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You should adapt your attending style to your patient’s style as much as possible
rather than expecting patients to adapt to yours. When you are uncertain about the
effects of your attending behaviors, ask your patient what feels comfortable or
uncomfortable, and observe the impact of your nonverbals. For instance, if you are
sitting close and your patient seems uncomfortable, try moving your chair back a bit
and see if that helps. Also keep in mind that you should vary your attending behav-
iors based on both a patient’s immediate needs and his or her cultural background.
As mentioned earlier in this chapter, you might pull your chair closer to a patient
who is crying. You would slow the rate of your speech and become less animated
with an extremely anxious patient. You would be careful about touching patients
whose backgrounds prohibit physical contact with nonfamilial members of the
opposite sex (e.g., members of some Muslim sects). Some couples who seek coun-
seling will prefer that you communicate with the husband who then translates to his
wife; for instance, in some Asian and Middle Eastern couples, the husband may
prefer that you communicate through him rather than speaking directly to his wife
(Lafans et al. 2003 ).
Some studies offer helpful insights about the role that culture might play in
attending behaviors and communication in genetic counseling. The results of these
studies suggest variability in patients’ verbal and nonverbal communication. Some
relevant examples are summarized below.
3.6.1 Verbalizations/Language
Ishii et al. ( 2003 ) noted that there are cultural differences in attention to certain
nonverbals. Specifically, they asserted that “Americans primarily attend to verbal
content [while] Asians pay closer attention to vocal tone...” (p. 39). In their study
they found American participants had an easier time ignoring vocal tone than verbal
content, while the reverse was true for Japanese participants. They also found that
Tagalog-English bilingual participants in the Philippines were biased toward attend-
ing to vocal tone regardless of the language spoken.
Cura ( 2015 ) discusses cultural meanings of nonverbal communication among
Filipinos. He asserts that “Filipino culture is characterized as less verbal, and non-
verbal cues usually provide meaningful signals during communication” (p. 221).
Patient silence may represent unwillingness to disagree with other family members
about a decision and wish to preserve family harmony. The author suggests health-
care providers attend to patient body language, such as bowing one’s head, lack of
verbal response (silence), blankly staring, or a lack of eye contact as cues they are
reluctant to express their views and/or are experiencing uncertainty. Cura also notes
Filipino patients may wish to rely upon health-care providers’ expertise. They may
seek their recommendations and adhere to them in “the midst of uncertainty and
unfamiliarity with the genetic condition... [even when] they are actually unsure of
[their] answers/decisions” (p. 219).
3 Listening tofiPatients: Attending Skills