Their view: difficulties and challenges of patients and physicians in cross-cultural encounters and a medical ethics perspective

Kristina Würth,Wolf Langewitz,Stella Reiter-Theil,Sylvie Schuster

doi:10.1186/s12910-018-0311-4

Kristina Würth, Wolf Langewitz + Show 2 more

Open Access

https://doi.org/10.1186/s12910-018-0311-4

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Abstract

BackgroundIn todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved.MethodsWe accompanied 32 migrant patients (16 of Albanian and Turkish origin each) during their medical encounters at two outpatient clinics using an ethnographic approach (participant observation and semi-structured interviews with patients and healthcare professionals). Overall, data of 34 interviews with patients and physicians on how they perceived their encounter and which difficulties they experienced are presented. We contrasted the perspectives on the difficult aspects and explore ethical questions surrounding the involved issues.ResultsPatients and physicians describe similar problem areas, but they have diverging perspectives on them. Two main themes were identified by both patients and physicians: >patients’ behaviour in relation to doctors’ advice< and > relationship issues<.ConclusionsA deeper understanding of the difficulties and challenges that can arise in cross-cultural settings could be provided by bringing together healthcare professionals’ and patients’ perspectives on how a cross- cultural clinical encounter is perceived. Ethical aspects surrounding some of the difficulties could be highlighted and should get more attention in clinical practice and research.

Highlights

In todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities
The foreign population’s increase and its diversification [2] is reflected in Swiss healthcare settings, such as at the University Hospital Basel (USB) where ‘non-Swiss’ patients made up 35.6% of all outpatients [3] in 2011
Literature shows that having a migration background is going along with risks to experience disadvantages regarding health and healthcare provision

Summary

Introduction

In todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved. Group attributions hold difficulties and ambiguity as both, migrants, as well as respective local populations, are anything but homogenous social groups. Literature shows that having a migration background is going along with risks to experience disadvantages regarding health and healthcare provision. Diverse aspects are mentioned in the literature as contributing to inequalities in health and healthcare between migrant- and local populations. Vague and static cultural concepts, which “reduce individual behaviour to broad stereotypical formulas, or at least encourage such stereotyping,” [18] are still often to be observed in the medical context [18, 19]

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