Mastering the physician-patient relationship: cultural sensitivity and building trust
Before beginning an abdominal exam (or any sensitive physician-patient interaction), it’s important to consider how to best approach the patient to build an atmosphere of trust and mutual respect. Start by drawing your attention to the possibility of any physician-patient differences that may exist. By intentionally setting out to bridge those gaps, you’ll be well on your way to building a good relationship with your patient.
Differences in communication are one example. Medicine has its own language, so it’s best to assume that the patient doesn’t know the terminology, and use simple terms during your explanations. A patient’s education level directly affects how they present their complaints to a healthcare provider. As clinicians, we need to take this into account and get to know a bit about our patients’ medical knowledge base.
As well, cultural differences must be considered to build a positive patient-doctor relationship. So, it’s crucial to practice cultural sensitivity with your patient.
Figure 1. To create a positive patient-physician relationship, it’s crucial to be aware of the patient’s education level and cultural background before performing an abdominal exam.
It is important to be aware that the patient’s intent behind acknowledging or denying a health issue is often deeply rooted in their culture. Their reasons and motivations for seeking treatment (and how they react to your plan) occur within the framework of their cultural background. The provider needs to acknowledge that piece of the picture and be sensitive to it.
For example, a patient may not want to discuss their sexual health, as it may be a taboo topic in their culture. So, instead of pressing the issue at that time, move on and give the patient some time to think and reflect.
The patient may open up more as your discussion continues and they begin to understand the importance of that piece of history to their immediate health concerns. Also, make sure that the patient is comfortable discussing these topics with whoever is in the room.
How can I build a positive doctor-patient relationship?
There are six ways to build a positive doctor-patient relationship with your patients:
- Broaden the inquiries
- Recognize symbolic language
- Try more indirect inquiries
- Bridge language barriers
- Build trust and respect
- Know the room
Broaden the inquiries
When listening to the patient, broaden the questions about the patient’s and family’s history. Ask the patient what they think is the cause of their illness. Their answer will provide you some perspective about their culture. Ultimately, respect the patient.
Broadening the inquiries is a phrase that refers to casting a wide net initially to get to the main problem. It involves asking open-ended questions to show interest and become familiar with the patient and their background.
Before delving into medical questions, ask about the patient, their family, and where they are from. You could also try, "Tell me one interesting fact about your culture.”
Once you become familiar with the patient’s cultural frame of reference, then you can switch to direct medical questions. The purpose of this is to seek clarification about the presenting symptom or illness.
Recognize symbolic language
The patient’s explanation may (or may not be) initially clear. Some cultures use symbolic descriptions and not literal meanings of things—complaints may reflect traditional folk concepts of an illness.
For example, some ethnic groups in South Asia may complain of elevated liver fire. You may think they are referencing pain in the right upper quadrant, but this complaint is based on traditional beliefs of the function of the liver and means difficulty in managing stress and anger. Traditionally, this is treated with acupuncture, herbs, and certain foods.
Another example is how a patient who is South Asian describes stomach pain. With further questioning, they may say that they have too much yin in their stomach. Yin and yang are part of Chinese mythology as two elements that were born from chaos and exist in harmony. Yin has negative energy, and yang has positive energy. Normally, they are in balance. Thus, a patient with stomach pain may refer to their stomach as having too much yin.
Try more indirect inquiries
The provider must be sensitive to cultural differences and direct questions in a way that will be most helpful to the patient. It’s also important to recognize that the patient’s cultural background influences how comfortable they feel during the visit.
Some patients may not be comfortable relaying their symptoms directly. In this situation, you can try an indirect inquiry. For example, you may ask, “When other people get the kind of illness or imbalance that you have, how would they describe it?”
Bridge language barriers
If the patient speaks a different language, that changes the interaction as well, and a medical translator should be obtained. A translator creates a connection between the physician and the patient. This can be in person, by mobile apparatus, or by telephone with a translator on the line.
However, translation may create some obstacles. Terms like cholecystitis and gallbladder disease may not directly translate into other languages or be a part of their culture’s vocabulary.
In these cases, focus on anatomical descriptions of function. Instead of speaking of gallbladder disease, you can try, “The gallbladder normally stores bile. It may produce stones that alter its function and can cause right upper quadrant pain.”
You can also ask the patient or the translator, “What is this called in your language?” to clarify medical terminology. Speak slowly for the patient and translator and give the patient time to process the information and respond.
Build trust and respect
One of the best ways to have good communication is to build trust with the patient. This is enveloped with respect.
Respect the patient by maintaining their modesty. This is especially important for women in some Middle Eastern cultures. Respecting modesty also includes acknowledging that the patient may feel uncomfortable if the provider is of a different gender. Provide a chaperone when necessary.
Know the room
Always introduce yourself and find out who everyone else is in the room. Is it a significant other, a child, a neighbor, or a coworker?
This is important because a patient may want privacy during the exam or when discussing certain topics. You may need to ask the person accompanying your patient to step out of the room during the exam.
Figure 2. Ways to build a positive doctor-patient relationship include broadening your inquiries, recognizing symbolic languages, trying more indirect inquiries, employing tools and resources to bridge language barriers, building trust and respect, and knowing the room.
That’s it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients.
- de Dombal, FT. 1988. The OMGE acute abdominal pain survey. Progress report, 1986. Scand J Gastroenterol Suppl. 144: 35–42. PMID: 3043646
- Jin, XW, Slomka, J, and Blixen, CE. 2002. Cultural and clinical issues in the care of Asian patients. Cleve Clin J Med. 69: 50, 53–54, 56–58. PMID: 11811720
- Tseng, W-S and Streltzer, J. 2008. “Culture and clinical assessment”. In: Cultural Competence in Health Care. Boston: Springer.
- Wong, C. 2020. Liver fire in traditional Chinese medicine. verywellhealth. https://www.verywellhealth.com