Intercultural Communication in the Medical Field

Her parents continued to bring her to the hospital with each seizure and she was admitted many times to both inpatient and outpatient facilities. Because the parents thought that Lia’s condition was a spiritual honor, they did not give Lia the medication prescribed by her doctors as they felt it would disrupt the spiritual process. One occasion, Lia’s father ordered that Lia’s IV be removed. Lia’s doctor believed the reason for this request was because the family rather have Lia die in peace than suffer but it was actually because they thought the medications would interfere with her status as a spiritual healer.

Lia’s doctors saw the parent’s noncooperation with Lia’s prescribed treatment as a form of child abuse, prompting them to call Child Protective Services. At the age of three, Lia was removed from her household and placed in the foster care system where she remained for one year, causing great stress and suffering to Lia and her family.

Shortly after being returned to her family, Lia suffered her largest grand mal seizure, leaving her in a permanent vegetative state. For the remainder of her life, Lia was completely paralyzed and showed no signs of mental awareness. She was only able to sleep, breath, and cry. Although doctors predicted that Lia would only live for another three to five years, Lia continued to live in a vegetative state for 26 years and passed away at the age of 30. The family’s experience in the American healthcare system is revealing of several glaring issues regarding intercultural communication in the medical field.

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First of all, the language barrier posed the most significant threat to Lia’s health. Although Lia’s family visited the hospital countless times, they were never once provided with a Hmong interpreter.

Their only method of communicating with the doctors was a family member who spoke minimal English, but still, there were repeated misunderstandings. Despite the fact that Merced had a prominent Hmong immigrant community, the hospital employed no Hmong speakers. The language barrier prevented the family from explaining their cultural beliefs to the doctors and left the doctors unable to communicate proper care instructions. This ultimately had a detrimental effect on Lia’s health, leading to her permanent coma and death. Had there been a Hmong interpreter available to the family, it would have helped diminish the significance of the cultural barrier that caused both the family and doctors so much stress and frustration and could have possibly controlled or prevented Lia’s life-altering seizures. Another blatant issue in Lia’s case was the doctor’s lack of understanding of Hmong culture.

The doctors were completely unaware that the family believed Lia’s condition had spiritual explanations and viewed her seizures as an honor. The doctors made no attempt to cater treatment to Hmong values or the family’s wishes. One of Lia’s doctors later stated that he never considered altering Lia’s treatment plan to accommodate their cultural values as he was generally unaware of their spiritual beliefs and firmly believed in providing every patient with the same quality of care. Although generally considered good medical practice, he admitted that perhaps prescribing a simplified treatment plan would have been more beneficial in Lia’s case. Lia’s medications were altered frequently as her epilepsy progressed, according to the severity of her seizures. Her doctor later considered that this may have been a difficult plan for the family to maintain and may have contributed to the worsening of Lia’s condition.

It is unknown whether Lia’s doctors completed any cross-cultural training, but it is likely that they were at least introduced to the topic of intercultural communication in medical school as medical schools require limited teaching of cross-cultural issues. It is clear that these training, if even present, were not effective in preparing the doctors for the interactions with Lia and her family. These findings on ineffective intercultural communication are consistent with a personal interview conducted with a second-year nursing student at Northeastern University. In the Northeastern nursing program, there are no courses on intercultural communication that are required for graduation and there are very limited options for electives that cover topics of intercultural communication.

In her three semesters completed at Northeastern, only one of her nursing courses even touched on topics of intercultural communication. The lessons cover the importance of translators in a healthcare setting because, as evident through the research previously mentioned and the case of Lia Lee, the language barrier poses a significant threat to quality of care. Nursing students at Northeastern University are also taught that hospitals are to ensure that everyone has the same access to healthcare information, despite the language they speak. This could include posters and pamphlets with information in different languages or with pictures and universal symbols to communicate the messages. However, in her experience, such materials are often not present in hospitals and health professionals are not doing as much as they should ensure proper communication to non-English speaking patients.

