title: Cultural differences in medical communication: a review of the literature.
abstract: OBJECTIVE
  Culture and ethnicity have often been cited as barriers in establishing an effective and satisfying doctor-patient relationship. The aim of this paper is to gain more insight in intercultural medical communication difficulties by reviewing observational studies on intercultural doctor-patient communication. In addition, a research model for studying this topic in future research is proposed.
  
  
  METHODS
  A literature review using online databases (Pubmed, Psychlit) was performed.
  
  
  RESULTS
  Findings reveal major differences in doctor-patient communication as a consequence of patients' ethnic backgrounds. Doctors behave less affectively when interacting with ethnic minority patients compared to White patients. Ethnic minority patients themselves are also less verbally expressive; they seem to be less assertive and affective during the medical encounter than White patients.
  
  
  CONCLUSIONS
  Most reviewed studies did not relate communication behaviour to possible antecedent culture-related variables, nor did they assess the effect of cultural variations in doctor-patient communication on outcomes, leaving us in the dark about reasons for and consequences of differences in intercultural medical communication. Five key predictors of culture-related communication problems are identified in the literature: (1) cultural differences in explanatory models of health and illness; (2) differences in cultural values; (3) cultural differences in patients' preferences for doctor-patient relationships; (4) racism/perceptual biases; (5) linguistic barriers. It is concluded that by incorporating these variables into a research model future research on this topic can be enhanced, both from a theoretical and a methodological perspective.
  
  
  CONCLUSIONS
  Using a cultural sensitive approach in medical communication is recommended.
authors.affiliation: Interdisciplinary Social Science Department, Research Institute for Psychology and Health, Utrecht University, Utrecht, The Netherlands. b.c.schouten@fss.uu.nl
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Schouten
authors.forename: Ludwien
authors.initials: L
authors.lastname: Meeuwesen
mesh_terms: D001291:Attitude of Health Personnel / Q000208:ethnology; D001294:Attitude to Health / Q000208:ethnology; D003142:Communication; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D018864:Cultural Diversity; D004645:Empathy; D005544:Forecasting; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007206:Individuality; D008913:Minority Groups / Q000523:psychology; D008960:Models, Psychological; D009042:Motivation; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations; D011287:Prejudice; D012107:Research Design; D012649:Self Concept; D012660:Semantics; D012933:Social Identification; D012945:Social Values; D016896:Treatment Outcome; D014705:Verbal Behavior