Professional Documents
Culture Documents
The Medical Interview
The Medical Interview
TABLE 121
FREQUENTLY MISTRANSLATED MEDICAL TERMS
Term How to Avoid Misunderstanding
Allergy
Anxiety,
nervousness
Blood tests
Dizziness
Fever
Sensation of
pins and
needles
Adapted from Rothschild SK. Cross-cultural issues in primary care medicine. Dis Mon 1998; 44:
293319, at 312.
Often a question about allergies is interpreted as meaning,
Does the medicine make you sick? To distinguish side
effects or ineffectiveness from true allergy, ask about spe-
cic allergic manifestations (e.g., Does it cause a rash?).
Use a variety of terms referring to both physical and
psychological manifestations to elicit a history of anxiety.
Ask about fears, racing heartbeat, sweating, and so on.
Taking some blood may be frightening and difficult to under-
stand. Be explicit about the amount (expressed in tea-
spoons, rather than tubes) and the purpose of the tests.
Distinguishing lightheadedness from vertigo can be challeng-
ing in translation. Make sure that the interpreter (or patient)
understands the distinction between unsteadiness or
drunkenness and the sensation that the room is spinning.
In cultures that divide illnesses into hot and cold, the word
fever may be used to refer to any hot disease, even in the
absence of measured variation in body temperature.
The literal translation of this term would be meaningless
in languages other than English. Many Mexicans refer
to hormingas (ants) crawling on the skin. This example
illustrates the importance of avoiding idioms or metaphors
when translating to a different language (or culture),
or making sure that the interpreter understands the
English idiom.
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Copyright 2006 by F. A. Davis.
HEALTH BELIEFS IN THE INTERVIEW
Stereotyping
Cultural values and beliefs are not the only factors that inuence how per-
sons understand health and illness or conceptualize health care. Religious,
gender-based, socioeconomic, educational, environmental, familial, and
personal factors also play roles. Thus, although cultural generalizations
provide us with useful information, they should not be used to stereotype
the attitudes or behavior of individual patients. Consider the following
global statement: In Hispanic cultures people tend to believe that they
have little or no control over natural forces in the world. Such a state-
ment might be helpful to clinicians insofar as it provides a context for
understanding expressions of fatalism among Hispanic patients; but such
a generalization is harmful if used to stereotype an individual, or to ration-
alize not educating and engaging the patient in his or her own health care.
Likewise, the statement that women in traditional Arab or Italian cultures
tend to express their pain loudly and dramatically may be true from a
broad anthropological perspective. However, a clinician who uses this
generalization to discount or minimize an individual patients expression
of pain is engaging in cultural stereotyping.
BPRACTICE POINT
In clinical practice we encounter unique individual patientsnot
generic cultural representatives.
A Multiplicity of Cultures
Sometimes using the concept of culture helps us to understand the com-
mon experience of groups of people who may not at rst blush appear to
constitute cultures. Take, for example, the community of persons who
were born deaf. The deaf community has its own language, traditions, and
rules of social contact. The life experience of deaf people may foster neg-
ative attitudes toward health care professionals who focus on deafness
solely as a disability, rather than as an alternative (and extremely rich)
way of being in the world. The term hearing impaired has clinical use-
fulness, but in no way does it capture the self-image of persons born into
the deaf world. In taking care of a deaf person, the culturally competent
clinician must be sensitive to cross-cultural aspects of the encounter. Here
are a few examples:
HEALTH BE LI E F S I N THE I NTE RVI EW 237
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Copyright 2006 by F. A. Davis.
Deaf persons rely on touch and vision rather than on sound to get
anothers attention. Touching that is considered appropriate in
deaf culture might seem aggressive or uncomfortable in the hear-
ing community. Likewise, exaggerated hand waving or stomping
of feet (which produces vibration) to attract attention is normal
behavior.
Because deaf persons value face-to-face encounters (which are
essential for signing), leave taking is often an extended process,
rather than an abrupt goodbye.
American Sign Language (ASL) is the native language of deaf
Americans; spoken English is their second language. Thus, mis-
communication is likely to occur, especially with sensitive or
complex topics, even when the patient reads lips well or the
communication is in writing. It is often desirable to enlist an
ASLEnglish translator.
Likewise, we might view the medically underserved population as a
separate, identiable culture, even though underserved communities in
the United States may include individuals from various ethnic identities.
These communities are generally characterized by low socioeconomic
status, multiple social problems, poor access to needed services, and skep-
ticism or distrust of the health care system. One benet of conceptualiz-
ing the underserved as a separate culture (or subculture) is that, by
doing so, one establishes a context for understanding how difficult it is
for some patients to think and act like we do regarding the benets
of health care or the benecence of health care institutions. Elements
in Interviewing Patients from Underserved Populations, below, summa-
rizes skills that assist you in reaching across the cultural divide to make
a therapeutic connection with patients from underserved and disadvan-
238 Chapt er 12 CULTURAL COMPETE NCE I N THE I NTE RVI EW
WHAT TO SAY
Elements in Interviewing Patients
from Underserved Populations
Empathize
Listen to the patients expressions of frustration, failure, and anger.
I can hear how frustrating it must be to have worked so hard and be
unable to pay for your medication.
Elicit a detailed patient prole, including health concerns and beliefs.