ABSTRACT
Communication is essentially a social phenomenon and although it is driven by cognition, sometimes associated with intelligence and thus perceived to be ‘determined’, it is socially loaded and context dependent. This chapter begins by exploring what we mean by communication; disentangling traditional distinctions between language (what is language per se) and parole (the use of language, and the behaviour that we experience and share with others). Culture is transferred through communication often at the individual level. However, it is clear that different cultures communicate differently with one another and this can present challenges when interacting in a culturally diverse healthcare setting. While linguistic differences make a change, they are not the whole story. For example, differences in the use of tones in person to person communication can affect the perception of the speaker.
Superficially, we all have equal access to our language, yet it is clear that some have a greater opportunity than others and we see this transpire in the types of vocabulary used, the language structures adopted, accent, and the ‘way’ that people communicate with one another, especially if there is a perceived power differential, as there commonly is between health practitioner and patient. While this is true in all consultations to some degree, it is exacerbated when the relationship is especially asymmetric, as it can be when one of the parties has a communication difficulty. With time constrained healthcare appointments, invalid assumptions can be made regarding the communicative and intellectual abilities of patients. These assumptions can be aggravated by healthcare conditions that further skew a patients communicative abilities.
This chapter aims to reflect the reality of clinical interactions with atypical communicators, considering the implications of a culturally and socially diverse healthcare context in how we communicate. It provides examples and clinical case scenarios and includes a series of exercises to draw the attention of the reader to the experiences of those with atypical communication conditions in a diverse healthcare setting.
