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Cultural Discord in a Medical Context: A Challenge for Physicians

Wachtler, Caroline LU (2006) In Lund University Faculty of Medicine Doctoral Dissertation Series
Abstract
Physician and patient do not meet as equals in the consultation. It is the responsibility of the physician to actively work for better communication in order to provide equitable health care for all individuals. Immigrant patients are a vulnerable group, shown in studies all over the world to have less access to care, fewer opportunities for health, and poorer health compared to majority populations. One barrier to equitable care may be cultural discord between patient and physician that hinders communication.



The aim of this dissertation was to explore the role of the physician in cultural discord. Two seemingly disparate areas were examined: the primary care sector and the medical school environment. By focusing on the... (More)
Physician and patient do not meet as equals in the consultation. It is the responsibility of the physician to actively work for better communication in order to provide equitable health care for all individuals. Immigrant patients are a vulnerable group, shown in studies all over the world to have less access to care, fewer opportunities for health, and poorer health compared to majority populations. One barrier to equitable care may be cultural discord between patient and physician that hinders communication.



The aim of this dissertation was to explore the role of the physician in cultural discord. Two seemingly disparate areas were examined: the primary care sector and the medical school environment. By focusing on the clinical environment of the primary care sector, the first part of this dissertation aims to uncover both what the patient and what the doctor bring to the consultation. In the second part of the dissertation, focus on the doctor was intensified by concentration on the pedagogic environment that forms the doctor.



In the clinical environment, patients? health status does depend on background. However, there are variations both within and between groups that make it difficult to generalize on the basis of background for a specific individual patient. Physicians need skills to address cultural background in order to ensure good communication and equity of care for all patients, but their skills are insufficient. While physicians do aim to focus on the individual patient in consultation, they do not address differences in cultural background between themselves and the patient in their consultations. Communication problems based on difference in cultural background are therefore difficult to solve.



Insufficiency in skills for addressing cultural background in the consultation was seen to be a structural problem located in the medical school environment. These skills are not a consequent part of the curriculum, and are not subject to examination. Furthermore, when an attempt was made to introduce these skills to medical students they were understood as outside of and lower status than medical knowledge. Students therefore did not come to understand these skills or learn to use them.



This dissertation shows that the role of the physician in cultural discord is problematic. Physicians do not address existing cultural discord in the clinical environment, and in the medical school environment they do not learn how to address cultural discord. Cultural discord can hinder to communication between physician and patient. In order to improve possibilities for equitable care, the challenge for physicians is to learn to address cultural discord both in the clinic and in the medical school. (Less)
Abstract (Swedish)
Popular Abstract in Swedish

Läkaren har en viktig roll när det gäller att tillförsäkra människor vård på lika villkor. Mötet mellan läkaren och patienten präglas alltid av maktobalans. Studier världen över visar att invandrarpatienter är en sårbar grupp eftersom invandrare generellt har sämre tillgång till vård, sämre förutsättningar för hälsa och sämre hälsotillstånd jämfört med majoritetspopulationerna. En barriär mot likvärdig vård kan vara kulturella skillnader mellan läkare och patient som hindrar kommunikation. Läkaren bär ansvaret för att aktivt arbeta för bättre kommunikation.



Syftet med avhandlingen var att utforska läkarens roll vid olikhet i kulturbakgrund. Två till synes olika områden... (More)
Popular Abstract in Swedish

Läkaren har en viktig roll när det gäller att tillförsäkra människor vård på lika villkor. Mötet mellan läkaren och patienten präglas alltid av maktobalans. Studier världen över visar att invandrarpatienter är en sårbar grupp eftersom invandrare generellt har sämre tillgång till vård, sämre förutsättningar för hälsa och sämre hälsotillstånd jämfört med majoritetspopulationerna. En barriär mot likvärdig vård kan vara kulturella skillnader mellan läkare och patient som hindrar kommunikation. Läkaren bär ansvaret för att aktivt arbeta för bättre kommunikation.



Syftet med avhandlingen var att utforska läkarens roll vid olikhet i kulturbakgrund. Två till synes olika områden undersöks: primärvården och läkarutbildningen. Genom att fokusera på primärvårdens kliniska verksamhet har första delen av avhandlingen som syfte att visa både vad invandrarpatienten och vad läkaren tar med sig till mötet. I avhandlingens andra del är fokus på läkarens roll förstärkt genom undersökningen av den pedagogiska miljön som formar läkaren.



