Culture and healthcare – Marilyn R. Gardner

In 2008 HSBC Bank unrolled a brilliant advertising campaign. Called “Different Values”, the campaign showed three pictures side by side.

Sometimes it was three identical pictures with a different word across each picture:

oriental-rug

Other times it was three different pictures with the same word across each picture:

The point of their campaign was that we all have different values. The head of marketing at the time, Tracy Britton, said “HSBC’s global footprint gives us the insight and the opportunity not only to be comfortable, but confident in helping people with different values achieve what’s really important to them.” Ideally people would choose HSBC to achieve “what was really important to them”.

Prescribing different meanings to words or having different concepts of the same item is a huge piece of miscommunication. If I think of a Persian carpet as decor, and my Muslim friend sees it as a sacred space for prayer, then there is possibility for offense when she sees it in my front hallway, subject to all the traffic – shoes, dirt, clutter – that comes with a busy household.

A couple of years ago I heard a story that perfectly illustrates this confusion in communication.

A nurse who is a diabetic educator was working with a woman from Brazil who had diabetes. We’ll call her Fernanda. Fernanda was doing well at understanding the need for recording blood sugars during the day, taking insulin based on those blood sugars, and keeping a food journal. At regularly scheduled times she would come to the diabetic educator for review of her journals and further diabetic teaching. Those appointments generally took place early morning.

One day the appointment was a bit later. When Fernanda got to the office the nurse chatted with her, and, as was customary, did a finger stick to check her blood sugar. At a number of 300, the blood sugar was off the charts high. They both looked at each other in alarm. Fernanda’s blood sugars had been consistently in the high 100’s or low 200’s. This was clearly a change.

The nurse began to question her — Did you do anything differently? What did you eat last night? Did you eat anything this morning?

Yes she had eaten something this morning but it was only a piece of bread.

Did the bread have anything on it? Was there honey on it? Sweet jam? Was it just one piece? The questions tumbled over each other. She was determined to get to the root of this extraordinarily high blood sugar.

Yes – there was something shiny on the bread and the bread was thick.

Did you eat it at home?

No – she had bought it at the cafeteria in the hospital.

The nurse’s eyes lit up. “Let’s go to the cafeteria and you can show me what you ate!” she said.

So they went on a field trip. All the breads were lined up on the far right side of the cafeteria. They walked over to the breads and stood before them. In true American style of ‘plenty’ there was a vast array of breads before them.

Had she eaten the white or wheat breads? No. Next in line were the English muffins, both whole wheat and white. No, not those either. Sweet breads? No.

And then they got to the thick, sweet, gooey, yummy, cinnamon rolls.

“That’s it! That’s what I ate! That’s the bread I had!” The nurse began to laugh and shake her head. It made complete sense that a 4 inch diameter, thick, sugar-filled cinnamon roll would send the woman’s blood sugar soaring.

When is a piece of bread not a piece of bread?

I love this story for many reasons but here are a couple of them: First – as a nurse it’s a reminder to me to dig deeper, especially when working with someone from a culture that is different from mine. Second – it’s a great lesson on cross-cultural communication. I might see cinnamon rolls – but you see bread.

What are your stories of miscommunication around words and phrases? I would love to hear them through the comments!