Have you ever prescribed a home program to a family for their child and realized that they were not following through with the program? Maybe you wondered if the program was not understood or whether it was too complicated.
It could actually be a cultural issue. The culture of biomedical Western medicine can be very different from the culture of the clients it is intended to help. While on the surface, you might perceive a non-compliance issue, digging deeper may reveal cultural differences, concerns about immigration status, or even an unintentional insult in your greeting style.
Cultural differences can have a huge impact on clinical interactions, and knowing how to deal with them professionally is a must for any clinician.
Introducing the Rodriguez Family
Imagine this scenario: You have been working with the Rodriguez family, who emigrated from Nicaragua. Their two-year-old son, Jorge, has been diagnosed with developmental delay.
Jorge and his parents have a standing appointment with you at 10 AM on Tuesdays. For the first session, they arrive at your clinic at 11 AM. For the next session, they arrive at your clinic at 10:30 AM. You are concerned because you have a very tight schedule for patient treatment, and you don’t understand why they are so late each time.
So why is this happening?
It turns out that the time issue is actually a cultural difference. Jorge’s family operates on polychronic, or multidimensional, time while you yourself operate on monochronic, or one-dimensional, time.
This means that the Rodriguez family views time as open-ended, without restraint. Pace and rhythm are determined by context, events take as long as they need to, and the clock does not dictate comings and goings. Time isn’t—and shouldn’t be—planned or managed.
A person with a monochronic perspective of time, however, expects people to arrive at a particular set time and follow a set schedule. Many healthcare practitioners in the U.S. follow this type of view of time in order to efficiently manage a caseload of multiple patients a day.
Neither of these approaches is right or wrong; they are simply different, although it can be difficult for a person accustomed to a particular view of time to imagine any other way of viewing it. So what can you do about this significant cultural difference?
Respectfully Addressing This Cultural Difference
The first step is acknowledging and better understanding the role that your own culture plays in the various interactions that will occur with your patients. As a Western biomedical professional, chances are good that you value monochronic time and follow a structured, timely schedule. You expect the family to arrive at the scheduled time on a regular basis.
Next, recognize the role the family’s culture plays. The Rodriguez family values polychronic time, in which time is unstructured and flows. Because of these different beliefs, attitudes and behaviors, you and the family operate differently. The family’s arrival time may vary depending on what is happening for them earlier in their day.
Discuss these differences with the family. An interpreter may be helpful, particularly one who is both bilingual and bicultural and has a good understanding of the medical and cultural nuances involved. Ideally, you and the family will gain a better understanding of where each of you is coming from and will be able to negotiate a mutually agreeable alternative.
To learn more about this specific cultural difference and other cultural differences you may encounter in your practice, watch the MedBridge Course “Enhancing Patient-Centered Care in Diverse Communities.” Gaining a deeper understanding of cultural differences and knowing what to expect will help you become a more culturally competent and effective practitioner.