Objective: This study investigated at a country level how cross-national differences in medical communication can be understood from the first four of Hofstede's cultural dimensions, i.e. power distance, uncertainty avoidance, individualism/collectivism and masculinity/femininity, together with national wealth.
Methods: A total of 307 general practitioners (GPs) and 5820 patients from Belgium, Estonia, Germany, Great Britain, the Netherlands, Poland, Romania, Spain, Sweden and Switzerland participated in the study. Medical communication was videotaped and assessed using Roter's interaction analysis system (RIAS). Additional context information of physicians (gender, job satisfaction, risk-taking and belief of psychological influence on diseases) and patients (gender, health condition, diagnosis and medical encounter expectations) was gathered by using questionnaires.
Results: Countries differ considerably form each other in terms of culture dimensions. The larger a nation's power distance, the less room there is for unexpected information exchange and the shorter the consultations are. Roles are clearly described and fixed. The higher the level of uncertainty avoidance, the less attention is given to rapport building, e.g. less eye contact. In 'masculine' countries there is less instrumental communication in the medical interaction, which was contrary to expectations. In wealthy countries, more attention is given to psychosocial communication.
Conclusion: The four culture dimensions, together with countries' wealth, contribute importantly to the understanding of differences in European countries' styles of medical communication. Their predictive power reaches much further than explanations along the north/south or east/west division of Europe.
Practice implications: The understanding of these cross-national differences is a precondition for the prevention of intercultural miscommunication. Improved understanding may occur at microlevel in the medical encounter, as well as on macrolevel in pursuing more effective cooperation and integration of European health care policies.