Degree of Acculturation and Strength of Ties with Traditional Beliefs

Respect/Protection of Elders/Filial Piety

May lead to not informing family members of illness to “protect” them, reluctance to place them in long term care, and reluctance to discuss Advance Directives (McLaughlin & Braun, 1998).

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Role of Superstition

It may be considered bad luck to talk about illness or death, as it may cause it to happen (McLaughlin & Braun, 1998). This might be a traditional Chinese belief, but not that of Buddhism. There may be considerable variation among such attitudes depending on the geographical area, degree of acculturation, and strength of ties with traditional beliefs.

For example, in Taiwan, the Hospice-Palliative Care Act, enacted in 2000, was designed to respect the end of life medical wishes of patients with incurable illnesses, safeguard the rights of these patients, and provide clinical guidelines for healthcare workers responsible to provide end of life care. Self-determination was deemed a core element of human dignity and decision making. (Fang 2009)

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Psychosomatic Integration

Somatic complaints as indicators of mental illness. Somatization in traditional Chinese culture is an acceptable way to express emotional distress and obtain attention; a patient may be perceived as a “hypochondriac” (Jung, 1998). More recently, however, Mak & Zane (2004) have explored the phenomenon of somatization in relation to the experiences of acculturation, stress, support, and distress. They found that Chinese Americans’ level of somatic symptoms, impairment related to somatization, and percentage of meeting the Somatic Symptom Index criterion were comparable to those found in other populations.

Regression analyses showed that anxiety, depression, gender, age, education, stressors, and support were significantly related to somatization, (ps < 0.05). Somatizers tended to perceive themselves with poor health and utilized both Western and indigenous Chinese medicine.

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Formalistic Conformity/Deference to Authority

Patients may not verbalize anxiety or doubts regarding their medical care in front of medical personnel, but then not follow through with treatments. This can be misinterpreted as patient noncompliance or insincerity. This deference to authority can also be misconstrued as lack of interest in participating in medical decision-making. It is a good idea to encourage the patient to briefly summarize the plan of care, and to ask questions so that their concerns can be addressed.

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Decision Makers

Traditionally expected to be husband or oldest son. However, this may change depending on the degree of acculturation as well as the patient’s life experiences. Thus, it is a good idea to ask the patient whether he/she would want to make their own decisions about health care, or defer to other family representatives. It is also important to clarify that physicians cannot act as surrogate decision-makers for the patient.

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“Saving Face”

This is the concept of “keeping one’s good reputation.” (Definition from This may make it harder for patients to admit to having problems, especially mental health problems. Patients who want to save face for the physician may not want to question or disagree with the physician to their face, thus resulting in patients not coming back for follow up, “doctor shopping”, or not taking medications as prescribed.

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Concepts of Yin/Yang and “Chi” or “Qi” (Vital Energy)

Traditional Chinese Medicine (TCM) is the most common form of healthcare among first generation immigrants, which is a majority of the Chinese-American population (Wang, C. 1996). TCM is mainly guided by a holistic concept of health that emphasizes achieving balance and harmony throughout bodily systems. Many elderly Chinese American people use TCM and allopathic medicine in a complementary fashion.

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