CROSS CULTURAL MEDICAL

COMMUNICATION

FAKULTAS KEDOKTERAN UGM

Pendidikan Dokter UNTAD
2011
 Budaya (CULTURE), apa itu?

Taylor (1871): Kesatuan antara pengetahuan,

kepercayaan, keyakinan, seni, moral, hukum,
kebiasaan dan berbagai macam kapabilitas yang
dipunyai oleh manusia sebagai anggota masyarakat

Keesing(1981): System of shared ideas system of

concepts, rules & meanings that underline and are
expressed in the ways that human beings live
 MEDICAL COMMUNICATION
Doctor-patient communication: cornerstone of good
medical practice (Doherty,1990, Rotter, 1995)
Interactional skills difference to a wide range of
desirable patient outcomes: accuracy of diagnosing
psychiatric disturbance patient, compliance with
prescribed medication, recovery from medical
interventions, smoking cessation, weight loss and Aids-
related risk behaviors
(Doherty, 1990, Mrks, 1979. Cockburn,1987, Mumford,1982, Slama, 1990,
Stunkard,1985, Coates, 1990).
 HOW ARE COMMUNICATION PROBLEMS IN
CLINICAL PRACTICE?

Common (Simpson,1991)
Late 1980th, few doctors has sufficient information
for patients to effectively comply with their
doctors recommendations (Cockburn, 1987,
Horne, 1987).
Several recent studies of communication skills
training have drawn positive conclusions regarding
its impact
 WHAT TO BE TAUGHT?

WHO (1993): Things to be taught need to be relevant

to particular culture.
Ask: 1). A group of doctors & other relevant
professionals to identify particular behaviors that
constitute good practice-core communication skills
for the particular culture,2).A group of people
representing consumers of health services-identify
aspects of a desirable consultation.
Definition : The process of understanding
and sharing meaning

KEYWORDS

Understanding: Perceiving, interpreting,and

comprehending the meaning of the verbal & non
verbal behavior of others
Sharing: An interaction between people in order to
exchange meaning
Meaning: The shared understanding of the message
(constructed in the minds of the communications).
 Transcultural

Different Cultural Setting

Some standards inappropriate

 Obtaining Consent in:
West Sumatra (Padang)
Moslem is a major religion West Padang,
whereas husband/ male have a major
influence in making decision.
Regarding the tradition (matriarchy),
older female family has a higher
authority in making the decision.
In signing informed consent, there are no
gender differences.
SENSITIVE to CHANGES?
 JAKARTA & BANDUNG

Regardless the level of education between husband

and wife, husband has right to make all decisions.
Without their fathers or husbands permission,
mothers or children can not be involved in a study or
receive any medical intervention.

Sometimes, grandparents are very powerful in

making decision for their grandchildren, therefore
informed consent, whether it is for research
involvement or getting certain medical intervention,
has to go through them. Parents do not have the
right to sign informed consent for their own children.
 Several International Studies
in Papua
In severely ill children: women are prone to agree &
sign blindly (most are illiterate); being desperate &
follow what med. Personnel tell them to do
In severely ill adult: more likely to agree with the
consent. Decision by male families/ relatives. Wives &
sisters ask their in laws
In healthy/ not severely ill children & adult: male
relatives sign it. Obtaining consent is more difficult
many problems; take extended family/ whole village
 CONCLUSION

Communication: patient-doctor
relationship is compulsory
Multidimensional communication is
needed
Communication models: move from
paternalistic (doctor authority to
deliberative (patient center)
Culture should be thought
 References

Jason, Hillard Md. 2000. A practical guide to communication skills in clinical

practice. Education for Health.

Pearson,Judy C & Nelson, Paul E. 2000. An Introduction to Human

Communication. 8th Ed. Mc Graw-Hill Higher Education. Boston

WHO. 2000. Health Ethics in South-East Asia. Vol 3. New Delhi

PATIENT-DOCTOR RELATIONSHIP

BASIC COMMUNICATION
 Patient-Doctor (P-D)
INTERACTION & COMMUNICATION
Effective P-D interaction & comm. Is:
central to P&D satisfaction, to the clinical
competence of D, & to the health
outcomes of their patients

Indicators show many doctors dont comm.

effectively , & training in interactional &
relationship skills is important & low cost
-- investment considering the high rewards
that can be gained for P, D, medical schools
& health care.
 COMMUNICATION

Definition (Pearson & Nelson, 2000):

The process of understanding
and sharing meaning.

