1. Dealing with Cultural Differences
Dr. Jill Benson
Director, Health in Human Diversity Unit,
University of Adelaide
Senior Medical Officer, Migrant Health Service, Adelaide
and Tullawon Health Service, Yalata Aboriginal community

2. Dominant vs Minority cultures
25% of the current Australian population was born in a foreign nation where English is not the dominant language
Culture is about more than just the country of birth - it is also about age, gender, education, socio-economic status, religion, language, occupation, sexuality, politics and life experiences

3. What is culture? What is your culture?
Are there any other ‘cultures’ in your life?
Does living in Adelaide give you a different culture?
Do doctors have a culture of our own?

4. Culture
The total way of life – the underlying pattern of thinking, feeling and acting – of particular groups of people
How people make sense of their surroundings including attitudes and behaviour, assumptions and values
What people ‘take for granted’, what they notice about others but is largely invisible to themselves
The interaction between language, social structure, religion, world view, environment, economy, technology, belief and values

5. Other cultural concepts
Multiculturalism: An ideology advocating that society should consist of, or at least allow and include, distinct cultural groups, with equal status
Cultural awareness: Knowing and understanding that there is a difference between people or cultural diversity; having insight into the physical, psychological, social, spiritual, economic and political context in which people live or have lived

6. Ethnocentricism
The unconscious tendency to assume that how we behave, think and feel is the absolute (behaviour, thoughts, feelings) way of being for everyone
Normal
Good
Right
Appropriate
Expected

7. Where does this come from?
Genetic predisposition
Childhood history
Culture
Spirituality
Personality
Finances
Education
Health
Sense of Humour
Personal Insight

8. Differences in other cultures
Communication styles
Attitudes towards conflict
Always agreeing
Approaches to completing tasks
Tomorrow will be fine
Decision-making styles
Procrastinators
Attitudes towards disclosure
Only if I know you and trust you
Approaches to knowing
“You’re the doctor”

9. Will this impact on patient care?
Eye contact
Medication – cure vs treatment
Appointments
Relationship with people in authority
Are they telling the ‘truth’ anyway?
Is health a priority in their life?
Consulting with other people – family, other healers

10. World-view ‘Western’ individualistic world-view
Individualism and consumerism
Body and mind are separate
Usually assumes people are responsible for their own misfortune
Collectivist world-view
(Indigenous cultures and the developing world)
Spiritual and ecological
Consensual and communal
Spirituality pervades every aspect of the lives of people from most indigenous cultures and cannot be differentiated from either their physical or mental well-being

11. Health literacy Understanding of anatomy and how the body works
Must be taken into account when talking to patients from different cultures
Causes of illness might be seen as spiritual or environmental rather than as bacteria or lifestyle
What causes disease, pregnancy etc?
What does this illness mean to the patient?

12. Concordance and communication
About 50% of our patients do not take the medication, have the investigations or follow the advice we give
If we listen to our patients for just 2 minutes they are more likely to comply with our advice
During this time we need to practice active listening techniques

13. ‘The answers to health problems must include giving people a sense of personal self-worth, a sense of being needed or loved, an ability to influence and control their own environment, and an ability to manage their own problems.’ (Trudgen)

14. Cultural Awareness Tool
What do you think caused your problem?
Why do you think it started when it did?
What do you think the illness does to you?
What are the chief problems it has caused for you?
How severe is your illness?
What do you most fear about it?
What kind of treatment/help do you think you should receive?
Within your own culture how would your illness be treated?
How is your community helping you?
What have you been doing so far?
What are the most important results you hope to get from treatment?

15. Working with different views of illness
The doctor works exclusively within the biomedical model
The patient and doctor function exclusively within each of their own cultures
The doctor works within the patient’s cultural framework
The patient and doctor negotiate between their concepts of the cause of the problem/illness/disease and the most appropriate management to reach mutually desirable goals

16. Styles of communicating
Authoritarian
Instructional
Empathic
Collaborative with the family, community and management team
Which are you most of the time?
Are any of these inappropriate?
Are there times when each might be appropriate?

17. Are any of these styles more helpful if there are different health beliefs?
Authoritarian
if their life is in danger
Instructional
if it is important to understand what is going on so that will feel safe, have the investigations, have the treatment, return for follow-up
Empathic
if what is happening is overwhelming or frightening
Collaborative
if there is a strong collectivist world-view or there is a need for support

18. Language Competency Tips
Asking people their name, address, date of birth and other predictable information is not an adequate test of English skills
Having social conversation skills does not always mean that the person understands complex information in spoken or written English
Verbal skills do not always equate with reading and writing skills
People often lose their second language skills in stressful situations
Always use a properly qualified interpreter

19. Family members If you use family members
They might filter the information to "protect" their parent, relative or friend
They might not be able to handle, or cope with things they will hear
They might use information for private advantage or gain
They cannot be expected to know the specialised terminology, and might make a serious or even fatal mistake
They will not be impartial

20. Jargon ‘I think your ticker’s on the blink’
‘I guess you’re keen to hit the road’
‘That probably drives you up the wall’
‘Hey dude, how’s it hanging?’
It is important that health professionals do not use jargon or local dialect when speaking to patients from a different culture, even if that culture has English as a first language
Always ask the patient if you don’t know what something means

21. Conclusion
Culture is an important aspect of any interaction with patients
Reflect on your own ethnocentricism
Ask the patient about the impact of their culture on their health
Remember to take health literacy into account
Be aware of what style is appropriate
Use the right interpreter if necessary
Don’t be afraid, be compassionate – courage and a good heart go a long way

22. Thank you