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<opml version="2.0">
  <head>
    <title>100-02 Culture, language, stigma, and clinical communication</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Culture, language, stigma, and communication">
      <outline text="Culture and explanatory models">
        <outline text="Culture is dynamic, not traits of ethnicity"/>
        <outline text="Multiple cultures, identification shifts with context"/>
        <outline text="Cultural humility, not mastery">
          <outline text="Curiosity, self-reflection, attention to power"/>
        </outline>
        <outline text="Illness experience versus disease account"/>
        <outline text="Explanatory models may differ">
          <outline text="Ask name, fear, cause, expected help"/>
        </outline>
      </outline>
      <outline text="Coexisting practices and structures">
        <outline text="Prayer, diet, herbs, family advice, medicine"/>
        <outline text="Dismissal drives practices underground"/>
        <outline text="Uncritical acceptance misses toxicity, delay"/>
        <outline text="Respect the person, test the claims"/>
        <outline text="Structural competence: housing, labour, transport">
          <outline text="Constrained behaviour is not preference"/>
          <outline text="Document barriers, connect resources"/>
        </outline>
        <outline text="Culture must not conceal deprivation"/>
      </outline>
      <outline text="Language access and interpreters">
        <outline text="Discordance affects accuracy, consent, safety"/>
        <outline text="Trained interpreter conveys pragmatic meaning"/>
        <outline text="Family may filter or be inappropriate">
          <outline text="Children should not interpret key information"/>
        </outline>
        <outline text="Automated translation for limited tasks only"/>
        <outline text="Face the patient, first person, short segments"/>
        <outline text="Brief the interpreter, state uncertainty"/>
        <outline text="Longer translation is not inaccuracy"/>
        <outline text="Record involvement; interpreter does not consent"/>
      </outline>
      <outline text="Health literacy and clear explanation">
        <outline text="Relational capacity within a task and system">
          <outline text="Fear, pain, unfamiliar language impair anyone"/>
        </outline>
        <outline text="Universal precautions avoid shaming tests"/>
        <outline text="Few actionable ideas, numbers linked to decisions"/>
        <outline text="Teach-back tests the explanation">
          <outline text="Neutral prompt makes repair safer"/>
        </outline>
        <outline text="Return demonstration for devices, injections"/>
        <outline text="Written material reinforces dialogue"/>
      </outline>
      <outline text="Nonverbal communication">
        <outline text="Gaze, posture, distance, touch, tone"/>
        <outline text="One sign should not be overinterpreted"/>
        <outline text="Averted gaze may reflect respect, pain, trauma"/>
        <outline text="Note word-affect mismatch, ask openly"/>
        <outline text="Same level, fewer interruptions"/>
      </outline>
      <outline text="Stigma, language, and bias">
        <outline text="Labelling, separation, status loss, discrimination"/>
        <outline text="Public, anticipated, experienced, internalised">
          <outline text="Anticipated judgement delays care"/>
        </outline>
        <outline text="Person-first versus identity-first">
          <outline text="Ask or follow the person&#x27;s language"/>
        </outline>
        <outline text="Polite words cannot offset discriminatory care"/>
        <outline text="Implicit bias affects pain, credibility, referral"/>
        <outline text="Awareness training alone has limited effect">
          <outline text="Standard criteria, audited support, time"/>
        </outline>
        <outline text="Algorithms can automate disparity"/>
      </outline>
      <outline text="Trauma-informed care">
        <outline text="Trauma shapes safety, trust, control"/>
        <outline text="Disclosure not required"/>
        <outline text="Predictability, explanation before touch, choice"/>
        <outline text="Difficult behaviour may be protective"/>
        <outline text="Compatible with firm limits and urgent action"/>
      </outline>
      <outline text="Interviewing, empathy, and bad news">
        <outline text="Open questions invite narrative"/>
        <outline text="Closed questions clarify detail"/>
        <outline text="Reflection and summaries allow correction"/>
        <outline text="Move deliberately and signal transitions"/>
        <outline text="Empathy without shared feeling or agreement"/>
        <outline text="Validation without confirming false belief"/>
        <outline text="Premature reassurance feels dismissive"/>
        <outline text="Bad news: privacy, time, support, facts">
          <outline text="Assess understanding, warn, speak directly"/>
          <outline text="Euphemism confuses, excess detail not retained"/>
        </outline>
      </outline>
      <outline text="Conflict, confidentiality, and purpose">
        <outline text="Conflict reflects unmet needs, fear, prior harm"/>
        <outline text="De-escalation: calm, space, limits, choices">
          <outline text="Safety first when violence is imminent"/>
        </outline>
        <outline text="Apology before technical explanation"/>
        <outline text="Explain limits of confidentiality"/>
        <outline text="Shared background does not guarantee trust"/>
        <outline text="Communication improves epistemic quality"/>
      </outline>
    </outline>
  </body>
</opml>
