37.1480, Reviews: Exploring Clinical Communication in Asia: Jack Pun & Audrey Chan (2025)

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LINGUIST List: Vol-37-1480. Sun Apr 19 2026. ISSN: 1069 - 4875.

Subject: 37.1480, Reviews: Exploring Clinical Communication in Asia: Jack Pun & Audrey Chan (2025)

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Date: 18-Apr-2026
From: Teresa Wai See Ong [ongtesa at gmail.com]
Subject: Applied Linguistics, General Linguistics: Jack Pun & Audrey Chan (2025)


Book announced at https://linguistlist.org/issues/36-3784

Title: Exploring Clinical Communication in Asia
Subtitle: Culture, Discipline, Best Practice and Clinicians’ Voices in
the Chinese Context
Series Title: Bloomsbury Studies in Language and Healthcare
Publication Year: 2025

Publisher: Bloomsbury Publishing
           http://www.bloomsbury.com/uk/
Book URL:
https://www.bloomsbury.com/exploring-clinical-communication-in-asia-9781350298118/

Author(s): Jack Pun & Audrey Chan

Reviewer: Teresa Wai See Ong

Summary
Written by Jack Pun and Audrey Chan, Exploring Clinical Communication
in Asia begins with an introduction chapter. The content is divided
into two sections: (i) Insights from interviews with clinicians and
(ii) Skills for effective clinical communication. Section one consists
of nine chapters where interviews covered a broad range of specialised
fields, such as Traditional Chinese Medicine (TCM) to oncology,
neurology and veterinary science. Section Two consists of four
chapters where the role of communication between doctors, nurses and
patients were discussed and recommendations were provided. The book
ends with a reference list and index.
In the Introduction chapter, Pun and Chan state that research on
clinical communication is growing in the East Asia context due to
governments’ aim to improve healthcare services. Nevertheless,
challenges are faced, such as high patient turnovers and expectations
and pressure from upper management. As building of trust is necessary
for clinician/nurse-patient relationships, the adoption of Western
models in a non-English speaking context, such as East Asia, is
inappropriate because of the differences in socio-cultural elements.
In the case of Hong Kong, Cantonese is the most commonly spoken
language while English is the language of prestige in many fields. In
everyday life, most people often code-switch between both languages.
Increasing in these days is the use of Mandarin Chinese due to
immigration. This situation causes code-switching between three
languages, a challenge for many clinicians and nurses. In this book,
the authors aim to develop an appropriate communication model that
suits the Hong Kong context so that a therapeutic relationship can be
achieved, and patients’ safety can be ensured.
Chapter 2 discusses the communication styles of TCM practitioners. TCM
practitioners are considered to have better communication skills
because TCM emphasises patients’ personal experiences and overall
physical body condition as it relates to the whole system (Chung et
al, 2009). When TCM practitioners talk to patients, they listen to
them attentively and prioritise interpersonal matters over physical
discomfort to achieve a holistic and positive outcome. Hence, Western
Medicine (WM) clinicians are encouraged to learn from TCM
practitioners in terms of understanding patients’ needs
comprehensively to promote better facilitation between family members
and healthcare workers. In Chapter 3, the authors continue to examine
the approach used by TCM practitioners when assessing patients (Gu,
1999): (i) observing visible signs, (ii) examining the voice,
heartbeat and oral cavity odour, (iii) asking about symptoms and
medical history, (iv) checking the pulse and (v) diagnosing. Because
of such a patient-centred, five diagnosis approach, studies have shown
that patients seeing TCM practitioners receive better emotional and
interpersonal support when compared to WM (Zhang & Sleebom-Faulkner,
2011). In sum, the ‘touch’ approach used by TCM practitioners, which
includes visible, auditory, verbal and physical examination, goes
beyond physical treatment and values the social wellbeing of patients.
Chapters 4 to 6 focus on the communication skills of WM clinicians in
different fields. In Chapter 4, Pun and Chan explore End-Of-Life (EOL)
communication between oncologists, palliative care providers and
patients in a wide range of Chinese settings. EOL communication is
difficult in the Chinese context because talking about death
symbolises bad luck. As Chinese people believe in ‘good death’,
ineffective communication may lead to negative results, including
sabotaging the quality care of patients’ final moments. Oncologists
usually face difficulties when relaying information about terminal
illness, dying patients or ‘shocking’ news to family members.
Therefore, to improve communication related to EOL matters, some key
communication skills are recommended: (i) communicating indirectly,
(ii) considering families’ opinions, (iii) conversing about EOL
matters at appropriate timings, (iv) informing patients of the natural
course of illness in various stages, (v) promoting health literacy
using standardised content coverage, (vi) increasing cultural
awareness, (vii) implementing patient-centred care, (viii) encouraging
