping". Because persons of the same ethnicity can have very different beliefs and practices, it is important to understand the particular circumstances of the patient or family by obtaining information on: place of origin; social and economic background; degree of acculturation; and personal expectations concerning health and medical care.

The following questions may be useful in assessing culturally diverse patients and families:

1. So that I might be aware of and respect your cultural beliefs,
2. Can you tell me what languages are spoken in your home and the languages that you understand and speak?
3. Please describe your usual diet. Also, are there times during the year when you change your diet in celebration of religious and other ethnic holidays?
4. Can you tell me about beliefs and practices including special events such as birth, marriage and death that you feel I should know?
5. Can you tell me about your experiences with health care providers in your native country? How often each year did you see a health care provider before you arrived in the U.S.? Have you noticed any differences between the type of care you received in your native country and the type you receive here? If yes, could you tell me about those differences?
6. Is there anything else you would like to know? Do you have any questions for me? (Encourage two-way communication)
7. Do you use any traditional health remedies to improve your health?
8. Is there someone, in addition to yourself, with whom you want us to discuss your medical condition?
9. Are there certain health care procedures and tests which your culture prohibits?
10. Are there any other cultural considerations I should know about to serve your health needs?

Understanding: Acknowledging that there can be differences between our Western and other cultures’ healthcare values and practices.

Empathy: Being sensitive to the feeling of being different.

Patience: Understanding the potential differences between our Western and other cultures’ concept of time and immediacy.

• The importance of culture as a determinant of health;
• The existence of other world views regarding health/illness;
• The adaptability and survival skills of our patients;
• The influence of religious beliefs on health; and
• The role of bilingual/bicultural staff.

Ability: To laugh with oneself and others.

Trust: Investment in building a relationship with patients which conveys a commitment to safeguard their well-being.

Speak in short units of speech - not long involved sentences or paragraphs. The UMHS interpreters use the Consecutive Interpreting format. This is where the providers and clients take turns speaking and the interpreter interprets at the end of each turn. The longer either party talks, the greater the margin of error.

Be patient. An interpreted interview takes longer. Careful interpretation often requires that the interpreter use long explanatory phrases. Not all words and thought exist in other languages; therefore, interpreting in another language may require more words to express the same meaning.

Expect that the interpreter may occasionally pause to ask you for an explanation or clarification of terms in order to provide an accurate interpretation.

Avoid colloquialism, abstractions, idiomatic expression, slang, similes, and metaphors.

During the interaction, look at and speak directly to the client, not to the interpreter. The interpreter will stand behind and a little to the side of the patient to assist in this interaction.

Avoid saying to the interpreter, "Ask him . . ." or "Tell her . . .". Speak in first person, as will the interpreter.

The interpreter will relay all that is said in the presence of the client and will not omit anything spoken on the side or anything that is said to others in the room.

Listen to the client and watch their nonverbal communication. Often you can learn a lot regarding the affective aspects of the client’s response by observing facial expressions, voice intonations, and body movements.

Repeat important information more than once. Always give the reason or purpose for a treatment or prescription.

Check the client’s understanding and accuracy of the interpretation by asking the client to repeat instructions or whatever has been communicated in his or her own words, with the interpreter facilitating.

When possible, reinforce verbal interaction with materials written in the client’s language and/or with visual aids. Do not use computer software to translate any written information. The translations are not accurate.

Realize that the interpreter can not reveal any information or opinions about the patients. Do ask the interpreter to clarify any cultural norms.

1. Interview and assess patients in the target language or via appropriate use of bilingual/bicultural interpreter.
2. Ask questions to increase your understanding of the patient’s culture as it relates to health care practices.
3. Where appropriate, formulate treatment plans which take into account cultural beliefs and practices.
4. Write instructions or use handouts if available.
5. Effectively utilize community resources.
6. Request the patient to repeat information provided by healthcare professionals to ascertain understanding of message - educational and language barriers.
7. Clearly communicate expectations (speak slower, not louder). Use drawings and gestures to aid communication.
8. Make no assumptions about education level or professionalism.
9. Avoid using phrases such as culturally insensitive terms, i.e., "You People" and "Culturally Deprived" which may be considered culturally insensitive.
10. A reflective approach is useful. Health care providers should examine their own biases and expectations to understand how these influence their interactions and decision making.
11. Listen carefully.

The following "cultural highlights" although not all-inclusive may assist clinicians in interacting with patients from these cultures. Again, "cultural stereotyping" should be avoided.

• Address patients by their formal name, not by their first name, especially for elderly patients.
• Make direct eye contact.
• Explain reason for obtaining information since there may be reluctance to engage in personal disclosure.
• Be cognizant of basic distrust of health professionals by many African Americans.

• Ask about his/her last name and how to address him/her (husband and wife don’t necessarily have the same last name). People from China tend to be more formal than Americans.
• Assertive and individualistic personalities may be considered crude and poorly socialized. This may mean that patients will not speak up in their own behalf.
• Treatment decisions are often made by the family, rather than by the individual patient. The patient may want conversations about treatment to take place when the family is present. Ask the patient if this is his/her preference.
• Patients may believe symptom relief should happen quickly, but they may also think the illness is cured when the symptoms go away. Pointing out progress or improvement may make results more obvious and act as an incentive for the patient to continue treatment.
• Be aware of the importance of the Chinese patient in "saving face". A response to yes/no questions is likely to be "yes,’ a nod, or "I know." These responses may not indicate understanding; they may simply mean that the patient has heard you. Ask the patient or family to repeat the information.
• Explain why blood drawing for tests is important. Chinese patients believe that blood is the source of life for the entire body and it is not regenerated.

• Be aware that Islamic patients tend to demonstrate passivity in the presence of an authority figure.
• Explain the need for requesting patients to disclose personal information. Islamic patients may be reluctant to share such content with others.
• Consider sharing some bit of personal information to gain the patient’s trust.
• Ask about including a family spokesperson rather than only communicating with the patient.
• Control the tendency to be "frank" when communicating a grave diagnosis or a poor prognosis.

 

Japanese Patients

• Doctors are seen as authority figures and patients and their families may hesitate to ask questions. Ask the patient or family members if they have questions more than once.
• Treatment decisions are often made by the family, rather than by the individual patient. The patient may want conversations about treatment to take place when the family is present. Ask the patient if this is his/her preference.
• Patients, particularly the elderly, are not accustomed to verbalizing their emotions. However, they appreciate empathy, sympathy, respect, and kindness. Nonverbal communication is important.

 

Latino Patients

• Involve the entire family in order to improve patient compliance. With a child’s treatment, it is imperative to involve both parents.
• Inquire about what personal health treatments they may use (folk medicine).
• Inquire about food choices. Latino patients believe in hot and cold food items to treat disease.

 

Russian Patients

• In Russia, bad news is not given to patients. Patients may demand to hear the truth but they do not want to hear the bad news. Talk to their relatives first.
• Be aware that Russian patients and families may ask for new treatments or procedures. Patients expect doctors to explain, in detail, new tests or new medicines.
• When explaining possible risks, complications and side effects of different procedures, be cautious and optimistic; Russian patients may overreact.
• Russian patients are distrustful of doctors. They tend to disobey doctor’s orders such as not taking medications as prescribed or combining them with Russian treatments.
• Russian patients prefer alternative methods or treatment such as massage or mud-therapy, a popular treatment in Russia. Russian patients are more likely to follow through with a homeopathic remedy versus traditional Western medicine.
• Psychiatric disease is disgraceful in Russia. Russian patients often do not provide answers regarding any family history of psychiatric illness or past psychiatric treatments. The same holds true for sexual history.