Ohtaki Sachiko, Ohtaki Toshio, Fetters Michael D
Department of English Language, Kanazawa Medical University, 1-1 Daigaku Uchinada-machi, Kahoku-gun, Ishikawa-ken 920-0293, Japan.
Fam Pract. 2003 Jun;20(3):276-82. doi: 10.1093/fampra/cmg308.
Little is known about the differences and similarities between doctor-patient communication patterns in different cultures.
The aim of this study was to examine communication patterns of doctor-patient consultations in two different cultures, namely the USA and Japan, and to elucidate linguistic differences and similarities in communication.
This cross-sectional study used quantitative discourse analysis from linguistics to compare 40 doctor-patient consultations: 20 out-patient consultations of five physicians in the USA and 20 out-patient consultations of four physicians in Japan. The main outcomes measured were time spent in each phase of the encounter, number of categorized speech acts, distribution of question types and frequencies of back-channel responses and interruptions.
The average length of doctor-patient encounters was 668.7 s in the USA and 505 s in Japan. US physicians spent relatively more time on treatment and follow-up talk (31%) and social talk (12%), whereas the Japanese had longer physical examinations (28%) and diagnosis or consideration talk (15%). Japanese doctor-patient conversations included more silence (30%) than those in the USA (8.2%). The doctor-patient ratios of total speech acts were similar (USA 55% versus 45%; Japan 59% versus 41%). Physicians in both countries controlled communication during encounters by asking more questions than the patients (75% in the USA; 78% in Japan). The Japanese physicians and patients used back-channel responses and interruptions more often than those in the USA.
While doctor-patient communication differed between the USA and Japan in the proportion of time spent in each phase of the encounter, length of pauses and the use of back-channel responses and interruptions, physician versus patient ratios of questions and other speech acts were similar. The variations may reflect cultural differences, whereas the similarities may reflect professional specificity stemming from the shared needs to fill the information gap between physician and patient. Adequate awareness of these differences and similarities could be used to educate clinicians about the best approaches to patients from particular cultural backgrounds.
对于不同文化中医患沟通模式的异同了解甚少。
本研究旨在考察美国和日本这两种不同文化中医患诊疗过程的沟通模式，并阐明沟通中语言上的异同。
这项横断面研究运用语言学的定量话语分析方法，比较40次医患诊疗过程：美国5位医生的20次门诊诊疗以及日本4位医生的20次门诊诊疗。所测量的主要结果包括诊疗各阶段所花费的时间、分类言语行为的数量、问题类型的分布以及反馈回应和打断的频率。
美国医患诊疗的平均时长为668.7秒，日本为505秒。美国医生在治疗和后续谈话（31%）以及社交谈话（12%）上花费的时间相对较多，而日本医生进行体格检查（28%）和诊断或思考谈话（15%）的时间更长。日本医患对话中的沉默时间（30%）比美国（8.2%）更多。总言语行为的医患比例相似（美国为55%对45%；日本为59%对41%）。两国医生在诊疗过程中都通过比患者问更多问题来控制沟通（美国为75%；日本为78%）。日本医生和患者比美国医生和患者更频繁地使用反馈回应和打断。
虽然美国和日本的医患沟通在诊疗各阶段所花费时间的比例、停顿时长以及反馈回应和打断的使用上存在差异，但医生与患者在问题及其他言语行为上的比例相似。这些差异可能反映了文化差异，而相似之处可能反映了源于填补医患信息差距这一共同需求的专业特殊性。充分认识这些异同可用于指导临床医生针对特定文化背景的患者采用最佳沟通方式。
