Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #102771

M. Barton Laws, PhD, Center for Research on Culture and Health, Latino Health Institute, 95 Berkeley St, Boston, MA 02116, 617-350-6900, bart@lhi.org

Background: The problem of cross-cultural competency in medicine has been a major area of interest recently, but there has been surprisingly little empirical investigation of cross-cultural communication and relationships in health care. The basic problematic of cross-cultural competency is often assumed to be disparate health beliefs and practices. In fact, culturally conditioned health beliefs as such may be of little importance compared with unrecognized differences between provider and patient in norms of interaction, expectations for the provider patient relationship, and the process of medical decision making. Equally important is providers' ability to gain understanding of patients' life circumstances and behaviors that go far beyond health beliefs. Methods: We audiotaped 153 pediatric outpatient visits at a clinic serving many immigrant families, most Latino. We also did extensive interviews with the children's caregivers (usually their mothers). The interviewers were native Spanish-speaking women from Puerto Rico and the Dominican Republic. We selected cases involving relatively complex medical and/or psycho-social issues. We identified mothers' specific concerns about their children as expressed in the interviews, and social contextual factors that may have been important to the children's health status, growth and development, or families' ability to adhere to medical advice. We then examined the content of the interaction with the provider to determine the extent to which these elements entered the encounter, and identified instances where marginalized issues appeared to result in an inadequate or inappropriate response to the families' needs, affected diagnostic accuracy, or caused advice to be given which was not understood or could not be followed. We also identified examples of successful communication about social context. The identified phenomena are presented in the form of case studies. Results: While some mothers report using non-allopathic healing methods, this was of no evident importance to the success of the clinical encounters. Rather, miscommunication occurred because of failure of the provider to enquire about basic questions such as mothers' employment; dismissal of questions and complaints by the provider; failure to ascertain whether instructions were understood; reliance on untrained and incompetent interpreters; and differences in expectations about interactions and relationships. None of the encounters appeared to be exemplary. Implications: These findings suggest a new phenomenological scheme for communication failures in cross-cultural situations, and that future investigation should focus on methods of facilitating the entry of important life-world issues into cross-cultural encounters, and negotiating relationships and interaction processes that will enhance effective two-way communication.

Learning Objectives:

• To understand specific ways in which cultural differences between physicians and patients can contribute to miscommunication, failure to recognize psycho-social context of families, and clinical errors. Participants will gain a better understanding of the underlying problems of cross-cultural competence in practice.

Keywords: Cultural Competency, Health Care Utilization

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.