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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 13: Cultural Issues
    Tools for Diagnosing and Mediating Cultural Misunderstandings

    Touch and Gender
    Medical Subculture
    Suffering
    Traditional Medicine
    Depression
    Body Language Bad News
    Fatalism
    Surgery
    Food
    Literacy
    Meaning of Illness
    Alternative Medicine
    Pain
    Imminent Death

    Body Language

    • Gestures and facial expressions communicate intent: dominance, deference, respect, fear, affection, embarrassment, and so forth
    • Two important aspects of body language are:
      • What you do with your eyes
      • What you do with your hands
    • Personal space and facial expressions are other important aspects

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    Eye Contact in Body Language

    • In general we think making eye contact is good, it shows you are paying attention. We interpret avoiding eye contact as either attempting to conceal something, not paying attention or possibly depressed mood. This is NOT universal
    • In fact, direct eye contact can be interpreted as hostile or at least rude in some cultures, e.g., African American men, Chinese women, Native Americans of either sex
    • When dealing with high status medical professionals, lowered eyes may signify respect
    • If there is mistrust of medical professionals, avoiding eye contact may signify conflict avoidance
    • This is something you should learn by experience
    • If you are not sure what to do with your eyes, looking just past the patient’s ear is usually safe

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    Hand Gestures in Body Language

    • Hand gestures are also complex. For instance, Italian gestural language is renowned for its expressive vocabulary
    • Hand gestures can easily be misinterpreted
    • In general it is acceptable to point at things but not at people
    • It is usually a good idea to keep your hands in sight, relaxed, resting on a tabletop, in your lap or if you are standing, holding a stethoscope, book, or pen
    • As you observe your patient and family watch what they do with their hands and you can pick up the vocabulary
        For Example
        The gesture for thumbs up is OK in Greek, but the gesture for OK is obscene. Hands wide is welcoming in southern Europe; hands together is welcoming many parts of Asia
    • Until you pick up the “lingo”, keep your hands neutral and quiet

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    Personal Space

    • Personal space is culturally determined
    • Most people have had the experience of backing away from someone who approaches too close
    • The distances that people tolerate are quite predictable
    • Generally speaking, people of Northern European origins become uncomfortable in conversation at about 2 feet and begin backing up at 18 inches
    • Mediterranean and southern Chinese people are comfortable until nearly touching face-to-face

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    Facial Expressions

    • Facial expressions are not universal
        For Example
        East and Southeast Asian people convey embarrassment by smiling and even laughing. A neutral or "impassive" expression suggests anger. It is incorrect to interpret this as concealment; these facial gestures are perfectly understood in their own communities
        By comparison, an impassive expression without eye contact among most, but not all, Native Americans communicates attentiveness and respect
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