Understanding cultural diversity: Who’s afraid of the number four?

If your patient is avoiding eye contact, would you consider it a sign of depression? However, in some cultures, it is a sign of respect. What about a patient who never asks any questions, taking your recommendations as orders? This might be a patient from a country where doctors are viewed as authorities, whose decisions are not to be questioned.

Ethnic minorities constitute 27.6 percent of the total U.S. population and, according to the projections by the U.S. Census Bureau, their percentage may reach 50 percent by 2050. Providing health care to this mosaic of nations, where each group has its own system of beliefs and customs, presents a considerable challenge.

For example, the custom in many cultures, including Filipino and Iranian, is for a patient’s family to decide whether to tell the patient about a poor prognosis or not, since they believe the truth will only destroy hope.

People from China, Malaysia and Japan might avoid a room that includes the number four. In their languages, the word for the number four sounds similar to the word “death.” To some Hmong people, a doctor can’t know about the possibility of a patient’s death, unless that doctor is planning to kill him or her. According to this culture’s belief, only God knows when someone may die.

Of course, this doesn’t mean that all people from a certain culture will have the same beliefs. A Chinese person raised in the U.S. might have different beliefs than the one raised in China. The following case study shows the danger of cultural stereotyping.

A few days before her surgery, an elderly Irish woman complained of pain to her family, but said nothing to her doctor, since Irish people tend to minimize expressions of pain. Confronted by the family, the doctor expressed little concern, because in his country of origin women in pain are typically much more vocal. During the surgery, the patient’s condition worsened and she died. Had the surgeon not relied on his own stereotypes and been more concerned with her dismissive behavior towards pain, she might have lived.

Expanding your cultural awareness helps to minimize risks, prevent tragedies and improves patient safety and satisfaction, thus leading to better outcomes.

The article was first published on The Midwest Chapter of the American College of Health Care Executives website