Eliciting the Patient’s Perspective: General Approach

Courtesy, respect, and thoughtfulness are particularly valued in the Japanese culture and these would be appreciated during an assessment.

It would be preferable, and more respectful, to call an elder by his or her last name with the appropriate suffix, rather than to call the elder by his or her first name.

A traditional Japanese elder may not volunteer information, and thus respectful inquiry might be helpful to elicit pertinent clinical information.

Some traditional Japanese elders may feel that pain should be endured because stoicism is highly valued. They must “gaman” or bear it and not complain. This may be rooted to some extent in Buddhism that teaches that life is full of suffering. Hardship and suffering may also be considered to build character.

In family meetings with a Japanese family, keep in mind the level of acculturation of different family members. More traditional family members might find open disagreements of care plans and goals unsettling. They may find this akin to bringing shame on the family name or losing “face” especially as this may reveal discord in the family. Traditional Japanese family members most likely will not voice their opinions, if they disagree. If the more acculturated family members speak out and the more traditional family members do not say much, there is a chance that the meeting, might appear to have gone well in the eyes of the casual observer, when in actuality, it has not.

An empathetic, blameless, problem solving approach, especially in counseling situations, would work better than a direct, blunt approach, as the traditional Japanese, in general, are indirect and non- confrontational.

Another behavior that may be observed is that of “enryo.” An elder may hesitate or refuse information or assistance initially, even if needed or desired, so as not to appear aggressive or greedy. However, the individual’s attitude may be changed if the invitation is pursued and encouraged.