Culture and physician-patient communication: a qualitative exploration of residents' experiences and attitudes

Increasing evidence suggests that communication plays a central role in effective clinical care. To facilitate effective instruction in this domain, this study seeks to understand how pediatric residents approach the challenge of cross-cultural communication.

A convenience sample of 29 pediatric residents participated in five focus groups that were jointly facilitated by a clinical and a process expert. Discussion was stimulated using two video scenarios of pediatric cross-cultural communication challenges.

Seven dominant categories were evident in the discussions: characteristics of culture, beliefs about culture, attitudes towards culture, opinions about how to build expertise in communication, cultural conflict, insights regarding prejudice, and comments about interview technique. Residents tended to view culture and difference as residing in patients (not in themselves), reflecting their assumption that western medicine is acultural.

Residents believe that lack of knowledge about other cultures causes their communication difficulties. Our findings suggest, however, that more basic issues may underlie their difficulties. Residents may recognize prejudice in the abstract but fail to see it in their environment, and they may spend minimal time reflecting on their professional culture and beliefs.