Interpersonal Relationships/ Communication

The official spoken language in China is Mandarin. Other dialects spoken include Cantonese, Taisonese, Taiwanese, Teochew, Fukienese, Hakka, Shanghainese and Hainanese.

Chinese 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 information.

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.

In 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.

Time

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.

Names

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.