a person can have with another human being, and having access to . affect the doctor-patient relationship in the third-world country of Bolivia. Ambulatory care, cross-cultural comparison, doctor patient communication, role in developing a trusting doctor–patient relationship, and the patient's trust in the . Hence, there is little cultural difference in the physician– patient patterns of .. of excellence in research, scholarship, and education by publishing worldwide. different aspects of doctor–patient communication and the GPs' performance of these aspects, both being from the patients' perspective. patients of GPs in six European countries (Netherlands, Spain, United psychosocial background) showed many relationships. bound by a seventeenth century world view.
Thirdly, the frequency of back-channel responses and interruptions uttered by doctors and patients were counted and compared to examine differences in the interaction properties of doctor—patient encounters. Back-channel responses are verbal markers of continued attention uttered by the listener: These serve as verbal indicators of sustained attention and encouragement emitted by the person who does not hold the speaking floor. The effect of this conversation device is intended to show rapport and that there is no need for the speaker to complete the sentence.
Interruptions almost always have negative implications in English but, linguistically, interruptions can have positive or negative effects in communication.
Seven types of interruptions include: Results Table 1 summarizes the socio-demographic characteristics of the 40 patient and nine doctor participants. All the US patients and physicians were Caucasian. A slight majority of participants in Japan and the USA were male, 11 out of 20 patients at both sites.
The patients had a variety of diagnoses, and there was a slightly greater preponderance of chronic diseases in the Japanese sample.
The mean age of the physicians was 45 years in the USA and Time distribution analysis There were considerable differences in the total encounter length, length of pause time and the proportion of time spent in each phase between the USA and Japan.
The average length of the doctor—patient encounters was In Japan, very little time was spent on discovering the reason for the visit, 0. Speech acts distribution We compared the total numbers and the physician versus patient ratios of total speech acts, questions, explanatory statements, directives and other speech acts. Despite a difference in the average numbers of speech acts in the two countries, the physician versus patient ratios of total speech acts and each speech act type were found to be similar Table 2.
The doctors asked more questions than the patients did in both countries: Comparative analysis of the question types used by the physicians showed that open-ended questions, closed questions and other questions were similar in the two countries. Explanatory statements were distributed fairly equally between doctors and patients in both countries, whereas in both countries directive statements had a physician versus patient ratio of Other speech acts were dominated by patients, who produced approximately two-thirds of such utterances in both countries.
Other interaction properties We found more back-channel responses used by both the physicians and the patients in Japan doctors However, as shown by the time distribution analysis, the average length of visits was longer in the USA than in Japan. As shown in Figure 2the mean frequency of interruptions was much higher in Japan doctors Discussion This is the first known investigation to identify specific linguistic differences and similarities in doctor—patient communication behaviours in these two countries, and provides compelling evidence that culture actually influences patterns of doctor—patient communication.
Our data strongly suggest that doctor—patient communication is different between the USA and Japan in length of total time, length of pauses, the proportion of time spent in each phase of encounters and the use of back-channel responses and interruptions.
Doctor—patient communication in these two countries appears similar in the physician versus patient ratios of questions or other speech acts.
Given the intense pressures for greater productivity, we were not surprised to find that the average length of US doctor—patient encounters was relatively shorter than noted in previous studies, 27, 28 although it was still longer than that in Japan. This USA and Japan difference of total time might stem partly from the different medical and health insurance systems in the two nations. While Japanese patients typically are expected to visit their physicians at the first sign of acute illness and every 2—4 weeks for chronic medical problems, patients in the USA, particularly those perceived to have a self-limited illness, are encouraged to self-treat and to schedule with a doctor only if not improved, and every 1—6 months for chronic problems.
Given these circumstances, individual visits in the USA would probably require more time for adequate communication. There were several notable cultural differences. In American low-context communication, where the vast majority of information is vested in explicit language, messages would feature more detailed information and quick turn-taking.
There were notable cultural differences in the relative time distribution of the doctor—patient encounters. Greater time spent in social talk in the USA appears to serve an affective function to build and maintain rapport. The aforementioned Japanese system of regular medical visits may allow for more cumulative discussion of the diagnosis and explain the lack of time spent in discovering the reason for the visit. In contrast to these differences in time distribution, the physician versus patient ratios of speech acts in both countries were similar.
Physicians in both countries controlled communication by asking far more questions than patients. However, the similar doctor versus patient ratios of total speech acts and explanatory statements in both countries implies that physicians and patients participate almost equally in exchanging information.
Hence, there is little cultural difference in the physician— patient patterns of controlling or participating in communication.
Doctor–patient communication: a comparison of the USA and Japan | Family Practice | Oxford Academic
This question of whether the pattern of more question asking is a dominating or non-dominating approach could best be answered in future research using a qualitative conversation analysis design. The higher frequency of back-channel responses and interruptions in Japan fits with an earlier USA—Japan comparative study on counsellor and client interactions during radio talk shows.
Unlike back-channel responses, the interpretation of interruptions, an important turn-taking mechanism, depends on a complex of factors. In our study, the interruptions were nearly eight times greater among Japanese physicians than US physicians, and five times greater among Japanese patients than US patients.
Facilitative interruptions were the most common type of interruption, but these numbered over six times greater for Japanese physicians and nearly four times greater by Japanese patients than US patients. We believe that interruptions in Japanese communication have a connotation that indicates positive involvement, not conflict or dominance.
Here, back-channel responses and interruptions convey a listening, facilitative attitude, and can be used to express interest and positive regard, to show willingness to work as partners or to demonstrate empathy.
The frequent use of back-channels and interruptions, effectively used in Japanese succinct communication and illustrating a marked contrast to quick turn-taking in US detailed communication, may function as a creator of a co-operative mood for sharing communication between physicians and patients in Japan.
As part of each consultation, he used to explain the options and implications of proposed investigation and treatment with the associated risks and benefits. Failing to interpret that strange look in the eyes of his patients, he used to ask them at the end: In Eastern and Arabian societies, the power balance of the doctor-patient relationship leans more toward the doctor, that is, doctors have more authority in the decision-making process than patients.
Such paternalistic relationships resonate well with an earlier study in ,1 where we reported professional autonomy of physicians not patient autonomy as a salient domain of medical professionalism in the Arabian context. Reflecting on these types of experiences and our article, from the perspective of a reader, led me to ponder certain questions: What is North on the compass that guides our behaviors in a new land?
What is the degree of flexibility that we expect from graduates who move to learn or practice in a different culture? But what is the ratio between these two components?
Becoming a Doctor in Different Cultures | AM Rounds
And how can we teach flexibility, adaptability, and cultural understanding or competence in our medical schools? Medical professionalism represents the expected behaviors and attributes of physicians while serving their patients and societies in a specific culture. Yet, throughout my Master and PhD studies in medical professionalism for almost ten years, I wondered: How can we draw the boundaries of a culture?