Communicative competence Anthropological competence Clinical competence Psychological competence Four competences are defined:
According Van Wieregen et al. (2002) in medical consultation in general practice mutual understanding was poor in 33% of consultations with ethnic-minority patient versus 13% with native-born patient Eur J Public Health. 2002 Mar;12(1):63-8. Intercultural communication in general practice. Van Wieringen JC, Harmsen JA, Bruijnzeels MA. Communication in Transcultural Medicine
The lack of comprehension may imply, medical misdiagnosis (false positive or false negative), erroneous prescriptions, a possible death toll Outcomes of poor comprehension in medicine
We need to know: Cultural medical models of the patient His cultural expectative How he/she communicates with linguistical and not-linguistical skills his/her problems How the doctor can communicate to her/him To improve medical comprehension
Models of Health and Disease in different cultures According to Tirodkar et al. (2011) …physician’s explanatory models of illness are still largely biomedical in that they emphasize the biological and physical aspects of disease etiology . However, patients or individuals who are experiencing illness may have different explanatory models. Explanatory models of health and disease among South Asian immigrants in Chicago Tirodkar,M.A.; Baker,D.W. ; Makoul,G.T.; Khurana,N.; Paracha,M.W.; Kandula,N.R. J.ImmigrMinor.Health., 2011, 13, 2, 385-394, United States
Pre-linguistic Linguistic Cultural (Different Customs in Food, Habits etc) Philosophical and Religious (Explanatory Model of Health and Disease, Existential meaning of Life and Disease ) The medical incomprehension is a multilayer issue:
Patient Doctor Sickness Intercultural communication is very complex Judgment fears objectifying subjectifying objectifying
Gesture Ambiguity (ex.: nodding and shaking head) Lack of grammatical precision Hyperbolic use of deictical terms (ex. that, this) that hides the meaning in case of lack of context Lexical Differences (Ethnoanatomy) False Friends in the Vocabulary The Rethorical use of Medical Language Differences in Conceptual Schemas (Frames di Minsky) Difference in the medical encyclopedia Difference in Health Customs Difference in Symbolic Values Difference in philosophical and religious values Some tipical issue in Crosscultural Communication in Medicine in
The reduction of the cultural gap in Healthis a two-way path Patient-PhysicianRelationship and RacialDisparities in the Quality of Health Care Saha et al. American Journal of Public HealthOctober 2003 Vol 93 n. 10
It is really necessary to constitute a knowledge base of alle the medical observations related to cultural and linguistically topics in all the culture ion the world
Pub Med (NLM Bethesda) for “cultural diversity” return 10.000 articles Non medical scientific literature: indetermined number Google Video looking for “traditionalmedicine” return 19.700 clips. Slideshare (presentations) for “traditionalmedicine ”return 28000 Powerpointpresentation. + i social forum, le news etc Terabytedi data Basic Problem: Huge Dimension of the Data Base
I we the number of cultural groups is proportional to the number of linguistic differences: How many cultures in the world? How many cultures in the world?
How many people clusters in the world? Modificato da http://www.joshuaproject.net/how-many-people-groups.php
This vision for an integrated approach is intended to serve as a catalyst for transforming the health care system to meet the needs of limited-literacy, culturally diverse, and limited English proficiency patients. Clinicians and health care staff have an important role to play, but the responsibility for achieving real progress for patients facing challenges related to literacy, culture, and language must extend to organizations that support them. Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse PopulationsDennis P Andrulis, Cindy Brach. American Journal of Health Behavior. : Sep/Oct 2007.