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Patronising (“correcting” cultural practices in the consultation)
In some cultures, men talk for their wives. The clinical encounter is not the appropriate setting to change that.
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Be tolerant
Respect differences; keep the patient central and ensure the patient answers PROMs him/herself whenever possible. Take care of including the patient in the communication by keeping eye-contact.
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Ignoring language obstacals and knowledge gaps
Medical knowledge alone is sometimes insufficient when caring for patients of other cultures. You may need to consult experts with knowledge about the respective culture and/or language knowledge.
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Provide native language, ask for support
If possible, provide PROMs in the native language of the patient. Consult an interpreter who is qualified for language mediation in the healthcare sector or family members if available and suitable. Make sure you still involve the patient in the conversation (eye contact, body language).
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Using medical language
Even when somebody is competent in everyday English, understanding medical informetion, diagnosis, etc. might be difficult, especially in an emotionally loaded situation.
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Adapt language
Use plain language; explain; slow down in emotionally stressful situations.
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Information overload and limited understanding
Patients may have different levels of knowledge on the topics and different needs for information. Avoid the question “Do you understand?”, as the answer might be affirmative due to social desirability and shyness.
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Tailor information and confirm mutual understanding
Explore information needs, give small portions of information; pause; invite questions, tailor amount and content of the information to the individual needs.
Make sure the patient has understood what was discussed by asking to repeat the information or instruction.
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Assuming that all patients communicate similarly
In many cultures it is common to communicate indirectly. In some cultures, disregarding a recommendation given by a person of authority (e.g. physician) is considered inappropriate and disrespectful. Doubts and unwillingness are expressed only indirectly or not at all for reasons of courtesy.
In some cultures it is good manners not to bother others with your own feelings. That might have an impact on the answering of PROMs and/or the discussion of PRO data.
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Clarify basis for communication, listen carefully and ask precisely
Ask open and specific questions.
It is useful to ask carefully for further information and the meaning of what has been said. You may say: “I do not know much about your country. What does it normally mean for you when XY is happening?” Be sensitive towards differences in the patients’ expression of the own condition.
Do not interpret silence/politeness as agreement; explicitly invite concerns; give attention to non-verbal communication and body language, inform yourself about cultural characteristics in advance and/or be sensitive for possible differences (e.g. in some cultures, shaking the head is a sign of approval).
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