“You learn something new every day” is one of my favorite sayings … because it is just so true. Last week, I stumbled across a reference to Geri-Ann Galanti’s Caring for Patients from Different Cultures, 4th Edition (Univ. of Penn. Press 2008, Kindle Edition). [1] Delighted to find it available for Kindle, I downloaded it and read it in a single day. This book explores cultural diversity in healthcare, using short case studies to make a big impact. Often the focus in healthcare is on overcoming language barriers. This entails using interpreters and translated documents to ensure that the provider’s words are understood in the patient’s language. A patient’s culture, however, can play a major role in communication, compliance with the provider’s instructions and advice, and overall wellness.
The dichotomy between “stoic” and “expressive” cultures is a recurring theme throughout the book, and truly resonated with me. So what do these mean?
Stoic:
Stoic people personify “grin and bear it.” When it comes to pain, stoic people don’t want to make a fuss. There are many reasons for stoicism, both in a general, cultural sense and for particular individuals. Sometimes it’s for religious reasons, such as the Filipino concept of Bahala na (God’s will). “Pain is the will of God and thus God will provide the strength to bear it.” Sometimes it’s just a matter of upbringing: “boys don’t cry” or “don’t be a baby.” And often it’s a matter of status: one does not bother the busy doctors and nurses. They are professionals and will see to me when they have time. Very generally speaking, Northern European and Asian cultures tend to favor stoicism.
Expressive:
Expressive cultures personify “let it out.” When it comes to pain, they aren’t afraid to let you know it hurts, often loudly. Again, the reasons underlying expressive cultures vary. For example, in both the Jewish and Italian cultures, children are warned to avoid injury, take precaution against illness like the common cold, and avoid physical confrontation. Expressing pain, such as crying, results in attention, sympathy, and help. The louder the expression – the more attention received. This behavior tends to stick into adulthood. Contrast that with Iranian culture for women during childbirth. In the Iranian culture, the louder the soon-to-be mom’s expression of pain, the more significant the gift her husband must give her for enduring the suffering and bearing his child.
“Typical American” culture tends toward the stoic, but with the expectation that if someone is hurting, they ask for medication. This cultural belief can often cause doctors and nurses to misunderstand their patients (sometimes subconsciously). A loud, expressive patient may be considered a nuisance or troublesome. A stoic patient may hinder his recovery without proper pain management, or may downplay painful symptoms.
As the author of Caring for Patients from Different Cultures suggests, examining your own personal and cultural background and beliefs, and learning more about the cultures of the patients you serve, can not only improve communication, it can also help with everything from diagnosis to prescription medication compliance to overall patient experience.
[1] A 5th Edition was published in 2014. Check out the author’s website at: http://www.ggalanti.org/
