Table 2.

The Hofstede theory model with examples of its application in clinical practice in different cultures

Hofstede theory domain	Explanation	Examples of countries	Example in clinical practice
Power distance	In large organisations, which commonly have hierarchical structures, authority and power, actual or perceived, is almost by definition distributed unequally, those at the top having most. Such inequality is accepted by the leaders and the led.	High ‘power distance’ countries are France and India.Low ‘power distance’ countries are Austria and Israel.	In a societal culture of high ‘power distance’, the patient perceives the doctor to be in a superior position; the doctor in turn accepts this, directs the consultation, which then becomes unidirectional. 37In a culture of low ‘power distance’, however, the patient and doctor regard themselves as equals, hence consultation becomes a bidirectional discussion. 37
Uncertainty avoidance	Members of a group commonly react, or as perceived to an outsider to react, to unexpected or unforeseen situations in accordance with prevailing culture.	Strong ‘uncertainty avoidance’ countries are Japan and Greece.Weak ‘uncertainty avoidance’ countries are Denmark and Hong Kong.	An example of ‘uncertainty avoidance’ is time made available per patient during clinics or ward rounds. In a strong ‘uncertainty avoidance’ culture, a rigid time management structure prevails, thus each patient is given precisely the same time and approached in the same manner. Doctors from countries with a high ‘uncertainty avoidance’ profile may find building a relation with a patient through empathy and non-verbal communication, such as eye contact, difficult. 37
Individualism versus collectivism	Cultures where ‘individualism’ is the norm are characterised by loose connections, thus allowing a person to act on his/her own initiative.In ‘collectivism’, in contrast, individuals in the group prefer to be instructed on what they can and cannot do.The emphasis in individualism is on being a good leader, while in ‘collectivism’ culture it is about being a good member.	‘Individualistic’ cultures are found in the USA and UK, while ‘collectivism’ is found in Peru and Iran.	Doctors from countries with high ‘collectivism’ may appear to be less assertive, which may become obvious when working in a country like the UK. 37
Masculinity versus femininity	This dimension reflects less the gender per se and more the culture associated with it. In ‘masculine’ countries assertiveness and competitiveness are acceptable, whereas in ‘feminine’ cultures the preferences are more on caring and improving the quality of life. The ‘feminine’ society treat male and female gender equally.	‘Masculine’ countries are Japan and USA.‘Feminine’ countries are the Netherlands and the Nordic countries.	Consultation and communication with patients and relatives is guided by societal perception of the role of men and women – whether both are treated equally or differently.

Statements are referenced, except those which are the authors’ personal views.