Cross-cultural communication in medicine: questions for educators

Most research into medical communication has had a western setting. It has been undertaken by western researchers and been influential in shaping comm unication skills curricula. However we know much less about what communicat ion is effective under other circumstances. This article highlights gaps in our knowledge from research in this field, and poses attendant questions f or debate by medical educators. We consider the following key aspects of de bate on cross-cultural work. (i) To what extent can our understanding of ge neral principles in other cultures be summarized and presented for teaching in a way which does not descend into caricature? Alternatively, can featur es of other cultures be presented in ways which do not descend into particu larity? (ii) Can such paradigms as 'patient-centredness' be transferred fro m culture to culture? Should they be presented across cultures as features of 'good' consultations? (iii) What use can be made of the role of interpre ters for teaching purposes? What importance does it have to the educator th at a doctor may not be a native speaker of the majority language of the cul ture in which s/he is operating? (iv) Although the language of illness, and particularly metaphors associated with illness, are studied in other cultu res, the way in which illness is metaphorized in British English is seldom discussed. What can educators learn and teach from a study of such matters? (v) What are the implications for communication skills teachers of the nee d to present materials within a culturally diverse environment?