The official spoken language in China is Mandarin. Other
dialects spoken include Cantonese, Taisonese, Taiwanese, Teochew,
Fukienese, Hakka, Shanghainese and Hainanese.
dialects are not phonetic; they are tonal. The characters
in written Chinese express words, thoughts, or principles.
Chinese characters used in writing are the same for all the
dialects, but are read according to the dialect spoken. Chinese
can be written with full traditional characters, or with simplified
characters. The Chinese traditionally read vertically downwards
from right to left, but some newspapers are now being printed
with characters from left to right.
The Chinese patient may avoid eye contact. Communication
is often non-verbal and indirect as a means of avoiding conflict,
and should not be perceived as indifference. The Chinese culture
has been described as a “high context” culture, one in which
words alone do not convey the message. It relies on presumptions
shared by people, non-verbal cues like body language, and
the very situation in which the interaction occurs. In contrast,
American communication is more direct, verbally expressive
and “low context.”
Outward expression of emotions and sexual relationships (hugging,
kissing in public, a man and woman holding hands) are uncommon.
On meeting someone, the Chinese may nod or bow slightly, and
may shake hands. They may stand to greet an older person or
offer a chair. A smile is acceptable.
The Chinese respect for authority may lead them to defer
all health decisions to the professional. This may be especially
true of new immigrants. They may not ask questions. The health
professional may need to ask the same question in different
ways in order to elicit their feelings, especially in discussing
issues such as advance directives. A response to yes-or-no
questions may be a nod to both, or a “yes;” this may NOT indicate
understanding, just that the person has heard you. Ask the
person to repeat back the information given. Because they
value privacy, there may also be a reluctance to share personal
Courtesy is highly valued, and the patient may decline an
offer made just to be polite. Patients may also not wish to
voice disagreement, even when there is no intention to comply
with instructions. A smile may also indicate embarrassment.
most Chinese families, the family comes first before the individual.
The Chinese value experience; they may consult with an older
member of the family for guidance. As a sign of respect, a
family member may call an older person who is close to them
“granny,” “uncle,” “auntie,” etc., even when the person may
not be a blood relative. Health care workers should establish
the relationships among patients and those who accompany them
rather than assume they are related. It is also important
for caregivers to address elders by formal title (“Mr.,” “Mrs.”)
and their family name rather than their first name.
Chinese and many other Asians view time as “polychronic,”
in which individuals adhere less rigidly to time frames. Therefore,
they may not be punctual for appointments and may hesitate
in making decisions concerning time. They may want to wait
for an auspicious day to do an important activity. For example,
4 o’clock, or the 4th day of the month may be perceived as
unlucky as “4” when pronounced in Cantonese sounds like the
word for death.
In Chinese tradition, the family or surname comes first.
In the example “Lim De Xian,” “Lim” is the family name, “De”
is the generation name and “Xian” is the person’s given name.
However, many Chinese living in the U.S. have adopted the
Western style of placing the surname last. To avoid errors,
ALWAYS ASK and CONFIRM patients’ surnames and given names.