Different cultural expectations and conventions result in varying types of surgeon-patient relationships in both East and West. When occurring outside of a person's usual cultural context, application of local norms may feel unfamiliar, inappropriate, and frustrating.

In the words of Dr. Stephen Tucker, an American physician who first practiced in Los Angeles and then throughout East and Southeast Asia before settling in Singapore,

"Practicing in the US, and Los Angeles in particular, is very different than practicing in Asia. The most striking difference is patient-doctor communication.

In the US, there is a more shared approach in the decision making process, where the doctor engages the patient, i.e. "these are my opinions, these are your options, tell me what you think".

In Asia, patients expect the doctors to make strong recommendations based on their expert opinion, so the dialogue tends to be more one-way than two-way."

Consultation with even excellent surgeons in (or from) Asia may sometimes feel too short (5-10 minutes), if not curt or rude, to a Western patient accustomed to the give-and-take of in-depth discussion, ample time for questions and answers, and careful weight given to personal preferences over a surgeon's routine "stock" approach.

While a known issue in the East, there are, of course, plenty of Western doctors who are also insufficient communicators by virtue of personality, choice, or overwork. In the West, however, cultural expectations and prevailing practice tend to keep this shortcoming under better control.

In any case, preoperative interaction is an excellent indicator of postoperative interaction. With elective surgery, it is always possible to hop off of a perceived assemby line and walk next door to another doctor. There is no good reason (including saving a few dollars) to ever undergo care in the absence of acceptable education, respectful discussion, and joint decision-making.