Representatives of different cultures have diverse values, demonstrate varying behaviors, adopt different perspectives, and in some cases even varied susceptibility to diseases.
Cultural differences are more profound than individual variations due to patient illness, social class, economic status, or educational background. A popular view among health professionals is that showing respect is the key to resolving absolute majority of cultural problems. Unfortunately, this simple recipe is not always effective: the profound differences between Chinese and American cultures presented below demonstrate that respect is only one aspect of cultural competence.
Chinese culture is characterized by specific attitude toward self. Thus, American Peter Hessler claims this to be the biggest difference between the West and what he observed while teaching literature in one of the Chinese provinces: "the sense of self seemed largely external; you were identified by the way that others viewed you" (Hessler 2001: 282). This difference is also reflected on the famous Geert Hofstede's model of cultural value orientation.
The model consists of five dimensions, one of which is individualism. This dimension reveals the degree to which the society reinforces individual or collective achievement. In case the IDV index is high, individuality and individual rights are emphasized by the society: citizens in such societies rely primarily upon themselves, and form a little number of closer relationships. If the IDV is low, the society is characterized by high degree of collectivism and closer relationships between individuals: such societies reinforce extended families and collectives with responsibility being shared between all members.
The difference between the United States and China is literally striking on this dimension: the U.S. ranks at 91 on Hofstede's scale (100 points is maximum) while China - at only 15, which is the lowest score (Hofstede, 2003). The high ranking for the United States indicates a society with a more individualistic attitude and relatively loose bonds with others. Self-reliance is the most distinctive feature of such society. The low ranking of Chine indicates and absolutely different system of attitudes toward self and implies much closer bonds with others.
Consequently, American health practitioners adopt more patient-centered approach putting emphasis on autonomy of the patients and their "right to know" precisely because American culture paying relatively little attention to social groups (including families) they belong to. This attitude is not common in Chinese health care because it contradicts the cultural orientation toward collectivism. The custom in Chinese culture is to first inform a patient's family about a prognosis, especially when the prognosis is bad. After that the family makes a decision about the information the patient himself should receive. Members of Chinese and other similar cultural groups may feel that it would be wrong and insensitive to inform the patient about the risks associated with his illness: "this would only cause the patient great stress and even hasten death by destroying hope" (Galanti, 2000:335). Treatment decisions made by Chinese patients are strongly influenced by the family or social groups they are affiliated with. Therefore, involvement of family members in the process of treatment is likely to make the therapy