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Year : 2009  |  Volume : 22  |  Issue : 2  |  Page : 376

In the News!: An opinion "Wat kan ik voor u doen?" Towards Culturally Competent Communication

Associate Editor, Education for Health

Date of Submission15-Jul-2009
Date of Web Publication24-Jul-2009

Correspondence Address:
J van Dalen
Associate Editor, Education for Health

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Source of Support: None, Conflict of Interest: None

PMID: 20029755

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How to cite this article:
van Dalen J. In the News!: An opinion "Wat kan ik voor u doen?" Towards Culturally Competent Communication. Educ Health 2009;22:376

How to cite this URL:
van Dalen J. In the News!: An opinion "Wat kan ik voor u doen?" Towards Culturally Competent Communication. Educ Health [serial online] 2009 [cited 2023 Feb 3];22:376. Available from:

Communication skills training is a highly regarded aspect of many medical schools around the world. In a lot of regions, the importance of high quality communication between doctors and their patients is a recognised component of medicine. Much evidence underpins guidelines for good doctor-patient communication (Silverman et al., 2005).

The guidelines for good communication are mostly derived from studies that have been conducted in Europe, Canada and the United States of America. The medical schools that have adopted these guidelines are, however, by no means restricted to those regions. Communication skills training is now also being developed and conducted in Uganda, Indonesia and Vietnam, to name but a few countries.

In order to compare different cultures, the Dutch psychologist Geert Hofstede has developed a set of dimensions with which different cultures can be compared (downloaded from on 1 July, 2009):

Power Distance Index (PDI): the extent to which the less powerful members of organisations and institutions (like the family) accept and expect that power is distributed unequally.

Individualism (IDV) versus its opposite, collectivism: the degree to which individuals are integrated into groups.

Masculinity (MAS) versus its opposite, femininity: the distribution of roles between the genders which is another fundamental issue for any society to which a range of solutions are found.

Uncertainty Avoidance Index (UAI) deals with a society's tolerance for uncertainty and ambiguity; it ultimately refers to man's search for Truth. It indicates to what extent a culture programmes its members to feel either uncomfortable or comfortable in unstructured situations.

Long-Term Orientation (LTO) versus short-term orientation: this fifth dimension was found in a study among students in 23 countries around the world, using a questionnaire designed by Chinese scholars. It can be said to deal with Virtue regardless of Truth.

The countries where guidelines for communication skills have been developed resemble one another fairly closely on these dimensions. However, when this group of countries is compared to Uganda, Indonesia or Vietnam for example, it turns out that there are dramatic differences between the ‘characteristics’ of these contexts. This raises the issue of cultural context in models of appropriate doctor-patient communication.

This issue is currently being addressed in the news. Recently, Hamilton (2009) wrote an insightful reflection on the issue in which he addressed the analogy between the cultural sensitivity between doctor-patient communication and the popular paradigm of constructivism in modern learning (as expressed in problem-based learning for example). Ahn et al. (2009) reported on the development of a Korean communication skills attitude scale and described some differences from European ideals. This year, Moore published his second article about the reception of patient-centered communication in Nepal (Moore, 2008; 2009) and Lee et al. (2008) studied attitudes towards the doctor-patient relationship in a Singapore Medical School. Seeleman and colleagues (2009) published a conceptual framework for teaching and learning cultural competence. Ho et al. (2008), in international collaboration between National Taiwan University, Johns Hopkins University, Massachussetts General Hospital and Harvard Medical School (USA) studied the impact of training in what they call non-Western countries. Finally, Harmsen et al. (2003) addressed cultural differences between doctors and patients in a European context while Schouten & Meeuwesen (2006) reviewed the literature on cultural differences in medical communication. I know that even more research is being conducted in different places in the world, to shed more light on the subject.

The results of these studies can be interpreted positively as well as negatively. Being an optimist, I find the most striking conclusion from this wealth of studies to be that the desires of patients from all over the world are very similar. Of course, there are cultural differences. Apparently, though, the basic desires are common: being listened to; being respected; and receiving explanations. Even that seemingly typically Western desire of having a say in the management plan is, to a certain extent, shared by patients in other cultures.

Let me be clear: Hofstedes ‘cultural dimensions’ address no more than that - cultural dimensions. However important, these dimensions do not map out the desires that individual patients or doctors have. There is a great risk of overinterpretation of these dimensions if we uncritically apply them to individuals. We must treat these dimensions as knowledge ‘in the back of our heads’ that may help our interpretations of our patients’ behaviour. Aside from that, we will always have to fine-tune our approach so that we respect and do justice to each individual’s desire.

Jan van Dalen

Associate Editor, Education for Health


Ahn, S., Yi, Y-H., & Ahn, D-S. (2009). Developing a Korean communication skills attitude scale: Comparing attitudes between Korea and the West. Medical Education, 43, 246-253.

Hamilton, J. (2009). The collaborative model of doctor-patient consultation – Is it always culturally appropriate? What do doctors and patients need to know to make it work in intercultural contexts? Medical Teacher, 31, 163-165.

Harmsen, H., Meeuwesen, L., van Wieringen, J., Bernsen, R., & Bruijnzeels, M. (2003). When cultures meet in general practice: Intercultural differences between GPs and parents of child patients. Patient Education and Counseling, 51, 99-106.

Ho, M-J., Lee, K-L., Beach, M.C., & Green, A.R. (2008). Cross-cultural medical education: Can patient-centered cultural competency training be effective in non-Western countries? Medical Teacher, 30, 719-721.

Lee, K.H., Seow, A., Luo, N., & Koh, D. (2008). Attitudes towards the doctor-patient relationship: A prospective study in an Asian medical school. Medical Education, 42, 1092-1099.

Moore, M. (2008). What does patient-centered communication mean in Nepal? Medical Education, 42, 18-26.

Moore, M. (2009). What do Nepalese medical students and doctors think about patient-centered communication? Patient Education and Counseling, 76, 39-43.

Schouten, B.C., & Meeuwesen, L. (2006). Cultural Differences in medical communication: A review of the literature. Patient Education and Counseling, 64, 21-34.

Seeleman, C., Suurmond, J., & Stronks, K. (2009). Cultural competence: A conceptual framework for teaching and learning. Medical Education, 43, 229-237.

Silverman, J., Kurtz, S., & Draper, J. (2005). Skills for communicating with patients. Oxon: Radcliffe Medical Press.


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