Culture, Indirect Communication, and Your Health

Happy New Year! I haven’t had time to think about a new year resolution yet (too many deadlines, yes, this early in the year, life as an academic…) but perhaps one should be to be more consistent with my blog and not let “the perfect be the enemy of the good” (attributed to Voltaire). I have so many ideas for a blog post but keep postponing it because I want it perfect. Out goes perfect and in comes posts!


I was at the hospital with my grandmother and aunt the other day for my grandmother’s knee surgery check-up by the Physio doctor (<–if this blog post were perfect, I would’ve spent extra time to look up what they are actually called, but I’m not going to :-)). According to my aunt, sometimes when the doctor asks my grandmother if she has had any pain at home, she’ll say “No” or that she’s getting better. Also, today, when the doctor was telling my grandmother that she should start pressing on her knee (to get rid of something around the scar), my grandmother said, “Never done it.” And we all assumed that she meant she knew she’s supposed to do it but she never got around to do it at home (like when she’s supposed to do a bunch of exercises for her knees at home).

Here’s where my cultural interpretation comes in.

1) My aunt doesn’t understand why my grandmother (also my grandfather) keeps telling their doctors that they have had no pain at home or that they’re getting better even though they have been in pain and sometimes things aren’t getting better. I think it’s because, in a collectivistic culture like Thailand (yes, I am back in Thailand now, and all my family’s here), the main social goal is group-harmony, and I think that my grandparents are trying to “please” the doctors by saying something they think the doctors would like to hear and not “complain” about their situation.

However, you can see why this is a problem. Doctors need to accurately diagnose the health conditions of their patients and they can’t always use machines to probe…sometimes they rely on verbal reports from the patients. But if the patients are “eager to please” the doctors and not tell them of their actual issue, the doctors can’t help them.

Perhaps there should be a way to educate patients about how to communicate to doctors or doctors ensuring patients that they want to hear the truth because they want to heal them. Or some kind of established norm that might be different from what the patients are used to for their own good.

2) When my grandmother said “Never done it” above, my grandmother meant that the nurse who was rehabilitating her after the surgery never did this one particular knee compression move on her, and therefore she has never been taught or told to do it previously. The confusion is both her fault and the Thai language’s fault.

First, it’s the Thai language’s fault because in Thai, some sentences do not require a subject, in this case, we don’t know who’s “never done it”. Was it my grandmother who’s never done it? (like we all though) or the nurse who’s never done it? (like what my grandmother meant). I am pretty sure because of this Thai is a higher context communication language, consisting of more “implicit, indirect messages” than low context communication, where the message is directly and clearly embedded in the message sent.

Second, it’s my grandmother’s fault for not clarifying this issue at the doctor’s office; it was only revealed that it was the nurse who’s never done it after we got home and my aunt was telling my grandma to do that move. But then again, it might not be her fault as to again her motivation to not cause a problem/conflict with the doctor or the nurse (i.e. telling the doctor that the nurse has never done it could mean the doctor scolding the nurse).

In this case, perhaps the doctor could be trained to probe when there is ambiguous communication. “Who’s never done it?” would’ve clarified the situation. Also, my grandmother, again, could’ve been reassured of the need to reveal all information for the doctor to help her better, so that she is more motivated to reveal information than conceal them (again, characteristics of a collectivistic culture, whose people tend to use high context communication).

A small example of how knowing about a patient’s culture and their communication style can potentially improve their healths and even save their lives.



Filed under Communication, Culture

2 responses to “Culture, Indirect Communication, and Your Health

  1. Having worked in a hospital in South Thailand for 14 years, and also because I have a degree in Linguistics, I found your article very interesting.
    Even here in Canada – when it is English to English- communications with a doctor is sometimes not straightforward. The dangers are more pronounced when doctors really don’t have the time to listen to what the patient is saying.
    Are you coming back to Canada?

    • I agree about doctors not having time, Lorraine! Especially in Canada, public health care = they want you out of there asap.

      I’m probably back in Canada around mid-April 🙂

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