Филологические науки /7. Язык, речь, речевая коммуникация

L.A. Khimatova (student of group 2-067 GM), G.K. Karimova (Master of Foreign Philology), O.I. Levina (Master of Arts of the philological speciality)

Karaganda State Medical University, Kazakhstan

Linguocultural aspect in medicine

Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups[1]. Building on this definition, the professional culture of medicine can be viewed as the language, thought processes, styles of communication, customs, and beliefs that often characterize the profession of medicine.

Traditionally, when discussing medicine as a culture, the focus tends to be on reinforcing the virtues of medicine, such as honesty, empathy, altruism, honor, and respect.

Examples of these elements include the white coat, a shared stylized dress code among physicians; doctor talk, a shared language or unique pattern of communication among physicians; and the physician explanatory model, a shared system of beliefs regarding health.

The way in which physicians express themselves verbally, doctor talk, is another element of the culture of medicine that is rarely taught explicitly. The lexicon of physicians is characterized by statistical facts, presented in terms of probability, gradations of severity, and the use of acronyms and medical terminology that is often unfamiliar to the patient.

It is important for doctors to acquire good consultation skills which go beyond prescriptive history taking learned as part of the comprehensive and systematic clerking process outlined in textbooks [2].

So what is the most important skill for each doctor to take history most successfully?

It’s asking open questions. These are seen as the gold standard of historical inquiry. They do not suggest a 'right' answer to the patient and give them a chance to express what is on their mind. Examples include questions such as 'How are you?'. There are other similar open questions, but it may be effective just to let the patient start speaking sometimes.

Open questions can be used to get specific information about a particular symptom as well. For example: 'Tell me about your cough' or 'How are your waterworks bothering you?'.

Here are some most informative questions to patient:

1. What brings you in today?

2. What hurts?

3. What are your symptoms?

4. How long has this been going on?

5. Has the pain been getting better or worse?

6. Do you smoke? Do you take any recreational drugs? Do you drink alcohol and how often?

7. Do you have a family history of this?

8. Do you take any medicines or supplements?

9. Are you sexually active?

10. Have you had any previous surgeries?

11. Does it hurt when I push here?

12. Are you allergic to any medicines?

The need for physicians who are well equipped to treat patients of diverse social and cultural backgrounds is evident. To this end, cultural competence education programs in medical schools have proliferated. Although these programs differ in duration, setting, and content, their intentions are the same: to bolster knowledge, promote positive attitudes, and teach appropriate skills in cultural competence. However, to advance the current state of cultural competence curricula, a number of challenges have to be addressed. One challenge is overcoming learner resistance, a problem that is encountered when attempting to convey the importance of cultural competence to students who view it as a soft science. There is also the challenge of avoiding the perpetuation of stereotypes and labeling groups as others in the process of teaching cultural competence. An additional challenge is that few cultural competence curricula are specifically designed to foster an awareness of the student's own cultural background. The authors propose the professional culture of medicine as a framework to cultural competence education that may help mitigate these challenges. Rather than focusing on patients as the other group, this framework explores the customs, languages, and beliefs systems that are shared by physicians, thus defining medicine as a culture. Focusing on the physician's culture may help to broaden students' concept of culture and may sensitize them to the importance of cultural competence. The authors conclude with suggestions on how students can explore the professional culture of medicine through the exploration of films, role-playing, and the use of written narratives [3].

Using the professional culture of medicine as a framework for cultural competence education has several potential benefits. First, engaging students and medical staff in a reflective discourse on the culture of the medical profession may help to reframe their perceptions on what constitutes culture and perhaps make them more receptive to learning about cultural competence. Second, discussion of the culture of medicine shifts the focus of the cross-cultural encounter from the patient as the deviant other to examination of perspectives of both patient and physician which may help to minimize the tendency for othering. Finally, the focus on the culture of the medical profession encourages students and medical staff to gain self-awareness by exploring their shared customs, their methods of communication, and their explanatory models regarding disease and illness.

References:

1. Office of Minority Health, U.S. Department of Health and Human Services. Teaching Cultrual Competence in Health Care: A Review of Current Concepts, Policies, and Practices. Washington, DC: U.S. Department of Health and Human Services; 2002.

2. Joyner B, Young L. Teaching medical students using role play: twelve tips for successful roleplays. Med Teach. 2006; 28: 225-229.

3. Ashton CM, Haidet P, Paterniti DA, et al. Racial and ethnic disparities in the use of health services: bias, preferences, or poor communication? J Gen Intern Med. 2003;18: 146-152.