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From the 2024 1st Quarter Pressure

Richard "Gus" Gustavson, MPH, RN, CHRNC, CWCN, CHT, CRT

Communication challenges among healthcare professionals and the patient

As the world gets smaller and moving from country to country becomes more accessible, our challenge as a healthcare professional is to meet the needs of individuals from various cultures and ethnic backgrounds who present with a medical issue or concern. To meet their needs, we have to use our best clinical judgment and tailor how we communicate our diagnosis and propose therapies to meet their cultural needs and expectations.

Some sources have identified 7,000 languages in the world. In addition, to add to the challenge, there are over 4,000 religions, not to mention the sects of the main religions. We also have to consider unique healthcare practices and beliefs of ethnicities worldwide.

One of the critical aspects of care includes empathy.

"Empathy, i.e., the ability to understand the personal experience of the patient without bonding with them, constitutes an important communication skill for a health professional, one that includes three dimensions: the emotional, cognitive, and behavioral. It has been proven that health professionals with high levels of empathy operate more efficiently as to the fulfillment of their role in eliciting therapeutic change. The empathetic professional comprehends the needs of the health care users, as the latter feel safe to express the thoughts and problems that concern them." (Moudatsou, M. 2020)

It is essential to recognize that in addition to our fundamental commitment to meet the standard of care and provide care that is sensitive to the wishes of the patient, there are regulatory requirements such as Title VI of the Civil Rights Act of 1964, (, Section 1557 of the Affordable Care Act, (, Americans with Disabilities Act](, Title III of the Americans with Disabilities Act, (, and Joint Commission Standards, (

Various sources for guidance on cultural issues such as Cultural and Religious Sensitivity, A Pocket Guide for Health Care Professionals, Galanti, G. 2018 published by Joint Commission Resources. In addition, we have access to the Internet.

Another resource states:

Culture and health are inextricably linked. Culture influences health and illness behaviour, including how illness is perceived and experienced, what symptoms are reported, what remedies are sought, and who is consulted in the process  (Srivastava, R. 2023)

No "cookbook" addresses all the permutations we may have to address. How do we effectively care for these individuals? We have the clinical knowledge, skills, and tools, but how do we apply these appropriately in today's multicultural environment?

The first step is to address the communication issue. Whether the patient is proficient in English, we must recognize that they may not be familiar with medical "lingo." Part of this first step is testing the patient's understanding of the information they were provided during the informed consent, pre-treatment education, and safety requirements specific to hyperbaric oxygen treatments. One technique is referred to as the "Teach Back Technique." After providing information, the healthcare professional asks the patient and the family to repeat what they were told in their own words. This technique will allow you to clarify any misunderstanding to assure compliance.

The next step is to ensure that cultural and ethic-based healthcare beliefs and practices are accommodated as much as possible. One technique is called the "The 4 C's of culture."

The key factor in achieving cultural competence is learning to ask the right questions to elicit an understanding of the patient's point of view. (Galanti, G. 2018, Pg 4).

The 4 C's

    1. "The first C is for "Call," What do you call your problem? This reminds the clinician to ask, "What do you think is wrong?"
    2. "The second C is for "Cause." What do you think caused your problem?"
    3. "The third C is for "Cope." How do you cope with your condition?"
    4. "The fourth and final C is for "Concerns." What concerns do you have regarding the condition? This should address questions such as "How serious do you think this is?" "What potential complications do you fear?" "How does it interfere with your life or your ability to function?" (Galanti, G. 2018)

However, as initially identified, the multicultural, multiethnic world can be complicated and adversely affect health care delivery. Hopefully, this brief column will either confirm that you have addressed these issues in your delivery of hyperbaric oxygen therapy or provide additional information on how to improve your delivery to the ethnically and culturally diverse population that may present to your practice.


Moudatsou, M., Stavropoulou, A., Philalithis, A., & Koukouli, S. (2020). The Role of Empathy in Health and Social Care Professionals. Healthcare (Basel, Switzerland)8(1), 26.

Srivastava, Rani Hajela. (2023) The Health Care Professional's Guide to Cultural Competence - E-Book (p. 5). Elsevier Health Sciences. Kindle Edition.

Galanti, Geri-Ann. Caring for Patients from Different Cultures: Case Studies from American Hospitals, 2018. (p. 4). University of Pennsylvania Press, Inc.. Kindle Edition. 

Galanti, Geri-Ann. Caring for Patients from Different Cultures: Case Studies from American Hospitals, 2018. (p.4-8). University of Pennsylvania Press, Inc.. Kindle Edition.