Healthcare

Information-Sharing, and Identity

Knowing the appropriate way to communicate with families and patients in an intercultural context can be incredibly complex. In some cultures, the family is involved in the healthcare and medical treatment of its members. In other cultures, medical information is confidential and only given to the patient. Some patients may not want their families involved in their care if they have had a miscarriage, are suffering from certain types of cancer, or are depressed. All patients will act within a framework of cultural values.

Information Sharing

In general, healthcare providers will give information regarding patient health in four general frameworks.

• Strict Paternalism – reflects a physician's decision to provide misinformation to the patient when he or she believes it is in the best interests of the patient.
• Benevolent Deception – occurs when the physician chooses to communicate only part of a patient's diagnosis.
• Contractual Honesty – refers to the practice of telling the patient only what he or she wants to hear or to know.
• Unmitigated Honesty – refers to when a physician chooses to communicate the entire diagnosis to a patient. 

In the United States, unmitigated honesty is the only one of these options that is legal for adults. When seen as too difficult or frustrating, cultural, and legal differences between provider and patient can contribute to a patient's inability to understand the provider's directions. Communication problems resulting from conflicting identities and perceptions can be overcome with sensitivity and adaptation.

Identity

Both patients and providers are concerned about their cultural identities. Communication Theory of Identity explains that people make assumptions about each other based on their backgrounds. The premise behind this theory can help to explain how misunderstandings occur in the intercultural healthcare setting. Individuals use their identities to affiliate themselves with groups and cultures. The extent to which people identify with specific groups and cultures varies based on the dimensions of salience and intensity.

Identity salience refers to the fact that people view their cultural identity as an important part of who they are, while identity intensity refers to the level of importance that people place on their cultural identity. When people from different cultures interact, they communicate according to the ways that people from their culture communicate, and by doing so, enact their identity with particular groups.

Hecht asserted that there are four frames that may overlap and occur in the same communicative interaction: personal, enactment, relational, and communal. Each identity frame has its own set of assumptions concerning how the intercultural provider-patient interaction negotiates identity. In a 2017 study on intercultural healthcare communication through the eyes of patients in the Netherlands, Patternotte et. al, found that a doctor's cultural background was not important if the doctor was a professional, but noted that all of the patients had already lived in the Netherlands for a significant amount of time. Some patients did have a clear preference for a doctor of a particular gender. Many patients felt that a competent doctor needed to be accessible, have enough time, treat them as unique people, and ask about cultural habits. Respect for cultural identity was an integral part of communication skills in a healthcare setting.