I just completed working with an organization whose employees interact with every foreign medical graduate who wants to become licensed in the US, the majority of whom are non-native speakers of English. Our training focused on developing the cultural competence and communication skills to provide the best customer service.

Working with over 100 employees organization-wide identified 3 common areas of conflict they had with the soon-to-be doctors in America. The conflict and differences are consistently between the low context American workplace and the applicants from high context cultures, in the following areas:

1. Gender – Issues of gender were a common theme. Men who could not get what they wanted from female employees often asked to “speak to a man” or “speak to the manager” only to find the manager was a woman, too. Some men outright refused to work with a woman. Men often called to demand confidential information about or to try and undermine female family member applicants.

2. Status – Doctors in general and those from high context, hierarchical cultures in particular, believed themselves to be of higher status than the employee who was helping them. Status is viewed through family name, connections, or job title. Status conflicts also extended to gender, with men viewing themselves of greater status. Employees also felt that applicants with high concepts of their status were often rude and demanding in interactions.

3. Cheating –The concept of cheating varies by culture and one shouldn’t assume all people share the same definition. Cheating for this organization included providing false documentation or unacceptable practices during licensing exams. American culture has very strict definition of cheating and plagiarism, which is more fluid in other cultures. Specific definitions with concrete examples and consequences must be communicated.

A doctor’s personal cultural beliefs and values do not stop once she or he becomes licensed in the US. It is reasonable to assume these carry over into the health care workplace.  Of course not every foreign doctor from a high context culture fits this profile. However, healthcare organizations must acknowledge and address the need for cultural competency training for many of their foreign medical professionals.