Doctor's ignorance of cultural dimensions puts patient at risk! Same for nurse!

An American doctor on staff at a major Boston MA hospital expressed concern upon realizing that a Filipino nurse was improperly using a particular machine to treat a patient. He instructed the nurse on the proper procedure and asked if she understood. She said she did. Two hours later the patient's condition deteriorated because the nurse had continued to administer the treatment improperly. The doctor more sharply queried the nurse, and she again affirmed her understanding of the procedure.

The doctor did not know that Filipino culture is very hierarchical (see Hierarchy vs Ad Hoc). He did not understand it is the responsibility of a subordinate NOT to call attention to a shortcoming in a superior. Based on her cultural assumptions, she could not tell the doctor that she did not understand without implying that he had given her poor instructions and thus cause him to lose face. The doctor, based on his cultural assumptions, expected "open communication"; he expected the nurse to say whether she understood his instructions and to ask questions if she did not. He considered it a sign of incompetence to assume responsibility for a patient's care without fully understanding the treatment procedure.

On the nurse's side, she felt she was put in an embarrassing and stressful situation, she could not tell the doctor his instructions were bad. Even worse from her perspective, the doctor had not given her a way to express her lack of understanding. The nurse had expected the doctor to ask her to describe her new understanding of the procedure. This would have given her a way of showing she still did not understand without having to say the directions were confusing. The nurse did not know the doctor's culture was very ad hoc. She did not understand the doctor would not take it as a personal affront if she said his explanation was unclear.