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# Culture, explanatory models and interpreters

- Topic

Each person understands their illness through their culture; asking for that explanation and using professional interpreters prevents errors.

Updated Nov 5, 2026

## Key points

- Explanatory model: what the patient calls the problem, what they think caused it, what they fear and what treatment they expect.
- Cultural humility: an attitude of lifelong learning and checking one's own biases, rather than memorizing traits of each group.
- A professional interpreter is preferred; relatives, and above all children, leave out or change information and compromise confidentiality.
- With an interpreter, speak to the patient in the first person, in short sentences, and brief the interpreter beforehand.
- Colombia has 65 Indigenous languages, 2 Creole languages (of San Basilio de Palenque and of San Andrés and Providencia) and the Romani of the Rrom people.

## What it is

Culture shapes how a complaint is named, what it is blamed on, whom people consult and which treatment they accept. Kleinman separated disease, the biological process, from illness, the lived experience, and proposed questions to learn the patient's explanatory model. When no language is shared, a professional interpreter is the safe option. Colombia is a multi-ethnic, multilingual country, which makes these skills part of daily work.

## Key facts

- Colombia's native languages are protected by Law 1381 of 2010; 21 February is the National Day of Native Languages.
- Speaking Spanish does not mean it is the patient's preferred language for health matters: ask.
- Ask respectfully about traditional healers, midwives, prayer healers and home remedies, without judging, to fit them into the plan and spot interactions.
- Some Latin American cultural concepts of distress, such as susto or ataque de nervios, are explored as ways of expressing suffering.
- Record in the chart the language used, whether an interpreter was used, and of what type.

## Step by step

- ‘What do you call this problem?’
- ‘What do you think caused it?’
- ‘Why do you think it started when it did?’
- ‘What does this problem do to your body? How does it work?’
- ‘How serious is it? Will it last a short or a long time?’
- ‘What do you fear most about this illness?’
- ‘What problems has it caused in your life?’
- ‘What treatment do you think you should receive, and what result do you hope for?’

## Options for bridging a language barrier

| Option | Advantage | Risk or limit |
| --- | --- | --- |
| Professional interpreter in person | Accurate, neutral, reads the nonverbal context | Limited availability in rural areas |
| Interpreter by phone or video | Fast, many languages | Loses some nonverbal cues; needs a good connection |
| Trained bilingual staff | Knows the clinical setting | Their language level must be verified |
| Adult relative or companion | Available and trusted | Leaves out, softens or adds; breaks confidentiality |
| Child in the family | None acceptable except in a life-threatening emergency | Emotional burden, serious errors, role reversal |

## Clinical notes

- In US oncology studies, patients from minority groups more often misunderstood that their treatment was not curative: a cultural barrier is also an information barrier.
- Teach-back works through an interpreter and is the best way to check that the message got through.

## Memory aid

Before explaining the disease, ask for the patient's explanation: ‘its name, its cause, its fear and its cure’.

## Test yourself

Think of the answer, then tap the question to see it.

## What distinction did Kleinman draw between disease and illness?

Disease is the biological disorder that medicine describes; illness is the lived experience of being unwell, with its personal and cultural meaning.

## Why is a child not used as an interpreter?

Because they make errors, leave out hard topics, carry an inappropriate emotional burden, reverse family roles and break confidentiality.

## What are Colombia's two Creole languages?

That of San Basilio de Palenque (Palenquero) and that of San Andrés, Providencia and Santa Catalina (an English-based Creole).

## Whom does the clinician address when working with an interpreter?

The patient, looking at them and speaking in the first person in short sentences; the interpreter translates without summarizing or adding.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/behavioral-science/culture-explanatory-models-and-interpreters/)

## Elsewhere in DurgiPedia

- [Interviewing in special situations: interpreters and breaking bad news](https://durgical.com/en/clinical-exam/interviewing-in-special-situations-interpreters-and-breaking-bad-news/)
- [The medical interview: rapport, open questions and listening](https://durgical.com/en/clinical-exam/the-medical-interview-rapport-open-questions-and-listening/)

## Connections

## Related 5

- [Health literacy](https://durgical.com/en/behavioral-science/health-literacy/)
- [Communication skills: open questions, empathy and teach-back](https://durgical.com/en/behavioral-science/communication-skills-open-questions-empathy-and-teach-back/)
- [Models of the doctor–patient relationship and patient-centred care](https://durgical.com/en/behavioral-science/models-of-the-doctor-patient-relationship-and-patient-centred-care/)
- [The reaction to illness: sick role, illness behavior and hospitalization](https://durgical.com/en/behavioral-science/the-reaction-to-illness-sick-role-illness-behavior-and-hospitalization/)
- [Adherence: what it is and why it fails](https://durgical.com/en/behavioral-science/adherence-what-it-is-and-why-it-fails/)

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Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Communication in Cancer Care (PDQ®)–Health Professional Version](https://www.cancer.gov/about-cancer/coping/adjusting-to-cancer/communication-hp-pdq) (National Cancer Institute (US), 2025); [Tenemos 65 lenguas indígenas en Colombia, ¿cuántas reconoces?](https://www.colombiaaprende.edu.co/agenda/actualidad/tenemos-65-lenguas-indigenas-en-colombia-cuantas-reconoces-dia-nacional-de-las) (Colombia Aprende, Ministerio de Educación Nacional, 2022).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/behavioral-science/culture-explanatory-models-and-interpreters/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/culture-explanatory-models-and-interpreters/