| The study is intended to explore how culture competence is defined and practiced by physicians who interact with culturally diverse patients and to present key themes that help us understand what culturally competent communication means in this context. The study addresses a gap that exists in the health and communication literature, which at present stresses cultural and linguistic differences leaving aside communication and relationship aspects that also serve to account for competency. Data were collected in a large multicultural midwestern hospital. Video and audio-recorded interactions between doctors and patients, interviews and focus groups with doctors, patients, other health care providers, and staff were the main research methods used to gain an understanding of how participants perceive and construct culturally competent interactions. Results show the existence of dissimilar expectations between doctors and their diverse patients. Doctors expected patients to be knowledgeable about their condition, take an active role in their treatment, and communicate directly to the physician. European American patients expected an equal relationship where they could have a say, be heard, and have their needs acknowledged. Patients from other ethnic groups (Hispanics, Eastern Europeans, Hispanic Americans, Africans, African Americans, Arabs, etc.) looked for a more paternalistic relationship with their doctor. They expressed a preference for a doctor whom they could consider a family member and who would let them tell their story. Those expectations, rooted in different cultural values and beliefs, were negotiated during the medical encounter through the use of different communication styles, approaches to medicine, and preferred types of relationship. In those interactions which were more effective (both interactants achieved their goals), doctor and patient negotiated the preferred medical approach, type of relationship, and communication style. In those interactions which were ineffective, the doctor imposed his/her medical approach, relationship style, and communication preferences without taking patients' needs and concerns into consideration. Theoretical and practical implications for physicians and other health care providers are addressed. |
