How to avoid ‘IMG Culture Shock’, and why you shouldn't cross an Australian nurse

4 minutes read time Categories: Overseas & Migration 05/04/2013

Arriving in another country to live and work is always exciting and challenging but it is the “unknown unknowns”  that lead to the type of culture shock that you will inevitably experience.

When I first moved to Australia from the UK it was the subtle differences between my home country and my new adopted land that caught me by surprise.

Some differences were job related. I learned early that the range of drugs on the PBS was a fraction of that of the BNF and that Australian doctors used drug brand names - not the generic names I had so studiously learned in medical school.

Other differences were social. The use of first names, or even nicknames, between junior and senior staff for example (my first boss insisted that I call him “The Poodle!”). Plus I was thrown by the sight of doctors in shorts and havaianas at work - a far cry from the white coats and ties of the NHS (this was Queensland in the 90’s).

Everything from the way patients were triaged to the level of investigation were similar, yet slightly different, requiring a settling in period to adjust to the new realities of work as a doctor in Australia.

Most differences were surmountable, even comical, but there were dangers lurking for those that were not aware of their own professional habits and prejudices.

For instance, I witnessed again and again newly arrived doctors making the fatal mistake of misjudging the collegiate nature of the relationship between nurses and doctors in Australia.

Many had come from health systems where the nursing staff were highly subordinate to the medical staff and they brought their attitudes with them. Hell hath no fury like an Aussie nurse patronised by a foreign doctor. Not only do they expect to be treated as an equal but it is in the nature of the average Aussie to be very direct and feedback was usually immediate, public and forceful.

So what advice can I give for those taking the plunge to ensure that it is not into hot water?

  • Don’t assume: It is better to work on the premise that things will be different and be pleasantly surprised when they are familiar.

  • Do more listening than talking: You will learn more when your mouth is shut and it is much harder to put your foot in it when it is closed.

  • Ask for clarification: If something is unfamiliar then ask about the 'right way' of doing things - at least as far as the locals are concerned.

  • Pay attention during your induction: these are geared to deal with people in just your situation and are developed through the experiences of those that have gone before you.

  • Find a “same culture” peer group: they will warn you of their mistakes and misunderstandings so you don’t have to go through them.

Above all make sure you retain a sense of humour. For the most part your naivety will lead to amusing, rather than unpleasant or embarrassing situations. Go with it, and laugh.

Talking of laughter - did you know that there was a town in France called "Herpes", or a Swiss toothpaste called "Candida"? Like our Facebook Page for more light-hearted medical trivia as well as finding out more about Wavelength and it's staff.

Dr John Bethell

Director, Wavelength International

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Post your comment


  • William LeMaire 08/04/2013 4:57am (6 years ago)

    That is a very nice post. I also liked the one "Etiquette for locums". I personally have done a large amount of short time (like 6 months at a time) locums work in various places around the world. I have been talked into writing a book about my multi varied experiences. It is an e book entitled: "CROSSCULTURAL DOCTORING. ON AND OFF THE BEATEN PATH". The book is available for free downloading at this link:

    if that link does not work you can Google: "CROSSCULTURAL DOCTORING" and select the format you prefer.

    I the book I describe my many culture shocks and how it all ended up to great enjoyment and satisfaction.

  • jbethell66 08/04/2013 6:55am (6 years ago)

    Thank you for bringing this to my attention, William. It seems like you have put much more thought into the subject than I have had a chance to do. Clearly a worthy read for anyone wishing to explore the topic further.

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