This document discusses intercultural communication challenges between a Chinese couple and their American oncologist. The couple had many questions about the wife's colon cancer diagnosis and treatment, which the oncologist perceived as obsessive and suggested they seek psychiatric help. However, the persistent questioning was culturally understandable to the couple from an emic perspective. The scenario highlights the importance of understanding different cultural perspectives to improve provider-patient communication and relationships.

1. Home Health Care Management & Practice
http://hhc.sagepub.com/
Intercultural Communication in Health Care: Improving Understanding Between Provider and Patient
Yu Xu
Home Health Care Management Practice 2006 18: 158
DOI: 10.1177/1084822305281830
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http://hhc.sagepub.com/content/18/2/158.citation
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2. HOME HEALTH CARE MANAGEMENT & PRACTICE / February 2006
Diversity Discussion
Intercultural Communication in Health
Care: Improving Understanding Between
Provider and Patient
Yu Xu, PhD, RN, CTN
R
ecently, I learned the shocking news that one of tem. I heard anxiety and frustration as well as a plea for
our family friends for years (to whom we feel understanding in our lengthy conversations. As a certi-
closer than some distant relatives) in the Deep fied transcultural nurse, I made conscious efforts to dis-
South was diagnosed with colon cancer. It was shock- sect their experiences in the context of the Chinese and
ing because she was in seemingly perfect health with U.S. health care cultures to shed light on why a particu-
no previous history of any major conditions or hospital- lar incident or experience happened. I feel that the least
izations. Well educated, she lives with her husband, I can do to help them cope with the daunting reality is
who is a tenured full professor at a local university. The improve their understanding of those situations and
diagnosis of cancer is the greatest challenge in their 20- nuances. The following is based on the couple’s experi-
plus years of married life. As typical Chinese, the cou- ences that have relevance to those on both sides of the
ple is very considerate and sensitive, especially the stethoscope.
wife. With plenty of spare time as empty nesters and As any other cancer patient and caregiver, both the
being very health conscious, the couple played table wife and husband went through the stages of denial,
tennis at least three times a week for 2 hours each time anger, and acceptance of the diagnosis. For the initial
to keep healthy. In my mind, she would be the last per- few months after the diagnosis, the husband exhausted
son on earth to get cancer. With this devastating diag- all sources of information on colon cancer and has
nosis, their peaceful, laid-back life was turned com- become an expert on the condition. Apart from teach-
pletely upside down. Until the cancer diagnosis hit ing, he literally withdrew from all other activities and
them, neither of them had real, in-depth experience and planned everything around the treatment of and care for
knowledge of the U.S. health care system beyond his wife. For months, he could not help but dwell on his
immunization and routine physical checks, in spite of wife’s condition. Within a 3-month period, he lost 10
the fact that they have lived in the United States since pounds.
the mid-1980s.
As a close family friend and a nurse, I was keenly
interested in their not-all-positive experiences as a can- Key Words: communication; cancer; husband; wife;
cer patient and a caregiver in the U.S. health care sys- oncologist
Author’s Note: Address correspondence to Dr. Yu Xu, School of Nursing, University of Nevada at Las Vegas, 4505 Maryland Parkway, Las
Vegas, NV 89154-3018; phone: (702) 895-3175; e-mail: yu.xu@unlv.edu.
Home Health Care Management & Practice / February 2006 / Volume 18, Number 2, 158-160
DOI: 10.1177/1084822305281830
©2006 Sage Publications
158
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3. Xu / DIVERSITY DISCUSSION 159
EXPERIENCE AND PERCEPTION tion channel that leads to an effective provider-patient
relationship.
Each time during their initial visits both husband and
Regarding the husband speaking on behalf of the
wife had a lot of questions to ask the oncologist regard-
wife, it is customary in the Chinese culture or even part
ing the labs, treatment, side effects of medication and
of the cultural programming (i.e., cultural inertia pro-
chemotherapy, prognosis, and so forth. As time passed,
grammed into one’s psyche based on one’s socializa-
the couple continued to ask a host of questions during
tion within a given culture that functions largely uncon-
each follow-up visit. Additionally, the husband opted
sciously) for the husband to reply to questions directed
to answer many of the questions posed to the patient
at the wife. Partly, this could be attributed to the hierar-
(the wife) during the initial visits. However, they
chical family structure not uncommon in the Chinese
sensed something abnormal about their behavior when
culture. In this case, the husband was more educated
the doctor suggested that both should seek help from a
and might have assumed that he could communicate
psychiatrist to manage their anxiety and stress levels. In
more effectively and efficiently, even when the wife
addition, the physician indicated that the patient was
could speak fluent English.