patients to communicate their needs, (ix) nurses guiding patients and
families to make EOL decisions and (x) borrowing the concepts from TCM
to carry out in-depth conversations between clinicians, families and
patients.
In Chapter 5, the authors look at another specialist field, neurology,
which encounters many challenges in communication due to the lack of
training in palliative care communication (Mehta et al., 2018).
Interviews have shown that neurologists find it difficult to break bad
news to patients and family members because it takes away their hope
of recovery. Such communication involves handling emotions, making
decisions and meeting families’ expectations. At certain times,
patients’ conditions deteriorate suddenly, which complicates the
communication process. During diagnostics and formulating treatment
plans, it is crucial for neurologists to take into account patients’
and family members’ body language to ensure they understand the
medical information provided.  Neurologists learn that, due to Chinese
cultural beliefs, many families refuse to accept patients’ ‘unable to
recover’ state and thus, they avoid discussing organ donation. To
facilitate better communication, suggested methods are to avoid using
medical jargon, increase access for support and promote empathetic
patient-centred care.
Chapter 6 continues with a discussion related to surgeon’s
communication challenges. With the advancement of surgical
technologies, the lack of communication in the operating theatre may
lead to complicated errors. Team leadership, cooperation and
orientation are crucial to building mutual trust and achieving
high-reliability teamwork, leading to quality treatment and patient
safety. Due to urgency and emergency in surgical settings, a key
challenge for surgeons is pre-operative consultation, including
explaining the risk and after-effects, and obtaining consent from
patients. Hence, it is vital for surgeons to understand that
communication between themselves and patients is a two-way process.
Nevertheless, surgeons find it a challenge to facilitate communication
with family members related to Do Not Attempt Resuscitation (DNAR)
decisions; and this has to be done in a timely manner. In the
post-COVID era, surgeons have also begun using technological tools to
speak to family members to ensure patients’ comfort and emotional
support.
Chapter 7 turns to nursing communication, which is significant for
providing quality care to patients. Because of cultural and linguistic
differences, Douglas (2011) suggest 12 standard practices to improve
nursing communication. Employing these practices, nurses should not
make cultural assumptions about patients’ heritage as mutual
understanding is needed in the high stress environment. Additionally,
they should equip themselves with bilingual medical terminologies and
plan treatments to accommodate to patients’ needs. AI-driven models
have been used to help mitigate nurses’ burdens while fostering a more
holistic patient care. In Chapter 8, Pun and Chan examine
communication with elderly patients in a related field, geriatric
care. Effective communication in geriatric care is critical for
formulating treatment plans for the elderly due to their multiple
complex health issues and chronic symptoms. Studies, such as Chan and
Pun (2007), have revealed that many Hong Kong nursing home patients
had difficulties discussing matters related to EOL plans, which prompt
an urgent need for medical practitioners and researchers to have a
comprehensive understanding of the cultural differences in EOL
communication. It is vital to encourage effective communication among
healthcare professionals and families when implementing an Advance
Care Plan (ACP) for terminally ill patients so that a holistic EOL
care can be achieved. Families’ emotions and patients’ goals have to
be addressed carefully in the Asian and Chinese contexts due to
diverse cultural backgrounds. The authors also highlight the
importance of choice of words when dealing with families to facilitate
mutual understanding.
The last chapter in Section One deals with veterinary medicine.
Failure in communication between veterinarians and clients may lead to
health, safety and legal issues (Kurtz et al., 2017). Therefore,
effective communication needs to be promoted between three parties –
veterinarians, pets and pet owners, particularly young children. As a
result, communication training is being emphasised in veterinary
education (Gaida et al., 2018). Like clinicians in medical
institutions, veterinarians find that delivery of bad news is a
challenge and hence, pet owners’ emotions need to be taken into
account during conversations to reduce risk of trauma. The COMFORT
(communication, orientation, mindfulness, family, ongoing, reiterative
messages and team) model (Villagran et al., 2010) and SPIKES (setting,
perception, invitation, knowledge, empathetic response and summary)
protocol (Baile et al., 2000) are commonly employed in veterinary
communication. Nevertheless, there remains a lack of research on
veterinary communication, particularly in bilingual or multilingual
contexts, which presents opportunities for future research.
Moving onto Section Two, Chapter 10 explores the complexities of
communication in high-risk medical environments, such as Intensive
Care Units (ICUs) and Emergency Departments (EDs), in multilingual and
