What matters to patients and physicians in their cross-cultural clinical encounters: an ethnographic study and a medical ethics perspective

Abstract

Given the current increase of global migration movements and its implications for healthcare systems (Carballo et al. 2017), it is important to better understand how patients with migration background and healthcare professionals experience their shared clinical encounters and the specific factors that can influence communication and interaction between them. Here, reflections on ‘culture’ and biases as well as the topics of language barriers and mutually perceived problem areas have proved to be fruitful. Furthermore ethical aspects surrounding the perceived issues have to be explored. If not addressed, language barriers can affect communication and interaction in cross-cultural clinical encounters and quality of care negatively. Although the need to address language barriers is widely acknowledged, little is known about how linguistic complexities shape decision-making for or against the use of interpreter services in everyday cross-cultural encounters. Also, it is crucial to explore the problem areas patients with migration background and healthcare professionals identify, and to reflect connected ethical aspects. Using an ethnographic approach, 32 migrant patients (16 of Albanian and Turkish origin, respectively) have been accompanied during their medical encounters at two outpatient clinics (using participant observation and semi-structured interviews with patients and healthcare professionals). Overall, 94 interviews with patients and healthcare professionals on how they perceived communication and interaction in their crosscultural clinical encounter were conducted. Perspectives of patients and physicians on their shared clinical encounters were triangulated regarding the topics ‘getting-by with limited language proficiency’ as well as ‘difficulties and challenges’. In one case a patient’s, a physician’s and the researcher’s perspective have been compared. Results show that reflecting on ‘culture’ and one’s own biases is an essential tool promoting insights about what can be relevant in a cross-cultural clinical encounter. In the context of language barriers, the assessment of the language situation, the involvement of interpreters, and dealing with conversational limits are important topics to physicians and patients shaping decision-making for or against the use of interpreter services. Furthermore, patients and physicians identified the topics of ‘patient behaviour in relation to doctors’ advice’ and ‘relationship issues’ as meaningful problem areas in their encounters. What makes perceived issues relevant from a medical ethics perspective is that potential ethical implications of perceived difficulties (e.g. regarding how shared decisionmaking can be made in the context of relationship issues or questions of responsibility in the context of the social embeddedness of health) were not identified during clinical routine. A deeper understanding of cross-cultural clinical encounters and ethical aspects of everyday cross-cultural clinical routine is provided by presenting patients’ and physicians’ perspectives on their shared encounters focusing on the interplay between ‘culture’, stance and biases, the complexities of decision-making in the context of language barriers and difficulties and challenges that can arise in cross-cultural settings.