Cultural Discord in a Medical Context: A Challenge for Physicians

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 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.