Crossing the inter-cultural divide: thoughts on medical specialists’ communication skills

New research published this week in BMC Medical Education takes a look at intercultural communication of medical specialists and how this is valued through reflective practice. Author Emma Paternotte tells us how this research came about and why it is so important.

As a resident in obstetrics and gynaecology, I experienced first-hand the challenges of intercultural communication, in the multi-cultural setting of Amsterdam, the Netherlands. Issues like the difference in habits, values, expectations, and perceptions, a language barrier or the cultural differences involving the role of the family, made me wonder why medical education had not prepared me sufficiently for these challenges. I wondered how my supervisors handle these issues of intercultural communication with their own patients.

This was the start of a research project about intercultural communication in the medical consultation room. As intercultural communication has many definitions, we defined it as the process of interpersonal interaction between ethnically different doctors and patients. We focused on native Dutch medical specialists communicating with non-native patients. Neither these non-native patients nor their parents were both in the Netherlands. As part of this larger research project, we recently published in BMC Medical Education the results of a reflective practice study with medical specialists of various specialties.

In this study medical specialists reflected on their own, videotaped intercultural communication behaviour. The medical specialists mainly focused on generic communication, such as listening and explaining, instead of intercultural communication, for example asking for the language ability of the patient. They mentioned the wish to treat every patient as a person irrespective of their background. Furthermore, they spoke of intercultural communication ‘challenges’ instead of ‘problems’ and consider the presence of a language barrier as the biggest challenge.

…even though medical specialists are more experienced than residents, they experience the same challenges as I did as a resident.

The reflective practice with medical specialists was not only informative for me as a researcher. All participants highly valued being able to see themselves communicating with patients. As a researcher I learned that, even though medical specialists are more experienced than residents, they experience the same challenges as I did as a resident. Continuing communication training after postgraduate medical training could help to create awareness about their own communication behaviour, which might change possible counterproductive communication habits, developed through years of experience.

I found it curious that medical specialists seem to experience difficulties in reflecting on their own communication. This is not something which gets a lot of attention in medical school and asks an open attitude and mind of doctors, which can be trained. Participating in this reflective practice study could create awareness of one’s own communication skills and behaviour.

Overall, we concluded that the medical specialist focused on their generic communication skills rather than on specific intercultural communication skills. Therefore, the interviews resulted in more knowledge about communication behaviour in general rather than intercultural communication skills specifically as was expected, since the medical specialists participating thought that every patient should be treated as a person. This could indicate an overlap between patient-centred communication and intercultural communication, since treating the patient as a person is important in both communication strategies. At the moment, this overlap is a focus of much discussion and we hope this reflective practice study can contribute to the literature by demonstrating the views of the medical specialist. Additionally, our results clearly showed that reflective practice is both a research method and the start of communication training.

…when it becomes normal to watch how you behave with others, it becomes easier to reflect on how you communicate with them.

Working as a resident myself I learned to reflect more on my communication skills and not being afraid to get feedback on my videotaped consultations. I learnt that when it becomes normal to watch how you behave with others, it becomes easier to reflect on how you communicate with them. I would like to plea for the introduction of life-long communication training for doctors which would ideally include both general communication skills and specific intercultural communication skills.

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