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Culture in Medicine and Healthcare

Interpreting performance through the cultural lens 

Understanding Concept of Culture - Definition

“Culture consists of a body of learned beliefs, traditions, and guides for behaving and interpreting behaviour that are shared among members of a particular group. It includes values, beliefs, customs, communication style, behaviours, practices and institutions” (Blue J 2003). Cultural studies show that “culture education” starts as a child and further reinforced in the school. Being part of a culture that honours these values, teachers and peers inculcate additional values that consolidate the learning and assimilation at home. The process of progression through education and work further refines cultural learning and leads to development of smaller cultures (layers of culture) within a general triangle of the individual, family and nation some like religious culture, Gender, Generation, or professional /organisational /regional cultures etc.

Perception of Performance of a GP through the Western Lens (Patients view)

Doctors, when taking history give undivided attention with overt signs of listening. Patients maintain social distance, recognise doctors’ power and authority, balanced with equality

They generally accept, where appropriate, there may not be a physical examination. They trust in doctors’ knowledge and expertise through verbal and non-verbal communication and management of the consultation.

Patients like shared management but can allow doctor to take authority. They seek and welcome explanation and information regarding diagnosis and management plan.

Perception of performance of a GP through the Eastern Lens (Patients view)

The doctor asks questions and can interrupt the patient, doctor shows authority by taking control, acts in paternalistic and authoritarian ways, interrupted consultations confirm status and importance of the doctor.

The doctor as healer – an instrument of divine mercy whose touch is essential, over-investigation/unnecessary physical examination and referrals are evidence of the doctor’s thoroughness

Doctor tells and directs, explanation and information unnecessary as doctor’s authority unquestionable, confidentiality is differently perceived

Traditional Values of GP Professional Culture

In addition to professional and personal development general practitioners are, traditionally, expected to make cost effective, comprehensive and community oriented decisions. They offer continuity and co-ordination of care. They have good communication and counselling skills.

GPs perceptions of personal and professional role in the healthcare system can lead to misunderstandings and misinterpretations by their patients whose expectations and demands are increasing mainly driven by media and politics.

How might performance be perceived in a Team

  1. Pyramidal – fear of senior and lack of organisational insight. Performance is judged by a senior person/s – risk of prejudiced decision making without involvement of the performer
  2. Well-oiled machine – slavish following of policies and procedures, loss of innovative ideas. Performance is based on how well procedures are followed – risk micromanagement and too early reporting without involvement of the performer
  3. Village market – lack of organisation and forward planning no set criteria for performance. Performance based on hear say and action may be delayed - after discussion with the performer and other team members
  4. Family - outcomes based on loyalties and emotional feelings. Judgment of performance based on relationships and negotiations with the team and performer

Personal Reflections

  • Organisational changes in the NHS mean that GPs have become living memory of the time past – is it frozen culture of the NHS?
  • A pause and reflection to consider personal, professional and organisational culture may help understand why what was acceptable yesterday has become unacceptable today
  • The factors influencing change in the culture are important to understand as answers may lie in sensitive engagement with these factors
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