This piece is the first in a new series on be:longing that aims to explore health and health-related topics in cross-cultural contexts. Today, we bring you an interview with Vinh Tran, a Canberra-born Vietnamese-Australian doctor.
Vinh recently graduated from the University of Western Australia. He spent 2.5 years of his medical degree studying in three major Perth hospitals – Royal Perth Hospital, Sir Charles Gardner Hospital and Fiona Stanley Hospital – and undertook his elective rotation at the National University Hospital in Singapore. Vinh is currently working as a junior doctor in the Acute Surgical Unit at Canberra Hospital in Australia.
Image: © Moustafa El-Kass, 2014
What has been your experience of working in healthcare in linguistically- and culturally-diverse settings?
It’s only been 4 months since I started work as a doctor, but I can definitely say that it has been both enjoyable and challenging. In terms of enjoyability, I love that I belong to a medical department that comprises health professionals from various backgrounds (e.g. Sri Lanka, China, India, Australia, the Netherlands). Although each of us has a different cultural background, we work together towards a common goal, which is to develop biopsychosocial plans tailored to patient needs. We share our cultural experiences with each other during social events (e.g. morning tea), and this allows our department to develop its knowledge and understanding of different cultures further, which then helps us to work sensitively in a cross-cultural setting.
In terms of challenges, the most challenging thing for me is interacting with patients from a cultural background that I’m not familiar with. The reason I say this is that, even though I have a South-East Asian background, I was raised in a “Western” society. As a result, the morals, ideas and beliefs that I developed growing up are not always applicable to other cultures; and, at times, this makes patient communication difficult. During these moments, I have to take a step back, reassess my thoughts from the patient’s perspective, and implement techniques (e.g. use of hand gesture or layperson terms) to improve my communication with the patient. In situations where I’m unable to communicate effectively with the patient, I may ask for an interpreter or family member to help me communicate with the patient.
How do you approach one-on-one health communication across different geographical, linguistic and cultural settings?
When it comes to one-on-one communication across different cultural settings, I utilise skills that I think of in terms of physical and non-physical. In terms of the physical aspects of communication, I tend to stay in close proximity with the patient, as I find I can build rapport more easily this way, rather than standing at the bedside. I also like to adjust my height by sitting or kneeling next to the patient. I find that this makes the patient feel more comfortable, as it balances out the power dynamic between the patient and the doctor.
With respect to non-physical communication, some basic skills I utilise are eye-contact and focused listening. By indicating that I am listening carefully through eye-contact and as simple a gesture as a nod; I find that patients from all cultures become more expressive about their needs and concerns. At times I use hand gestures and layperson terms alongside these methods. This is because some patients have trouble understanding the complex medical terminology, while others aren’t fluent in English. This means that I have to develop a range of communication skills to ensure patient understanding across medical settings.
What have you found to be universal across the settings you have worked in?
After working and interacting with a variety of health professionals and patients from diverse backgrounds, one thing that I’ve found to be universal is the importance of intentional and respectful communication. When working with health professionals, it’s vital that communication is constantly occurring within the team. The reason for this is that clear communication allows all team members to stay updated with the progress of each patient’s management plan, and to initiate the necessary steps to improve a patient’s prognosis (e.g. discharge from hospital, transfer of care to another medical team).
With regards to patients, I have found that many are either anxious or frustrated when they are not updated about the progress of their evolving management plans. In the hospital environment, health professionals manage multiple patients at any one time, so there can be delays to updating patients and their loved ones on the details of their management plans. In situations where I am required to speak to anxious or frustrated patients and families, I find that the most effective skill is to allow them to speak uninterrupted for several minutes. This shows them that I am listening to their concerns. My next step is to state their concerns back to them to show that they have been understood. As a junior doctor, I don’t make medical decisions about a patient’s management, so I emphasise this to the patient. To help calm the environment, I try to answer as many of their concerns as possible, and when I am unsure of a response, I emphasise that I will ask my senior colleagues and update them as soon as possible with further information.
Where can a biomedical model of healthcare let down patients whose conceptions of health, disease and care have been developed outside of this system?
The biomedical model of healthcare can let down patients whose conceptions of health are developed outside of this system in several ways. This is best exemplified by speaking in terms of a patient’s psychological and social concerns.
Patient beliefs about disease are strongly influenced by their cultural background. For example, there are patients from cultural backgrounds that use herbal medications for treatment of a wide range of illnesses, because it is believed that such medication can help to expel toxins responsible for causing illness. A health professional raised in a society that applies a biomedical model of health to develop treatment and management plans (where antibiotics are the main form of medication used to fight disease) may then have difficulty understanding and interacting with patients from cultures that do not.
Further, each patient’s social life is strongly influenced by customs taught to them in a particular cultural setting. For example, there are patients who do not talk without their spouse being in the room, as it is customary for their spouse to be with them for any consultations. A health professional with a different set of social cues can then find it difficult to elicit all the required information, as they need to balance out accommodating this patient’s social customs with drawing out information a patient may be reluctant to disclose in front of their spouse.
How does your own cultural identity shape the way you communicate as a medical officer?
My cultural identity shapes the way I communicate in several ways. I was raised in a bilingual family, so I had to develop alternative ways, early on, to communicate with my non-English speaking relatives. Some techniques I developed were to use hand gestures, simplified English words and even drawings to communicate. Being part of a bilingual family meant that I had many useful communication tools for interacting with non-English speaking patients in my role as a doctor. I understand their frustration of not being able to express their thoughts and emotions in the language(s) of their doctors. Knowing this, I adapt my previous experiences of interacting with my family to develop rapport and to communicate as effectively as possible with my patients.
While I was raised in a “Western” society, I have a strong South-East Asian background. I feel that this allows me to create a unique bond with patients from similarly cross-cultural backgrounds, by sharing my own cultural experiences and listening to their cultural stories.
© Vinh Tran, 2019
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