Book Review
Cross-Cultural Communication in the Health Sciences: Communicating With Migrant Patients
Anne Pauwels
ISBN: 978-0-732929541; 1996; 206 pages; Palgrave Macmillan, New York;
Virginia Hussin
Faculty of Health Sciences, Flinders University, Adelaide SA
There has been much recent debate about how health professionals can more appropriately meet the needs of migrant patients in Australia's multicultural and multilingual society. This publication sets out to address issues in cross-cultural interaction by allowing the reader to 'get inside' communication patterns which occur in health care settings and by encouraging the reader to adopt strategies which will enhance encounters with migrant patients.
A feature of the book is the description of differences in languages in terms of grammar, lexicon and sound system and most importantly, in terms of discourse aspects. Pauwels highlights the language and culture specificity of 'conversational management rules' governing aspects of interactions such as turn-taking and the expression of social relations between speakers. She succeeds in making these differences more explicit by analysing data of conversations with people from various cultural backgrounds, in a manner which is accessible to non-sociolinguists. Pauwels demonstrates effectively how misunderstanding due to cultural and linguistic differences in communication rules and routines can lead to confusion and conflict.
Communication routines which are specific to health care settings are examined by Pauwels. Drawing on linguistic and sociological research, she outlines common complaints of migrant patients about their communication difficulties with health professionals; difficulties which can impact negatively on patient compliance. While most of the extracts used to illustrate these complaints are of interactions between doctors and patients, many of the ritualised routines such as history taking are equally relevant to nurses. Some issues of power and gender are touched upon here but they are not dealt with in depth.
A strength of the book is the extent to which communication difficulties are addressed. Pauwels provides a range of practical strategies which can be used by health professionals to improve communication with migrant patients. For example, the reader is shown how to modify their own linguistic behaviour and questioning techniques when gathering health data from patients. Pauwels also provides comprehensive guidelines about how to work with interpreters to negotiate improved care for non-English speaking background patients, including an outline of the pitfalls of this threeway communication.
This book is well researched and is both authoritatively and clearly written. Exercises at the conclusion of each chapter invite the reader to reflect on theory and to apply it to their own field of health care and to case studies. The index is easy to use and each chapter is supported with an excellent list of references for further reading, making this a valuable resource for all health professionals. It is recommended reading for nurses and would also be a useful text for students doing communication courses in the health sciences.
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