Cross Cultural Communication Workshop

IBS - The Global Perspective

April 6, 2011

Cross Cultural Communication

Interactive Theatre Workshop

Douglas A. Drossman MD,

Moderator

Ben Saypol PhD,

Moderator

Cast of Characters

Vignette #1 – Nigerian Patient

Doctor Doug Drossman, MD

Patient Ademola Aderoju, MD

Vignette #2 – Mexican Patient

Doctor Lin Chang, MD

Patient Carolina Olano, MD

Vignette #3 – Russian Patient

Doctor Lin Chang, MD

Patient Albena Halpert, MD

Goals

To highlight cultural

differences in

communication in a

medical setting using

interactive theater and

facilitated discussion

To apply strategies to

obtain more effective

interactions consistent with

the patient’s illness

schema/explanatory model

Case History – Last Ten Years

36 years old

10 year history of mid to lower generalized abdominal cramp-like pain -- made worse after eating.

Frequent stools with some relief of the pain after defecation.

Abdominal bloating and occasional nausea

Symptoms occurred several times a month without loss of ability to work or engage in usual activities.

Case History – Last 6 Months

Within last six months symptoms became more acute

Severe episodes of abdominal pain and watery diarrhea with fever and chills.

Several episodes of urge incontinence

Patient has cut back on eating and has lost 5 kg.

Saw the family physician 2 weeks ago. No abnormalities.

Blood work including CBC, sedimentation rate, CRP, serum TTG, electrolytes and liver chemistries were normal. Stool culture for bacterial infection and for Ova and parasites were negative. A barium enema and CT scan were normal.

Experiencing an inability to carry on usual work and social activities. Limited activities outside of the home.

Interactive Theatre Format

Presentation of Vignette – A condensed medical interview

Facilitated audience discussion – What did you notice in the vignette? (specifically looking at cultural characteristics/communcaition

Check in with Patient – How was your experienced with the Doctor?

Facilitated audience discussion – How can the Doctor improve?

Replay the vignette with Doctor taking the suggestions

Vignette #1 – Nigerian Patient

Some cultural characteristics Strong National Identity (“I’m

Nigerian”)

Hesitancy to share symptoms of bowel dysfunction (“Heaviness … maybe … probably not…”)

Patient’s mother seek religious remedy

Abdicates full responsibility for cure to Doctor

Strong negative reaction to antidepressants “I’m not depressed” (stigma)

Vignette #2 – Mexican Patient

Some cultural characteristics Calls female Physician

“Senorita”

Unique terminology (e.g. “Inflammada” instead of Bloating)

Thinks she must have a amoeba/parasite

Fear of Cancer

Has been to a “Curandero” (Traditional Folk Healer)

Negative reaction to antidepressants (“No soy loca!”)

Vignette #3 – Russian Patient

Some cultural characteristics

Energized verbal communication style

Tendency to interrupting – which seems

argumentative, but is not meant to be. She

is trying to be helpful and give Doctor

desired information

Desire for Russian medication, unavailable

in States

Wary of American medicine, which she

believes orders too many tests (“Is that

really necessary?”)

Themes/Strategies

Themes

Listen (Active Listening techniques)

Increase empathy

Yes, and instead of yes, but

A few small changes can make a world of difference

Strategies

Increase knowledge of characteristics of patients from other cultures (helps to know what might be coming)

Manage physician emotions when differences trigger reactions

Avoid dismissing and diminishing patient views and attitudes

Increase awareness and exploration of psycho-social issues – specifically ones that arise from the patient’s unique culture

Resources – Memory Key

Summary of Clinical Session and Case Study

Comparison chart of the three cases (Nigerian, Mexican, Russian)

Extensive info on cultural spects of illness communication (Nigerian, Mexican, Russian, and Chinese

Background reading on:

Cultural Competency, The Office of Minority Health

Cultural and Health Belief Assessment Tool (CHAT)

Overview of a Chinese Patient Case by ( Dr. Kewin Siah)

National Standards on Culturally and Linguistically Appropriate Services (CLAS)

Commentary: socio-cultural factors in medicine and gastrointestinal research by Douglass A. Drossman and Stephen R. Weinland

Theater Delta

Mission: Theater Delta uses scripted and improvisational theater to promote social change in communities around the globe. We believe that when people participate in creating drama on stage, they are more likely to explore and change personal attitudes and behaviors in their own lives. Interactive Theatre Carolina is a program of Counseling and Wellness Services

http://theaterdelta.com/