Rothschild S K
Department of Family Medicine, Rush-Presbyterian-St. Luke's Medical Center, USA.
Dis Mon. 1998 Jul;44(7):293-319. doi: 10.1016/s0011-5029(98)90010-4.
A generation ago, the experience of practicing medicine across cultural lines was far less common than it is today. In contemporary American society, the population is much more diverse in race, culture, language, religion, and ethnicity. Although health care is increasingly guided by scientific, evidence-based models, individual patients are increasingly seeking health care that addresses their personal beliefs and needs. Physicians must develop the knowledge and the skills to engage patients from different cultures and to understand the beliefs and the values of those cultures. If physicians focus only on a narrowly defined biomedical approach to the treatment of disease, they will often misunderstand their patients, miss valuable diagnostic cues, and experience higher rates of patient noncompliance with therapies. Such miscommunication will also result in greater patient dissatisfaction and more malpractice suits. This article reviews the role of culture in primary care medicine and the effect of health beliefs on decisions to seek care. Other influences, including the patient's family, language, and socioeconomic status, are examined. The possible effects of the physician's own culture are looked at as well. Methods of eliciting the patient's explanatory model are reviewed, and guidance is given on strategies to avoid miscommunication or misunderstandings. Additionally, the physician is given guidance on how to draw on the patient's beliefs and values as resources in health promotion and the treatment of disease. Specifically, the use of interpreters to overcome language barriers is reviewed. Behaviors are identified that can maximize the accuracy of communication when interpreters are needed. Physicians who actively seek to understand their patients' cultures will find their simple efforts amply rewarded by improved patient access to health care, increased patient satisfaction, and greater clinical effectiveness.
一代人以前，跨文化行医的经历远不如如今这般常见。在当代美国社会，人口在种族、文化、语言、宗教和族裔方面的多样性要大得多。尽管医疗保健越来越多地以科学的、循证医学模式为指导，但个体患者越来越多地寻求能满足其个人信仰和需求的医疗保健服务。医生必须培养相关知识和技能，以便与来自不同文化背景的患者沟通，并理解这些文化的信仰和价值观。如果医生只专注于狭义定义的生物医学方法来治疗疾病，他们往往会误解患者，错过有价值的诊断线索，并经历更高的患者不遵医嘱治疗率。这种沟通不畅还会导致患者更大的不满以及更多的医疗事故诉讼。本文回顾了文化在初级保健医学中的作用以及健康信念对就医决策的影响。还探讨了包括患者家庭、语言和社会经济地位在内的其他影响因素。同时也考察了医生自身文化可能产生的影响。回顾了引出患者解释模型的方法，并就避免沟通不畅或误解的策略给出了指导。此外，还就如何将患者的信仰和价值观作为健康促进和疾病治疗的资源给予了医生指导。具体而言，回顾了使用口译员来克服语言障碍的情况。确定了在需要口译员时可使沟通准确性最大化的行为。积极寻求理解患者文化的医生会发现，他们的这些简单努力会因患者获得更好的医疗保健服务、更高的患者满意度以及更大的临床疗效而得到充分回报。
