How do junior doctors working in a multicultural context make sense of somatisation?

Abstract

Physicians' explanatory models of commonly encountered clinical problems reflect not only formal medical training, but also personal and professional experience. In situations where formal training is absent, the clinical context of informal learning is likely to have an important influence on junior doctors' evolving knowledge and practice. The purpose of this study was to explore junior doctors' explanatory models of somatisation in the absence of formal training, and in particular the influence of working with a large proportion of immigrants (asylum seekers and refugees) on their understanding and practice. Semi-structured interviews were conducted with all 14 junior doctors working at the Geneva University Hospitals general medicine outpatient clinic. Interviews explored junior doctors' definitions, understanding and management of somatisation. Interviews were tape-recorded, transcribed verbatim and analyzed for key themes. In the absence of formal training, somatisation evoked considerable uncertainty and frustration in terms of diagnosis and management. Junior doctors' understanding of somatisation was heavily influenced by their contact with immigrant patients. They primarily attributed somatisation to psychosocial stresses related to migration and tended to label certain socio-cultural groups as more prone to somatisation than others. It is important to recognize that contextual factors have an important influence on physicians' evolving explanatory models for commonly encountered problems, especially in the absence of formal training. Results from this study suggest that formal training in management of somatisation should be offered in order to broaden junior doctors' understanding of somatisation and avoid cultural stereotyping.