Beyond Language Barriers: An Integrative Review of the Cognitive and Cultural Determinants of Doctor-Patient Communication in Malaysia

Abstract

Background: Communication difficulties in multicultural healthcare settings such as Malaysia are frequently attributed to language barriers; however, misunderstanding often persists even when doctors and patients share a common language. This suggests that clinical dissonance is not merely linguistic but conceptual. Aim: This integrative review examines theoretical scholarship to explore the deeper cognitive and cultural mechanisms that shape doctor-patient interaction, with particular attention to how patients may become effectively ‘voiceless’ during clinical encounters due to misalignment in Explanatory Models (EMs). Methods: Adopting the methodology of Whittemore and Knafl (2005), this review synthesises diverse literature from Social Constructionism, medical anthropology and cognitive linguistics. The analysis integrates work on EMs and Conceptual Metaphor Theory (CMT) to identify points of convergence relevant to hierarchical and medically pluralistic contexts. Results: The analysis reveals a critical theoretical gap: while EMs describe what patients believe about illness (content), CMT explains how such beliefs are cognitively structured (mechanism) yet these perspectives are rarely examined together. In the Malaysian context, communication breakdowns frequently arise when patients’ culturally grounded metaphors, specifically those related to angin (wind) and panas (heat), are literalised or overridden by biomedical frameworks. Conclusion: On this basis, the paper proposes the Conceptual-Anthropological Framework (CAF) as an integrative model. By foregrounding metaphorical reasoning as a central dimension of meaning-making, CAF offers a lens to better understand and address the ‘silent’ non-adherence often observed in medically pluralistic societies.