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Cultural competence in medical communication

Cultural competence in medical communication. Conny Seeleman Academic Medical Center, dept. Social Medicine 10 th February 2006. Cultural competence in medical communication. Program: Introduction Cultural dimensions – Hofstede Discussing a case-study.

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Cultural competence in medical communication

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  1. Cultural competence in medical communication Conny Seeleman Academic Medical Center, dept. Social Medicine 10th February 2006

  2. Cultural competence in medical communication Program: • Introduction • Cultural dimensions – Hofstede • Discussing a case-study Academic Medical Center, dept. Social Medicine

  3. Introduction (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

  4. Introduction (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

  5. Introduction (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

  6. Introduction (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

  7. Cultural Dimensions Geert Hofstede Academic Medical Center, dept. Social Medicine

  8. Cultural dimensions - Hofstede(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

  9. Cultural dimensions - Hofstede(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

  10. Cultural dimensions - Hofstede(3) Five dimensions • Power distance • Individualism • Masculinity • Uncertainty avoidance • Long term orientation How about our countries? Academic Medical Center, dept. Social Medicine

  11. Low power distance Inequality should be as small as possible Parents treat children as equal Teachers expect students’ initiative Subordinates expect to be consulted High power distance Inequality is wanted and expected Parents teach children to obey Teachers have all initiative Subordinates expect to be directed Power distance(1) Academic Medical Center, dept. Social Medicine

  12. Power distance (2) Power distance in medical practice • Power difference between physician and patient • Initiative for communication • Expecting participation Academic Medical Center, dept. Social Medicine

  13. Power distance (3) Power distance: how about our countries? High power distanceLow power distance Academic Medical Center, dept. Social Medicine

  14. GB GER IT NL T Power distance (4) Power distance: how about our countries? High power distanceLow power distance MAR Academic Medical Center, dept. Social Medicine

  15. Individualism Consider oneself as ‘I’ Personal opinion is expected Virtue to be totally honest; confrontation can be beneficial Low context communication Guilt Collectivism Consider oneself as ‘we’ Opinions determined by group Harmony should be kept; confrontation avoided High context communication Shame Individualism(1) Academic Medical Center, dept. Social Medicine

  16. Individualism(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

  17. Individualism (3) Individualism vs. collectivism: how about our countries? IndividualismCollectivism Academic Medical Center, dept. Social Medicine

  18. NL IT GER MAR T Individualism (4) Individualism vs. collectivism: how about our countries? IndividualismCollectivism GB Academic Medical Center, dept. Social Medicine

  19. 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 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 Masculinity (1) Academic Medical Center, dept. Social Medicine

  20. Masculinity (2) Masculinity vs. femininity in medical practice • Different ideas about good doctors • Aggression • Sexuality issues Academic Medical Center, dept. Social Medicine

  21. Masculinity (3) Masculinity vs. femininity: how about our countries? MasculinityFemininity Academic Medical Center, dept. Social Medicine

  22. MAR T NL GB GER Masculinity (4) Masculinity vs. femininity: how about our countries? MasculinityFemininity IT Academic Medical Center, dept. Social Medicine

  23. 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 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 Uncertainty avoidance (1) Academic Medical Center, dept. Social Medicine

  24. Uncertainty avoidance(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 Academic Medical Center, dept. Social Medicine

  25. Uncertainty avoidance(3) Uncertainty avoidance: how about our countries? High uncertainty Low uncertainty avoidance avoidance Academic Medical Center, dept. Social Medicine

  26. T IT MAR GER NL GB Uncertainty avoidance(4) Uncertainty avoidance: how about our countries? High uncertainty Low uncertainty avoidance avoidance Academic Medical Center, dept. Social Medicine

  27. Short term orientation Short efforts with quick results Aggression and emotions are not expressed Old age is an unhappy phase, fortunately is starts late Long term orientation Perseverance leads to gradual results Thrift, deal with means sparsely Old age is a happy phase that starts relatively early Time orientation (1) Academic Medical Center, dept. Social Medicine

  28. Time orientation (2) Long term orientation in medical practice • Logic of preventive measures • ? Academic Medical Center, dept. Social Medicine

  29. Time orientation (3) Time orientation: how about our countries? Long term orientationshort term orientation Academic Medical Center, dept. Social Medicine

  30. NL IT GER Time orientation (4) Time orientation: how about our countries? Long term orientationshort term orientation GB Academic Medical Center, dept. Social Medicine

  31. Cultural dimensions - Hofstede Discussion • What attracted your attention? What amazed you? • Can such a theory as Hofstede’s be helpful in medical practice? Academic Medical Center, dept. Social Medicine

  32. case-study: A dialogue with a Moroccan man and woman Academic Medical Center, dept. Social Medicine

  33. Case-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? Academic Medical Center, dept. Social Medicine

  34. Case-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

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