I den kliniska verksamheten spelar bakgrund roll för patientens hälsotillstånd. Men det finns skillnader både mellan och inom grupper som gör det svår att generalisera om en enskild individs hälsa grundat på bakgrund. Kulturell bakgrund är en faktor av många som kan påverka hälsa. Läkare behöver kunna hantera kulturell bakgrund för att säkra god kommunikation och likvärdig vård för alla, men till viss del saknar de redskap för att kunna göra det. Läkare har som mål att fokusera på individen i konsultationen men tar inte upp kulturella skillnader som visar sig mellan dem själva och deras patienter. Kommunikations-problem som baseras på skillnader i kulturell bakgrund är därför svåra att ta itu med.



Bristen på redskap för att bemöta kulturell bakgrund i konsultationen har sitt ursprung i strukturella problem i läkarutbildningen. Läkarstudenterna undervisas och bedöms inte på ett konsekvent sätt när det gäller kompetens för att bemöta kulturskillnader. Undervisning om sådana redskap uppfattas som utanförliggande och av lägre status än medicinsk kunskap. Studenter uppnår därför inte kompetens att förstå och att använda sådana redskap.



Avhandlingen visar att läkarens roll vid kulturella skillnader är problematisk. Läkare tar inte upp kulturella diskrepanser i den kliniska verksamheten. På läkarutbildningen lär studenterna sig inte hur man kan gå till väga för att ta upp kulturella olikheter. Kulturella skillnader kan hindra kommunikation mellan läkare och patient. Därför kan brister i kompetens vara ett hinder för vård på lika villkor. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • professor Westman, Göran, Inst för folkhälsa och klinisk medicin, enheten för allmänmedicin, Umeå universitet.
organization
publishing date
type
Thesis
publication status
published
subject
keywords
ethnology, medical training, Allmän medicinsk utövning, medicinsk utbildning, Cultural anthropology, General practice, Folkhälsa, epidemiologi, epidemiology, Public health, Equity in health, Communication, Medical education, Kulturantropologi, etnologi, Social medicine, Socialmedicin, samhällsmedicin, Cultural difference
in
Lund University Faculty of Medicine Doctoral Dissertation Series
pages
150 pages
publisher
Department of Clinical Sciences, Lund University
defense location
Lilla Aulan, Medicinskt forskningscentrum, ing 59, Universitetssjukhuset MAS, Malmö.
defense date
2006-09-29 09:00:00
ISSN
1652-8220
ISBN
91-85559-22-9
language
English
LU publication?
yes
additional info
id
0607c254-3808-470e-83f7-02ed853043c8 (old id 547206)
date added to LUP
2016-04-01 16:15:16
date last changed
2019-05-22 05:54:58
@phdthesis{0607c254-3808-470e-83f7-02ed853043c8,
  abstract     = {Physician and patient do not meet as equals in the consultation. It is the responsibility of the physician to actively work for better communication in order to provide equitable health care for all individuals. Immigrant patients are a vulnerable group, shown in studies all over the world to have less access to care, fewer opportunities for health, and poorer health compared to majority populations. One barrier to equitable care may be cultural discord between patient and physician that hinders communication.<br/><br>
<br/><br>
The aim of this dissertation was to explore the role of the physician in cultural discord. Two seemingly disparate areas were examined: the primary care sector and the medical school environment. By focusing on the clinical environment of the primary care sector, the first part of this dissertation aims to uncover both what the patient and what the doctor bring to the consultation. In the second part of the dissertation, focus on the doctor was intensified by concentration on the pedagogic environment that forms the doctor.<br/><br>
<br/><br>
In the clinical environment, patients? health status does depend on background. However, there are variations both within and between groups that make it difficult to generalize on the basis of background for a specific individual patient. Physicians need skills to address cultural background in order to ensure good communication and equity of care for all patients, but their skills are insufficient. While physicians do aim to focus on the individual patient in consultation, they do not address differences in cultural background between themselves and the patient in their consultations. Communication problems based on difference in cultural background are therefore difficult to solve.<br/><br>
<br/><br>
Insufficiency in skills for addressing cultural background in the consultation was seen to be a structural problem located in the medical school environment. These skills are not a consequent part of the curriculum, and are not subject to examination. Furthermore, when an attempt was made to introduce these skills to medical students they were understood as outside of and lower status than medical knowledge. Students therefore did not come to understand these skills or learn to use them.<br/><br>
<br/><br>
This dissertation shows that the role of the physician in cultural discord is problematic. Physicians do not address existing cultural discord in the clinical environment, and in the medical school environment they do not learn how to address cultural discord. Cultural discord can hinder to communication between physician and patient. In order to improve possibilities for equitable care, the challenge for physicians is to learn to address cultural discord both in the clinic and in the medical school.},
  author       = {Wachtler, Caroline},
  isbn         = {91-85559-22-9},
  issn         = {1652-8220},
  language     = {eng},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University Faculty of Medicine Doctoral Dissertation Series},
  title        = {Cultural Discord in a Medical Context: A Challenge for Physicians},
  year         = {2006},
}