2.2 Analysing communication problems

Below are two very different responses to Case Study 1.

1. The main cause of the ‘communication problem’ was the Bangladeshi woman’s poor grasp of spoken English, which meant she was unable to communicate her needs clearly or to understand what was being said to her during her stay in hospital. She probably lacked confidence in herself, either because of her language difficulties or because of her cultural background. Perhaps the hospital could have done more to provide facilities to support her, but she also has a responsibility to improve her English, and maybe undergo some kind of confidence-building process to improve her ability to cope with the dominant culture.

2. The communication ‘problem’ arose because the hospital failed to address the indirect and direct racism inherent in its practices. Indirect discrimination was evident in the failure to take account of the diverse needs of patients, for example by ensuring bilingual workers or interpreters are available for the main community languages in the area. Direct racism was apparent in the way in which the two nurses ignored this particular patient. In addressing this problem, the hospital needs to ensure that all staff are trained in anti-racist practice and that positive steps are taken to ensure that all patients are treated equally, regardless of their ethnic, gender or other identities.

What is the main difference between these two responses, and how do they reflect contrasting approaches to issues of ‘difference’ and communication? One answer to this question is that the first approach locates the ‘problem’ in the patient herself and in the needs that derive from her ethnic and cultural background, while the second approach locates the problem in the racist attitudes and practices of the hospital. Of course, it could be argued that there is an element of truth in both responses, and that there is no need to choose between them. It may be the caseboththat the Bangladeshi woman has specific communication needs because of her cultural backgroundandthat part of the problem arises from the inadequate response of the institution to that identity. However, presenting the two approaches in this contrasting, if rather simplistic, way helps to demonstrate two fundamentally competing ways of understanding the nature of ‘difference’ – whether of ethnicity, gender or disability – and its link with issues of interpersonal communication.

Much of the discussion about issues of diversity in the context of health and social care has tended to concentrate on the apparent difference in communication styles or communication needs of particular groups, such as black people or disabled people. In the case study, there seemed to be a fairly clear-cut ‘difference’ related to the Bangladeshi woman’s ability to speak English, although the first response also suggested ‘needs’ related to confidence and cultural skills. However, even where spoken English is not a problem, there is often an assumption that members of particular ethnic groups (or women, or disabled people) have specific communication ‘styles’ or ‘needs’, simply because they belong to that group. An article by Theodore Dalrymple in the Anthology suggests an assumption that Indian women tend to be emotionally inexpressive. The clear implication being that this style of communicating – or, more accurately, failure to communicate – was directly related to their ethnicity and gender. Dalrymple also made generalisations based on age about the communication styles of older and younger British people, characterising the former as emotionally reticent and the latter as over-emotional. Other broad generalisations are often made about the ways in which people with learning disabilities communicate, and about their communication needs.

The response to the existence of these apparent differences is often to provide specific facilities that enable better communication with particular groups, such as offering interpreters for non-English speakers or installing communication aids for some groups of disabled people. Beyond this, there is often an emphasis on training staff in ‘cultural awareness’ and in ‘cross-cultural communication’, which is designed to make workers aware of the diverse communication styles and needs of specific groups. The response may also include offering training in language skills, or more broadly in social and communication skills, for particular groups of service users. So, for example, women may be offered assertiveness training, or people of Asian origin may be taught confidence-building skills.

However, this raises fundamental questions about the nature of cultural and other ‘differences’. Are there really significant differences in communicating styles and needs between groups, based for example on ethnicity or gender? If so, what is their origin, and what is the most appropriate response? Is there an alternative way of viewing difference in relation to questions of interpersonal communication?