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Doorway Thoughts

Cross-Cultural Health Care for Older Adults

Aug 28, 2008 Michael Irvin Arrington

This article reviews the American Geriatrics Society book, Doorway Thoughts: Cross-Cultural Health Care for Older Adults.

Doorway Thoughts: Cross-Cultural Health Care for Older Adults

American Geriatrics Society; Sudbury, Massachusetts; Jones and Bartlett Publishers; 2004; ISBN 0-7637-3338-5; 113 pages; $21.95

The population of the United States is growing older and more diverse every day. For health care providers, an important effect of this trend is the rising number of elderly patients from various ethnic groups. Doorway Thoughts – a term used to refer to the reflections physicians should undergo before entering a room to interact with a patient – was written to provide advice and information to health care providers who might encounter older patients from various ethnic and cultural groups.

The book devotes separate chapters to seven groups: (a) African Americans, (b) American Indians and Alaska natives, (c) Asian Indian Americans, (d) Chinese Americans, (e) Hispanic Americans, (f) Japanese Americans, and (g) Vietnamese Americans. At the same time, however, the American Geriatrics Society acknowledges that each ethnic group includes more diversity than could be covered in a single book chapter. Rather than attempt to create a universal guide to intercultural provider-patient communication, the AGS presents useful information about relevant cultural factors that physicians can use as a starting point for their discussions with patients.

Across the book’s sections, readers will notice significant cultural differences that likely impact conversations between physicians and patients. Factors covered in Doorway Thoughts include, but are not limited to, preferred terms for cultural identity, nonverbal communication norms, expectations of the physician-patient relationship, culture-specific health beliefs, disclosure norms, gender roles, and views of end-of-life issues. Each chapter includes several examples that illustrate the potential challenges posed by these factors. For instance, the chapter on older Hispanic American patients explains that traditions of machismo and marianismo inform the ways in which Latinos and Latinas interact with each other and with members of other cultural groups.

Also, the chapter on older Vietnamese American patients cites the popularity of smoking and the higher rates of certain cancers within that culture as variables worth considering in treating patients. This chapter also describes a cultural belief that presents a potential barrier to communication about end-of-life matters: Vietnamese people prefer not to die in hospitals because they believe that a soul that dies away from home will be forced to wander with no place to rest. Consequently, Vietnamese patients likely will reject aggressive treatments that require hospital stays in favor of other approaches that allow them to remain at home.

Likewise, Asian Indian Americans might believe depression to be the result of bad karma and, hence, reject medical intervention. Some fear the voicing thoughts about death and dying might make it happen. On the other hand, Japanese Americans might be more comfortable with the inevitability of death and more open to talking about end of life issues. Each chapter of Doorway Thoughts includes case studies that illustrate the unique challenges and opportunities that arise during interaction with members of each culture.

The book’s most important contribution might be its emphasis on cultural competence as an approach rather than a technique. Such an approach to intercultural communication makes Doorway Thoughts a useful text for physicians and medical students. In an effort to train physicians and physicians-to-be to communicate effectively with a population that simultaneously grows older and more diverse, the American Geriatrics Society has crafted an important text that addresses both population trends at once.

The copyright of the article Doorway Thoughts in General Medicine is owned by Michael Irvin Arrington. Permission to republish Doorway Thoughts in print or online must be granted by the author in writing.