Module 4 – Part 2 – What to ask during the consultation

Structured cultural sensitive questions can help you to receive more detailed and relevant information and to better understand the patient in his/her context – to learn about their illness experiences, as well as their beliefs and behaviour. There are several tools that support you to facilitate further discussion and investigate what is really at stake for patients, their families, their communities, and perhaps to prescribe more appropriate treatments.

Tips for the practice summarized after Kleinman and Benson (2006):


Ethnic Identity: does it matter for the patient and is it an important part of his or her identity? 


People live and experience their ethnicity differently. It can but not necessarily must be an important part of an individuals live. Therefore, ask the patient if his or her ethnicity means to them. The patient is an individual and not a representative of a group.


What consequences does the illness have for the patient and his or her family?


The explanation may be about a variety of things including a person’s social life, resources, and religiousness. This will help you to understand the life world of the particular patient better.


Illness narrative: How does the patient understand his/her illness? What does it mean to them and how did they experience it over time? 


Both the patient and the doctor/ physician/ health care worker require openness for cultural differences and the will to engage in an exchange about why things are seen as they are. Even when the patient has lay models of the origins of his or her illness, they are still suffering and it is an ethical duty to acknowledge that even if they express it differently than you are used to.


How is the daily life of the patient? What are the stresses and what are the social support networks? What can the doctor/ physician/ health care worker do to support the patient?


For example referral to refugee aid organisations.


How does culture really influences the clinical relationship? Does it even play a role? 


Stereotyping (“the refugee”, “the Afghan”…) causes more harm than it does good. Examine and reflect on the cases individually in order to see whether an intervention based on cultural stereotypes actually works. Focusing on cultural differences with stereotypes can make your patients feel stigmatized. Not all problems in a clinical setting are rooted in culture; there often is no easy solution.

6. Think about your own culture. What is your background?    At the beginning of this module there was an exercise for you to think about your own culture. Remember what you have learnt about yourself in the interaction with your patients.


Tool for the practical encounter:

Kleinman’s model (Kleinman 1978) contains eight questions that you can ask your patients:

  Possible questions
Eliciting the patient explanatory model
  • What do you think has caused your problems?
  • Why do you think it started when it did?
  • What do you think your sickness does to you? How does it work?
  • How severe is your sickness? Will it have a long or short course?
  • What kind of treatment do you think you should receive?
Therapeutic goals and the psychosocial and cultural meaning of his illnes
  • What are the most important results you hope to receive from this treatment?
  • What are the chief problems your sickness has caused for you?
  • What do you fear most about your sickness