As a nursing student about to begin clinical rotations in a hospital setting, she does not feel that the lessons taught in her courses have adequately prepared her to be able to effectively communicate in an intercultural interaction. Although she feels her courses generally gave her useful insight into how she should ideally act, she would still feel uncomfortable interacting with a person who does not speak any English (Lewis, 2018). The story of the Lia Lee and her family provides insight into the issues faced by many immigrant and minority populations in the American health care system. Their experience is consistent with previous research suggesting that the language barrier is the most significant factor preventing effective healthcare to immigrant and minority populations.

A possible improvement to alleviate the effects of this barrier is to ensure that non-English speakers have access to an interpreter in hospital settings. This may seem like an unrealistic demand, as it would logistically be difficult for hospital to readily provide translators for the wide range of languages spoken by immigrants in the U.S. But, at the very least, hospitals should be equipped with an interpreter that can speak the language of any significant immigrant or minority population in the geographic area of the hospital. Additionally, the use of posters and pamphlets giving medical information in multiple languages or universal images should be more available in hospitals. The importance of effective verbal communication in healthcare cannot be understated. Miscommunication of treatment can lead to misdiagnosis, worsening of conditions, or even death, as seen in the case of Lia Lee, so it is crucial that all patients, regardless of their native language, have equal access to medical information. As earlier hypothesized, it is evident in this case study and interview that healthcare providers do not receive adequate cross-cultural training and are ill-equipped to deal with cultural conflicts over treatments.

Cross-cultural training should be a required part of medical training in today’s globalized society. Any training that doctors do receive in undergraduate education or medical school is often general diversity training and is not culture-specific (Lewis, 2018). Perhaps requiring that healthcare providers complete culture-specific training, based on the geographic location of their employment, would be of greater benefit. Since different areas of the United States have localized concentrations of different minority or immigrant populations, it would be extremely useful for physicians to understand the cultural background and values of ethnic populations that they frequently interact with. For example, Merced, CA has a very high percentage of Hmong immigrants, so health care providers at MCMC could learn more detailed information about Hmong culture such as their view of modern medicine.

Had Lia’s doctors had more understanding of the family’s cultural background, they likely would have better understood the reasons behind the family actions, like not giving her medication, improving the interactions and ultimately decreasing the anxiety of the family and healthcare providers. Conclusion This paper examined the current state and future outlook of intercultural communication in modern American healthcare. A case study and person interview were used to determine the largest barriers associated with intercultural communication. Additionally, this research provided insight into the efficacy of current cross-cultural training for health care professionals. This information was used to make suggestions for improvements that could be made to cross-cultural training and well as suggestions for future research of intercultural communication in healthcare. As supported by previous research, the language was identified to be the most prominent factor contributing to negative experiences in intercultural interactions in a medical setting. Next, it was established that the current, limited cross-cultural training that healthcare providers receive is generalized and non-specific.

Without specific information, health care providers are ill-equipped to handle intercultural conflicts as they do not have any knowledge of individual patient backgrounds and therefore cannot make proper accommodations. One suggestion to ameliorate this major issue is to employ more interpreters in hospitals, especially in geographic areas with high concentrations of a particular minority or immigrant population. Similarly, culture-specific training could be offered to healthcare providers after they have established a location of employment, based upon ethnic populations of that area. Evaluation of the efficacy of these suggestions would be an interesting topic for future research. For future studies on intercultural communication in healthcare, case studies would be a valuable technique for collecting information.

A case study may not be representative of the experience of all ethnic or racial minorities in the healthcare system and it is important to recognize that every patient will have a varied experience. However, case studies yield specific information which is suitable for evaluating both successful and inadequate components of current cross-cultural training. It is clear that the current cross-cultural training for healthcare providers is not effective as minorities continue to be disproportionally affected by disease. As the ethnic and racial diversity continues to increase, the number of intercultural interactions in medical settings will inevitably increase. It is a pressing concern that improvements be made to intercultural communication education for health care providers to close the health inequity gap and ensure that all Americans are provided with equal medical treatment.