Culture, Language and Pain in Medical Tourism

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Narrowing the Language Gap in Medical Tourism: Communications Guidelines for Physicians

Part 3: Culture, language and pain

Ways of describing pain and even the intensity of pain are both linguistically and culturally dictated.  While both patient and physician may understand one another regarding the main concepts of pain, their ways of describing (and interpreting) the intensity and types of pain both conceptually and language wise may be very different. The patient’s culture will also influence his or her ability and willingness to express pain and request relief. However, your own culture will also influence how you interpret both his or her verbal and behavioral expressions regarding the intensity of pain and requests for or refusal of pain medications.  For example, one U.S. study[1]  shows that Hispanic patients were regularly under-medicated by Anglo caregivers because of conflicting cultural influences.  While their culture “allowed” the Hispanic patients to openly cry out in pain, the culture of the US caregivers caused them to view these patients are “cry-babies”.  This interpretation caused them to lower the dosage or withhold pain medications.

With the growth of medical tourism, there has been a rapid increase of US patients traveling to Asia for medical treatment.  How might Asian physicians, whose culture may promote the acceptance of pain and/or the lack of demonstration of pain, be influenced in their response to a medical tourist’s open expression of pain and/or request for pain relief?

False cognates and misdiagnoses

Words that sound alike but carry very different meanings in the patient’s and physician’s languages can also cause miscommunication and misdiagnosis.  False cognates illustrate the saying that “A little knowledge can be a dangerous thing.” Take, for example, the case of a young Cuban man living in Florida, who suffered an aneurysm, but was not tested before the bleeding in his brain resulted in his becoming a quadriplegic.  His limited English-speaking relatives told the paramedics that he was “intoxicado”.   This word, in Cuban Spanish, means that someone has eaten contaminated food or something to which he is allergic.  However, the English-speaking paramedics interpreted the word to mean what “intoxicated” means in English—that he was drunk and noted this in their report. The physician, who was actually a native speaker of Spanish, but from another culture and a higher socio-economic status than the family didn’t feel comfortable speaking to the family personally so he simply accepted the paramedics’ assessment and treated the patient for alcohol abuse.[1]  Or a young girl suffering from a psychological breakdown was forced to undergo an examination for rape because her family told caregivers she had been “muy molestado”[2];or a young Russian woman being treated for the wrong type of cancer because the physicians misinterpreted the diagnosis on her medical records (from Russia)which were written in Latin.  They treated her for the type of cancer which “looked” most similar to the English term.

2. Gail Price-Wise, “An Intoxicating Error: Language, Culture and Medical Tragedy”, 2013, www.flculturalcompetence.org.

3. “Molesto” refers to any type of bother or trouble in Mexican Spanish, but “molested” almost always means sexually assaulted in English.

4. Although, there is yet not globally recognized body which certifies medical interpreters, there are well-reputed public and private medical interpreter training programs in many countries. Most require a minimum of 40 hours of training and issue a certificate upon completion.[/vc_column_text][/vc_column][vc_column width=”1/3″][vc_column_text]This article is part of a series by Dr. Suzanne Salimbene, a senior consultant with the Mercury Advisory Group. Dr Salimbene’s book, What Langauge Does Your Patient Hurt In? is currently being revised for 3rd edition release later this year.

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Learn more about culturally Competent Care with the US Department of Health and Human Services Office of Minority Health.

In April 2013, the National CLAS Standards were re-released after undergoing a two-year enhancement initiative. This program, along with others featured on TCH, is scheduled to be under annual review for accreditation purposes and will be updated to reflect the National CLAS Standards enhancements.

To assist you during this transition, we recommend that you reference this crosswalk (PDF – 115 KB) and fact sheet (PDF – 59 KB) which will assist in understanding the numbering and organization of the re-released National CLAS Standards.[/vc_column_text][/vc_column][/vc_row]