Relationship orientation
Dialogue between Doctor and patient.
The conversation between a Russian patient and a Western European doctor takes place in the Emergency Department. The patient has acute respiratory problems. He has come to the Emergency Department with his wife.
German (Deutsch) |
English |
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| Doctor: | Guten Tag, Herr Ivanov. Wie fühlen Sie sich? | Well, Mr. Ivanov. How do you feel now? |
| Man: | Ein bisschen besser, danke. Die Medizin, die Sie mir gegeben haben, ist gut. Ich kann jetzt viel besser atmen. | A bit better, thank you. The medicine you gave me is good. I can breathe much easier now. |
| Doctor: | Sehr schön. Das hört sich gut an. | Fine. That’s good. |
| Man: | Ja, wir aus unserem Land sind bekannt dafür, hart im Nehmen zu sein. [lächelt] | Yes, we from our country are known for being made of a strong fibre. [smiling] |
| Wife: | Ja. Mein Mann hatte die letzten zehn Jahre nie eine Erkältung. | Yes, my husband has never had a cold in the last ten years… |
| Doctor: | [zum Mann, wie nebenbei] Wir haben uns die Röntgenbilder noch einmal genauer angeschaut und es scheint, als wäre da noch etwas in Ihrer Lunge. Wir wissen noch nicht, was es ist. Wir werden es nach einer weiteren Untersuchung wissen, wenn wir die Ergebnisse der Biopsie bekommen. | [to the husband, in a matter of fact manner] We have analysed the x-rays and there seems to be something on your lung. We don’t know yet what it is; we’ll know after a further check, when we get the biopsy results. |
| Man: | In meiner Lunge? Ist es etwas Ernstes? Oh mein Gott. Alina, hast du das gehört? [er sieht gestresst aus] | On my lung? So it is serious? Oh, my God! Alina did you hear this? [looking very stressed] |
| Wife: | Ja, mach dir keine Sorgen. Ich bin mir sicher, die Ärzte hier geben ihr Bestes. | Yes, don’t worry, I am sure the doctors here will do their best… |
| Doctor: | Nun, da ist ein dunkler Bereich, bei dem wir noch nicht wissen, was es ist. Wir werden Sie einige Tage hier im Krankenhaus behalten. Sind Sie damit einverstanden? Morgen reden wir über die weiteren Untersuchungen. Bitte ziehen Sie sich wieder an. Die Krankenschwester wird Ihnen Ihr Bett zeigen. [verlässt den Raum] | Well, there is a dark patch, there may be something. At the moment we can’t tell what it is. We’ll keep you in hospital for a few days. Is that ok with you? Tomorrow we’ll discuss further checks. Please get dressed. The nurse will show you your bed. [leaves the room] |
| Wife: | [folgt dem Arzt aus dem Raum] Also ist es ernsthaft. Können Sie mir bitte noch Genaueres sagen? | [following him out of the room] So is it serious, could you please tell me more? |
| Doctor: | [zur Frau, während er den Raum verlässt] Ja, wie ich sagte: die Lage ist ernst. Doch wir müssen die weiteren Untersuchungen morgen abwarten. Danach können wir mehr sagen. | [to the wife, while leaving the room] Well, yes, as I said: the situation is serious. But we will do further checks tomorrow and then we’ll be able to tell more. |
| Wife: | Vielen Dank für Ihre Erklärung. Ich werde versuchen, meinen Ehemann zu beruhigen. | Thank you for telling me. I will try to comfort my husband. |
| Doctor: | [etwas überrascht] Ja, sehr gut. Auf Wiedersehen. | [a bit astonished] ... Well, yes, fine, good-bye. |
| Man: | [immer noch völlig durcheinander] | [still completely shaken] |
| Wife: | Was für ein Arzt! Mach dir nicht zu viele Sorgen. Abgesehen davon bist du bei guter Gesundheit. Du bist ein Kämpfer. | What a doctor! Don’t worry too much. Apart from this you are in good health. You’re a fighter. |
Intercultural comment
In some Northern European cultures, for example in Scandinavia, the Netherlands or German speaking countries, communication is more about the task at hand than on building relationships. By comparison people from Eastern European countries treat each other in a much more personal way in professional settings. For people from these countries, it is important to establish a personal relationship before starting to discuss professional topics. The doctor in the dialogue is very task oriented. To make his patient feel more at ease, he could have tried to establish a personal relationship at the beginning of the interview by picking up on the topic suggested by the patient (his home country, to which the patient shows a strong emotional bond) and adding a comment such as “Yes, you’re a strong man. A good friend of mine comes from the same region as you, he’s 85 now and he still works in his garden two hours a day“. This would have improved the level of trust and sympathy between the doctor and his patient.
People from cultures which are highly task-oriented are more likely to communicate in a ‘direct’ or ‘low-context’ way than people from cultures with a strong focus on relationships. This means that they do not pay much attention to the way they ‘package’ their words. The patient in the dialogue was not used to such a direct style of communication and instead of being told hard facts about his state of health, would probably would have felt more at ease with a less truthful, but more empathetic, explanation.
In Eastern European countries, it is seen as important to encourage patients, and sometimes this means not telling them the whole truth about their state of health. In countries such as Russia or Georgia, for example, doctors often tend to speak more openly with about treatment strategies with the patient’s relatives rather than with patient him/herself, because they fear that the patient might become distressed by the truth. It is for this reason that the wife in the example above, follows the doctor out of the room, hoping to obtain more information from him which she can then pass on to her husband in a more appropriate way. In this case it would also have been helpful for the wife to have been treated in a more personal and empathetic way.