Doctor–patient communication: a comparison of the USA and Japan

要旨

BACKGROUND: Little is known about the differences and similarities between doctor-patient communication patterns in different cultures. OBJECTIVES: The aim of this study was to examine communication patterns of doctor-patient consultations in two different cultures, namely the USA and Japan, and to elucidate linguistic differences and similarities in communication. METHODS: This cross-sectional study used quantitative discourse analysis from linguistics to compare 40 doctor-patient consultations: 20 out-patient consultations of five physicians in the USA and 20 out-patient consultations of four physicians in Japan. The main outcomes measured were time spent in each phase of the encounter, number of categorized speech acts, distribution of question types and frequencies of back-channel responses and interruptions. RESULTS: The average length of doctor-patient encounters was 668.7 s in the USA and 505 s in Japan. US physicians spent relatively more time on treatment and follow-up talk (31%) and social talk (12%), whereas the Japanese had longer physical examinations (28%) and diagnosis or consideration talk (15%). Japanese doctor-patient conversations included more silence (30%) than those in the USA (8.2%). The doctor-patient ratios of total speech acts were similar (USA 55% versus 45%; Japan 59% versus 41%). Physicians in both countries controlled communication during encounters by asking more questions than the patients (75% in the USA; 78% in Japan). The Japanese physicians and patients used back-channel responses and interruptions more often than those in the USA. CONCLUSIONS: While doctor-patient communication differed between the USA and Japan in the proportion of time spent in each phase of the encounter, length of pauses and the use of back-channel responses and interruptions, physician versus patient ratios of questions and other speech acts were similar. The variations may reflect cultural differences, whereas the similarities may reflect professional specificity stemming from the shared needs to fill the information gap between physician and patient. Adequate awareness of these differences and similarities could be used to educate clinicians about the best approaches to patients from particular cultural backgrounds.

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