multicultural Hong Kong. In such settings, communication openness is
essential to ensure patient safety and should be done with trust,
honesty and support. Unfortunately, due to the rigid hierarchy system
that is often practised in Asia, junior healthcare workers always keep
silence and are worried about speaking up, causing patient safety to
be at risk. To avoid medical errors, hospitals need to provide
training sessions and ensure healthcare workers’ safety, regardless of
ranks, when voicing their ideas, concerns or pointing out errors
without humiliation, shame or guilt (Edmondson, 2012). Essential
aspects of communication in such settings include (Ng et al., 2017):
(i) clinician interactions across different ranks and departments,
(ii) timely communication, (iii) clinicians’ understanding of
patient’s health goals, (iv) effectiveness of team’s leadership and
(v) overall effectiveness of the units and departments.
In Chapter 11, the authors address the challenges faced in primary
care settings within the Chinese context and the importance of
cultural competence while integrating technology to improve patient
communication. The usual challenges encountered are time constraints,
language barriers, cultural differences and asymmetrical power
dynamics. In primary care settings, a doctor is often overloaded with
patient consultations, limiting their time for in-depth discussions.
In Hong Kong, doctors usually code-switch between Cantonese, English
and Mandarin Chinese with patients, leading to potential risks when
translating certain medical terminologies. Family involvement is
another challenge that doctors face because some patients may defer
communication with family members, creating additional layers of
complexities during communication. At many times, patients also feel
less authoritative to ask questions to the doctors due to hierarchical
structure, leaving them feeling misunderstood. These challenges need
careful attention for solving so that patients and doctors can have
mutual understanding and build trust and rapport to ensure effective
treatment.
Chapter 12 unpacks the role of communication in nursing handover
within the Chinese context. Because of authority and social harmony
matters, many nurses are hesitant to ask questions during handover
even though the information provided is unclear. Such situations lead
to misunderstandings and errors in patient’s care. To help nurses
organise and deliver patient information in a precise, clear and
logical manner, a recommended communication protocol, ISBAR
(introduction, situation, background, assessment, recommendation), is
adopted (Burgess et al., 2020). During handover, nurses are encouraged
to refine their communication skills using the following principles
(Eggins et al., 2016): (i) asking questions and clarifying clinical
information, (ii) providing updated and accurate information, (iii)
engaging in interactive communication, (iv) having active listening
and using non-verbal cues and (v) building confidence in
communication.
The final chapter wraps up by summarising the communication strategies
listed from the twelve chapters to promote healthy and effective
communication skills between patients, family members and healthcare
professionals in Hong Kong. It is noted that in Asia including Hong
Kong, family members play an important role during decision making and
patients prefer clinicians to be more dominant during medical
discussions (Pun et al., 2018). Nonetheless, clinicians and nurses are
facing various challenges, including a hierarchical system in medical
settings, language barriers, and difficulties when speaking about EOL
matters and the subject of death. Therefore, the authors conclude that
it is significant for healthcare workers to adopt communication
strategies that promote empathy and cultural competency. For future
studies, the authors recommend examining the effectiveness of
technologies in real time clinical interactions.
Evaluation
This book aims to report the many challenges faced by healthcare
professionals, ranging from senior clinicians to junior nurses, when
communicating with patients in various Asian settings and recommend
communication frameworks that are able to facilitate and improve their
communication skills. Using Hong Kong as a case study, it begins by
investigating how TCM practitioners have more effective communication
styles, which offer more interpersonal support and satisfaction to
patients. TCM practitioners are known for being good listeners because
the TCM approach focuses on holistic care for patients’ physical body,
rather than addressing specify health issue(s) only. Past studies have
shown that WM clinicians should establish a trust rapport with
patients via their excellent listening skills to speed up patients’
recovery process. Thus, they are urged to pick up communication
techniques from TCM practitioners in terms of understanding their
patients more comprehensively.
To achieve the aim of this book, the authors examine various
specialised fields in WM. They conduct interviews with clinicians in
oncology, palliative care, neurology and surgery, where similar
findings are found. Clinicians have difficulties speaking with
patients and family members about DNAR decisions, EOL discussions and
sudden changes in terminally ill patients that may lead to death,
