Friends of the Nonverbal Communication Blog, this week we present the paper “Communication training is inadequate: the role of deception, non-verbal communication and cultural proficiency” by Baugh, A. D.; Vanderbilt, A. A. and Baugh, R. F. (2020), in which authors explain why they consider is necessary to improve the communicative training in the context of medicine.
This week’s paper starts from the next question: are we training our doctors well, so that communication is effective with all types of patients?
Health systems in all societies have an interest in improving the ability of their physicians to provide competent care to all users of the system, regardless of their culture.
The United Nations has recognized that the inequalities faced by marginalized populations must be addressed, and also has placed the issue on its agenda.
More than 20% of displaced or marginalized people say they have given up seeking medical care at all, due to difficulties they found along the way and previous bad experiences too, demonstrating the importance of culturally sensitive care. In addition, they identified racism as one of the main causes of dissatisfaction.
What the authors argue, considering all these ideas, is that communication failures underlie these problems, and are rooted in the changing and heterogeneous demographics of today’s culture, but also attitudes of clinicians. Moreover, they consider that effective intercultural communication stems from an awareness of cultural differences and a genuine desire to communicate actively and correctly.
For this, it is important to bear in mind that socialization during childhood imparts values and social tendencies that take root in us and guide our behavior in life, despite education, subsequent experiences, etc.
Medical students often lack intercultural exposure, due to the tendency toward residential, economic, and cultural self-segregation. In the absence of this, the tendency to privilege one’s own predominates and a negative effect on intercultural attitudes is presaged when exposed to diversity. And rising inequality will only make matters worse.
Communication, a fundamental pillar of human social interaction, and therefore also for the practice of medicine, requires the alignment and synchronization of the speaker and the listener.
Effective communication between two people requires the overlapping of verbal and non-verbal cues, which can sometimes be culturally specific.
Healthcare must aspire to something bigger: the creation of a shared reality between doctor and patient.
Cultural influences arise as a result of many factors: ethnic origin, religion, age, socioeconomic status, or educational level among others.
Both the aspiration of achieving a shared reality, as well as the complexities inherent in the practice of medicine and cultural influences, make relying solely on verbal or non-verbal signals an unsuccessful strategy, because both are necessary.
For example, due to most nonverbal communication being unconscious, signals that may not be appropriate can be used by default, consequently frustrating attempts to improve communication.
There is also the point that damage to doctor-patient relationships is also related to the patient’s ability to perceive dishonest communication.
Incongruous non-verbal behavior or communication is what underlies most lie detection. For example, there are detectable differences based on the activation or not of certain muscles of the face to know if a smile is fake or genuine (the so-called “Duchenne smile”).
Patients notice physicians’ nonverbal inconsistencies and may understand them as signs of dishonesty.
In addition, medical encounters represent tense or risky situations, which make the detection of insincerity more likely.
Students have been found to acquire cultural fluency more slowly when done in small doses, for example, in medical encounters; while the opposite happens if they spend time immersed in a different culture. Furthermore, the greater and more extensive the previous exposure and interaction with another culture, the less unconscious biases there will be.
There are some schools that offer medical language courses, recognizing the relationship between language and culture, however, they have limited accessibility and it would be very positive to facilitate it more.
Medical schools should be trained to redesign communication training so that students are more aware of these weaknesses and how to change them.
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