the one who should answer the questions, not anyone
However, from the etic (outsider) or professional
else.
perspective, the persistent questioning could be per-
ceived as an obsession and therefore necessitated psy-
EXPLANATION AND INTERPRETATION chiatric help, especially when the associated anxiety
and stress interfered with the normal functioning of
From the emic (insider) perspective, it was only nat-
daily life. Additionally, such unrelenting questioning
ural and understandable for the patient and caregiver to
could be viewed as challenging authority, thereby lead-
ask a lot of questions, because they wanted to know all ing to mistrust between the patient and doctor.
there is to know about the condition and treatment
options. Naturally, the oncologist is the ultimate source
for such information, despite of a wealth of information IMPLICATIONS FOR PRACTICE
on the Internet. For many patients and family members, What can we learn from this real-life scenario? First,
one of the primary reasons to get professional medical there are different perceptions, attributions, and reason-
help is to seek assurance. This is particularly true in the ing regarding the same phenomenon—the emic versus
context that there is a cultural fear of cancer among the etic perspective. Differences in cultural background,
Chinese, because it is frequently associated with a ter- personal experiences are among major determinants
minal condition without a cure or even with a death ver- that account for these differences. The relationship
dict. In addition, high-profile medical accidents and between the Chinese couple and their American
injuries in the media in recent years heightened the cou- oncologist turned sore because of the gap in mutual
ple’s vigilance and, based on information available to understanding. At the cultural level, the couple does
them, even raised skepticism regarding what they feel some disconnection with their oncologist.
observed in clinical settings. Nowadays, it is not Although the couple has not changed their health care
uncommon to find that patients and their families are provider (oncologist), such an option is at the back of
much more informed about a specific condition than their mind. Second, it is wrong to assume that a higher
the nurse and even the doctor. educational level and longer residency in this country
To a large extent, the couple was stunned on hearing would automatically translate into more knowledge of
the oncologist’s suggestion, which was perceived not the U.S. health care system and its underpinning val-
only as incorrect but also as inappropriate and even ues, beliefs, and assumptions. Third, the effect of cul-
insulting. They just wanted to know everything there is tural programming needs to be fully recognized and
to know about the condition. However, their response warrants serious research. Its significance is that it
to the recommendation was anything but the physi- guides and controls behaviors at the unconscious or
cian’s expectation. The oncologist’s suggestion basi- subconscious level. Fourth, stepping into others’ shoes
cally silenced the couple or at least made them think helps facilitate understanding of a different or even
twice before asking another question. This chilling conflicting position, hence improving communication
effect could act as a barrier to a two-way communica- effectiveness.
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4. 160 HOME HEALTH CARE MANAGEMENT & PRACTICE / February 2006
Understanding between people is challenging, and On a positive note, the husband got to know the
even more so between people from different cultures. rationales of why health care providers in this country
However, such a challenge should not be the reason for insist that patients speak for themselves if at all possi-
stopping learning about others to promote mutual ble. He learned to consciously suppress his urge to
understanding; rather, it should be the motivation. I speak for his wife during late appointments.
believe that the oncologist would have made an alterna-
tive recommendation or at least thought twice before Yu Xu, PhD, RN, CTN, is a tenured associate professor at the Uni-
making the suggestion if he had treated the couple not versity of Nevada at Las Vegas School of Nursing and an adjunct
only as stressed clients but also as cultural beings. On professor at Bengbu Medical College, China. He is a certified
the other hand, the couple would have behaved differ- transcultural nurse, and his research interests can be broadly cate-
gorized into transcultural/international nursing and comparative
ently if they had a real understanding of the values, nursing education. Specifically, he is interested in studying issues
beliefs, and assumptions undergirding U.S. health care related to internationally educated nurses in the U.S. nurse
practices. Although these incidents happened between workforce. He has made nearly 70 professional presentations at the
a Chinese couple and their American oncologist, their local, regional, national, and international levels. He has published
universal implications can apparently extend to 22 full-length scholarly articles in peer-reviewed nursing journals
since 1999 and has consulted, both nationally and internationally,
intercultural communication between other health care
on retention of second-language/international nursing students,
providers and their clients. nursing education curriculum, and international nurse training.
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