Notes:
Communicare (Latin word): to share
A process : dynamic, ongoing, always
changing, continuous
Definition : The process of understanding
& sharing meaning

KEYWORDS

Understanding: Perceiving, interpreting,and

comprehending the meaning of the verbal &
non verbal behavior of others
Sharing: An interaction between people in
order to exchange meaning
Meaning: The shared understanding of the
message (constructed in the minds of the
communications).
Full Communication Involves:
(Jason, 2000)

Learning & sustaining trust,

Listening actively,
Mastering timing,
Formulating ideas clearly & succinctly,
Conveying a sense of sincere caring,
Transmitting sympathy or empathy as
needed
 HEALTH PROFESSIONALS
NON-HEALTH
(Physician,PH,nurse,mid-
PROFESSIONALS
wife, dentist, pharmacist)
(administrative, finance)

HOSPITAL (others)
How to serve the community How to make money
(colleagues/team members) (competitors)

PATIENTS
PATIENT-DOCTOR
COMMUNICATIONS CONCEPT

PATIENTS AUTONOMY vs DOCTORS

RESPONSIBILITY on PATIENTS VALUE vs
HEALTH PROFESSIONALISM THE ROLE
OF PATIENT - IN MEDICAL DECISIONS
MAKING PROCESS CONFLICT?
PATIENTS & DOCTORS NEED ON ETHICAL
& LAW STANDARD FOR DOCTOR, INFORMED
CONCENT & MALPRACTICE
4 MODELS OF COMMUNICATION

1. INFORMATIVE
2. INTERPRETIVE
3. DELIBERATE
4. PATERNALISTIK
 MODELS OF P - P COMMUNICATION; BASED
ON:
PATIENTS VALUE - AUTONOMY CONCEPT
DOCTORS RESPONSIBILITY -
PROFESSIONALISM

Autonomy:
Central concept in health ethics-
Respect for person-beneficence (do
good), non-malfeasance (do no harm)
& justice.
Patient Autonomy:
- Autonomy requires:
Capable of deliberation-personal
goals - treated with respect for
capacity for self determination

- Impaired autonomy:
Dependent/vulnerable be provided
security against harm or abuse
INFORMATIVE MODEL
SCIENTIFIC,ENGINEERING,CONSUMER

PATIENT:
AUTONOMY HIGHCONTROL THE
CLINICAL DECISION.
PATIENTSS VALUE HIGH; FACTS LOW

PHYSICIAN:
PROVIDE RELEVANT INFORMATION.
PATIENT CHOSE THE THERAPY;
DOCTOR IMPLEMENTS PATIENTS CHOISE
INTERPRETIVE MODEL

PATIENT:
VALUE :
UNCLEAR/CONFLICTING MANAGEMENT
AUTONOMY
SELF UNDERSTANDING RELEVANT TO MEDICAL
SERVICE
PHYSICIAN:
1. ROLE:
TO CLARIFY & INTERPRETATE PATIENTS
VALUE, AND IMPLEMENT SELECTED
INTERVENTION
2. RESPONSIBILITY
GUIDING & COUNSELING
MAINTAINING EXPERTIES &
REFERRING OR ASKING SECOND OPINION
DELIBERATIVE MODEL

PATIENT:
1. VALUE:
OPEN FOR DEVELOPMENT & CORRECTION
OF MORAL DISCUSSION

2. AUTONOMY:
MORAL SELF DEVELOPMENT WHICH RELEVAN
TO MEDICAL SERVICES.
PHYSICIAN :
1. ROLE : AS A FRIEND/TEACHER

2. RESPONSIBILITY
TO ADAPT AND TO PERSUATE
PATIENT FOR HAVING BEST MARKS
& SELECTED IMPLEMANTATION
PATERNALISTIC / PARENTAL MODEL

PATIENT:
1. VALUE :
OBYECTIVE & DISCUSSED AMONG
PHYSICIANS

2. AUTONOMY
AGREEMENT OVER OBJECTIVE VALUE
PATERNALISTIC MODEL

PHYSICIAN:
1. ROLE:
TO PROTECT AND TO GUARD

2. RESPONSIBILITY:
TO PROMOTE THE BEST
INTERVENTION
 Traditional
Tradition:
The passing down of elements of a culture
from generation to generation, especially by
oral communication:
- thought or behavior
- a set of such custom and usage viewed.
Latin: traditio to hand over, deliver,
entrust
Traditional
Relating to or in accordance with tradition
 SELESAI

Ronny T Wirasto
Ronny3w@yahoo.com
Psikiater Jogja