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By Mari D. González
Published at DTC Perspectives on September 16, 2014
As a professional medical interpreter and a cross-cultural communication consultant, I find cultural contexts the most challenging and fascinating aspect of translating between Spanish-dominant patients and English-dominant doctors during medical interpreting assignments.
Cross-cultural communication refers to the comparing and contrasting of different communication styles based on culture. One of the basic tenets in cross-cultural communication is the influence of our personal and social identities on the way we communicate.
If we are dominant in one language—in the case of monolingual speakers—or more dominant in one language than another—in the case of Spanish-dominant or English-dominant speakers—a particular cultural programming or set of values, world view, or behavior always dominates when we converse. Harry C. Triandis observes in his article, “The Self and Social Behavior in Differing Cultural Contexts” that “People who speak different languages or live in nonadjacent locations…have different subjective cultures” (1989, p. 506). Our dominant or primary language provides an essential clue into our social upbringing and communication styles.
Spanish-dominant Latinos/Hispanics are predominantly “collectivist” and “high context” due to their group-based identity and their ability to get implied meanings in oral communication. Triandis further states, “Individualists give priority to personal goals over the goals of collectives; collectivists either make no distinctions between personal and collective goals, or if they do make such distinctions, they subordinate their personal goals to the collective goals” (p. 509).
Generally, Spanish-dominant patients lack the necessary knowledge of U.S. culture to completely understand the narrowness, linear-ness, and precision of “individualist” or “low context” communication. On the other hand, a medical provider or physician whose primary language is English may often get frustrated by the expansiveness, circular-ness and all-over-the-place “high-context” communication style of Spanish-dominant patients.
The medical interpreter, in her role as cultural broker, performs a delicate balancing act: She has to explain to doctors that the patient is giving the context for his or her answer while explaining to the patient that the doctor is looking for a precise, specific, and short answer. Impatience is the doctor’s natural reaction to a perceived overload of information. This need for exactness is crucial in the financial, accounting, and technology fields, but it is not always recommended at the doctor’s office because impatience does not help in building trust. It results in patients not asking the right questions or reporting inaccurate information due to a fear that the doctor may get upset.
People from collectivist cultures, such as Spanish-dominants, value harmony over confrontation. Harmony is an essential value if you come from a large and extended family. Maintaining harmony and balance is a requirement to keep large groups functioning. Furthermore, people from high-context societies sharply scan emotions and grasp what was not explicitly said. It does not matter if a doctor smiles at the patient while being impatient. The emotion and what he or she implied was perceived first.
To mediate this exchange of low context and high context communications, medical interpreters find themselves repeating the doctor’s linear and precise questions to patients who typically give the whole context by using stories and not answering with a yes or no or with a specific number. Most patients eventually understand that their doctors are looking for clear-cut information, but they do not always understand why the rest of the information is not as important.
Let’s not confuse a basic-to-intermediate-level of fluency in a foreign language with understanding the culture of those who speak it as their primary language. Applicants for jobs as health care providers may include fluency in Spanish, or any other second language for that matter, among their qualifications, but that may indicate nothing about their “cultural fluency.” Cultural fluency is gained through socialization or a constant association with those who speak a different language, which promotes a sense of shared comfortableness. If language fluency was acquired indirectly through media such as CDs, DVDs, books, or even through courses that are devoid of people from that culture, the cultural fluency that allows one to perceive differences in communications styles will be lacking.
By Mari D. González
Here is an audio interview with Dr. Mario Martinez, a licensed clinical neuropsychologist, in which he talks about how our cultural contexts or social environments affect our cognition and health.
Dr. Martinez is a neurologist and a clinical psychologist who studies cultural anthropology. He draws his insights on health and longevity from these three fields. Like many of us from high context societies—I’ll cover this topic in a later post—Dr. Martinez acknowledges his frustration with the narrowness in the field of psychology and mind-body medicine. On his website he declares that “Academic science continues to divide mind and body, as well as ignore the influence cultural contexts have on the process of health, illness, and aging.”
According to his cross-cultural analysis in medicine, “a migraine in the U.S. is treated as a vascular problem. In England and Wales, they believe that a migraine is gastrointestinal, and in France, it is treated as being caused by the liver.” He concludes that medicine is also cultural. He explains that the attribution of certain symptoms is related to our social view of aging, which is ingrained by our context in our culture.
He proposes a radical view of medical research and pushes the boundaries. He criticizes the inadequacy of utilizing animals on which to base medical research that will be applied to human beings who are rational and who also search for meaning. He points out, “While rat research could be productive, the results must be interpreted as responses from animals that do not have the capacity to find meaning in their actions and awareness of their mortality.” And he concludes by saying, “Cultural anthropology is the missing link of psychoneuroimmunology” (a branch of medicine concerned with how emotions affect the immune system).
I find his perspective not only fascinating but ground-breaking. He highlights the fact that external factors—including social and cultural—have a greater impact on our health than genetics, a belief that has more weight in the medical field outside the U.S.