because they are considered sensitive matters within the Chinese
culture. To clarify, it is vital to prepare a person for a ‘good
death’ from the Chinese perspective. Nurses encounter similar
challenges in their conversations with patients and family members ,
who may have difficulties digesting ‘bad’ news. Furthermore, nurses
have heavy workloads in highly stressful working environments. The
common culture of code-switching and code-mixing in Hong Kong adds
another layer of complexity to communication issues. In veterinary
medicine, veterinarians state that it is never easy to break ‘bad’
news to pets and pet owners, including children. All in all, failure
to communicate effectively may lead to health, safety and legal
issues.
To address the stated issues, the authors propose several strategies
including structured communication training for both clinicians and
healthcare professionals, inclusive leadership practices and sensitive
cultural tools to enhance patient-doctor/nurse interactions,
communication within team/department and shared decision making in
critical care environments. Junior healthcare professionals should not
be afraid of speaking up and asking questions for clarification – this
situation will avoid embarrassment and unnecessary work pressure. Such
strategies are hoped to improve both patients’ and healthcare
professionals’ wellbeing.
What I find interesting in this book is the inclusion of veterinary
medicine, which is commonly neglected. Nevertheless, it is unfortunate
that only one chapter focusing on this field is included, because
there needs to be more discussion of pets and pet owners. Animals’
conditions deteriorate quickly when they are sick and veterinarians
have to act swiftly to save their lives. As animals do not communicate
in the same way as humans, careful observations have to be made to
discern signs of distress and symptoms of various health issues.
Therefore, I wish that deeper examination could be made within this
field. Despite that, the authors are to be congratulated because they
have addressed critical concerns that every patient and healthcare
professional faces in everyday life.
References
Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., &
Kudelka, A. P. (2000). SPIKES – a six-step protocol for delivering bad
news: Application to the patient with cancer. The Oncologist, 5(4),
302-311.
Burgess, A., Van Diggele, C., Roberts, C., & Mellis, C. (2020).
Teaching clinical handover with ISBAR. BMC Medical Education, 20, 1-8.
Chan, H. Y., & Pang, S. M. (2007). Quality of life concerns and
end-of-life care preferences of aged persons in long-term care
facilities. Journal of Clinical Nursing, 16(11), 2158-2166.
Chung, V. C. H., Lau, C. H., Wong, E. M., Yeoh, E. K., & Griffiths, S.
M. (2009). Perceived quality of communication amongst outpatients in
western and traditional Chinese medicine clinics in a Chinese
population. Healthy Policy (New York), 90(1), 66-72.
Douglas, M. K. (2011). Standards of practice for culturally competent
nursing care: 2011 update. Journal of Transcultural Nursing, 22(4),
317-333.
Edmondson, A. C. (2012). Teaming: How organisation learn, innovate and
compete in the knowledge economy. A Wiley Imprint.
Eggins, S., Geddes, F., & Slade, D. (Eds.). (2016). Effective
communication in clinical handover – from research to practice
(Patient safety, 15). De Gruyter Mouton.
Gaida, S., Härtl, A., Tipold, A., & Dilly, M. (2018). Communication
identity in veterinary medicine: A grounded theory approach.
Veterinary Record Open, 5, 1-11.
Gu, Y. G. (1999). A brief introduction to the Chinese health care
system. Health Communication, 11(3), 203-208.
Kurtz, S. M., Draper, J., & Silverman, J. (2017). Teaching and
learning communication skills in medicine. CRC Press.
Mehta, A., Najjar, S., May, N., Shah, B., & Blackhall, L. (2018). A
needs assessments of palliative care education among the United States
adult neurology resident programs. Journal of Palliative Medicine, 21,
1448-1457.
Ng, G. W. Y., Pun, J. K. H., So, E. H. K., et al. (2017). Speak-up
culture in an intensive care unit in Hong Kong: A cross-sectional
survey exploring the communication openness perceptions of Chinese
doctors and nurses. BMJ Open, 7, e015721.
Pun, J., Chan, E. A., Wang, S., & Slade, D. (2018). Health
professional-patient communication practices in East Asia: An
integrative review of an emerging field of research and practice in
Hong Kong, South Korea, Japan, Taiwan and Mainland China. Patient
Education and Counselling, 101(7), 1193-1206.
Villagran, M., Goldsmith, J., Wittenberg-Lyles, E., et al. (2010).
Creating comfort: A communication-based model for breaking bad news.
Communication Education, 59, 220-234.
Zhang, X. Q., & Sleeboom-Faulkner, M. (2011). Tensions between medical
professionals and patients in Mainland China. Cambridge Q Health
Ethics, 20(3), 458-465.
About the author
Teresa W. S. Ong is a research fellow at the Early Mental Potential &
Wellbeing Research (EMPOWER) Centre, Nanyang Technological University,
Singapore. She focuses on project management and provides assistance
for several projects that aim to create home-based intervention tools
for high-risk children to support their early cognitive development
while guiding parents in real time.



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