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BOUNDARY VIOLATIONS Text Button D CULTURAL ASPECTS OF CARE The physician’s message is conveyed through both verbal and nonverbal communication, which are heavily influenced by culture. Physicians who are not aware of cultural differences can inadvertently convey a different message from what they intended. Consider how frequently we physicians say something will happen (a hospital discharge, a lab test) right now. The Spanish word “horita” means “right now” in Mexico, but means “in about an hour or so,” in Puerto Rico. The English phrase “just now” means “later” in South Africa. Words may create a different expectation for the patient than what the physician intends, leading patients to be frustrated or even angry. In many cultures there are different meanings associated with touch or the amount of physical space between two individuals. Touching a small child or even paying significant attention to him/her in some cultures may be interpreted as friendly. In others cultures, it is considered an indication of bad luck. Physicians should learn the common cultural norms of the patients with whom they interact, but avoid making assumptions based on stereotypes. In addition, they should have a very low threshold for asking patients and families directly what is acceptable to them. For instance,“I have some important news I need to communicate. With whom would you like me to discuss this?” Adapted from Galanti GA. Caring for patients from different cultures: case studies from American hospitals. 2nd ed. Philadelphia, PA: University of Pennsylvania Press, 1997.