Barriers to Health Care for Chinese in the Netherlands

This study examines utilisation of the Dutch health care system by Chinese people in the Netherlands as well as their attitudes to the system, paying special attention to mental health. Information was gathered by semistructured interviews (n = 102). The main issues investigated are access, help-seeking behaviour, and quality of care. Results showed that most respondents used Dutch health care as their primary method of managing health problems. Inadequate knowledge about the system and lack of Dutch language proficiency impede access to care, in particular registration with a General Practitioner (GP). Users complained that the care given differed from what they expected. Results also showed that the major problems are to be found in the group coming from the Chinese-speaking region. Western concepts of mental health appear to be widely accepted by Chinese in the Netherlands. However, almost half of our respondents believed that traditional Chinese medicine or other methods can also help with mental health problems. The provision of relevant information in Chinese appears to be important for improving access. Better interpretation and translation services, especially for first-generation migrants from the Chinese-speaking region, are also required

GPs’ Interactional Styles in Consultations with Dutch and Ethnic Minority Patients

The aim of this study was to examine interactional styles of general practitioners (GPs) in consultations with Dutch patients as compared to ethnic minority patients, from the perspective of level of mutual understanding between patient and GP. Data of 103 transcripts of video-registered medical interviews were analyzed to assess GPs’ communication styles in terms of involvement, detachment, shared decision-making and patient-centeredness. Surveys were used to collect data on patients’ characteristics and mutual understanding. Results show that overall, GPs communicate less adequately with ethnic minority patients than with Dutch patients; they involve them less in decision-making and check their understanding of what has been discussed less often. Intercultural consultations are thus markedly distinguishable from intracultural consultations by a lack of adequate communicative behavior by GPs. As every patient has a moral and legal right to make informed decisions, it is concluded that GPs should check more often whether their ethnic minority patients have understood what has been said during the medical consultation

Verbal analysis of doctor-patient communication

A microscopic analysis of doctor-patient communication in the general practitioner's surgery is presented. Verbatim transcripts of 85 medical interviews, audiotaped in a natural situation were analysed. The effects of type of complaint, patient gender and physician gender on the process of verbal communication were assessed. This study focused upon the relational aspects of communication, using Stiles' Verbal Response Mode coding system (VRM), and, to a limited extent, upon the content of patient's complaints--whether they were primarily somatic or of a psychosocial nature. The hypothesis of an asymmetrical relation between physician and patient was confirmed. Results partially confirmed the hypothesis that interviews of psychosocial patients take more time than those of somatic patients. There was also some evidence that psychosocial patients try to exert more control over the conversation as compared to somatic patients. Male and female patients differed in the way they elaborated their complaints. When telling their complaints, women referred more to persons (family, friends, colleagues) than did men. In case of male GP's, the interviews of female patients took more time than those of male patients. The largest differences were between male and female physicians. In agreement with the hypothesis males were more imposing and presumptuous (giving more advisements and interpretations). Female GP's were more attentive and non-directive (giving more subjective and objective information and acknowledgements). The medical interviews of female GP's took more time than the interviews of their male colleagues. The results are discussed in the light of theoretical concepts of harmony and discrepancy with respect to doctor-patient communication and theories about gender differences.doctor-patient communication conversation analysis gender differences somatization disorders

Religion and worldview in the work of Marie Muller-Lulofs, a pioneer in Dutch social work

Social workers nowadays are confronted with recurrent issues about religion and spirituality when in contact with diverse client groups. This was also the case in the beginning of the profession around 1900, in Europe as well as in the US. This study analyses the work of a Dutch pioneer in social work, Marie Muller-Lulofs (1854–1954) and presents the religious and worldview aspects of her reflections on social work. Her standard work Van mensch tot mensch (From person to person) of 1916 forms the basic text for theory-driven content analysis by applying the seven-dimension model of worldview of Ninian Smart: doctrine/philosophy, organisations, ethics, stories, experiences, rituals and materials. Results show that Muller-Lulofs makes a strong plea for a secular profession. Social-economic approaches are on the foreground. And yet, the methods, skills and professional attitudes she describes are substantially accounted for in religious and spiritual terms. This is mainly done by introducing narratives and metaphors derived from Christian and Buddhist traditions. It is concluded that Muller-Lulofs uses religion and spirituality in a non-dogmatic and non-prescriptive way, but as a source of inspiration to underpin the new profession. Her approach is relevant for current issues in social work in multicultural societies

Effects of Psychiatric Consultation on Medical Consumption in Medical Outpatients With Abdominal Pain

A randomized controlled clinical trial was conducted in an outpatient clinic of internal medicine to test the hypothesis that a protocol of cooperation and communication between internist and general practitioner, sustained with psychiatric consultation, would reduce medical consumption in a group of medical outpatients with abdominal pain (N = 106). A reduction in medical consumption could not be demonstrated. However, a great variation in protocol adherence was found, partly related to the severity of the psychological problems. There is some evidence that the protocol, if restricted to cases with more severe psychiatric comorbidity, might reduce medical consumption

The effect of educational intervention on intercultural communication: results of a randomised controlled trial

BACKGROUND: Due to worldwide migration to Western countries, physicians are increasingly encountering patients with different ethnic backgrounds. Communication problems can arise as a result of differences in cultural backgrounds and poor language proficiency. AIMS: To assess the effectiveness of an educational intervention on intercultural communication aimed to decrease inequalities in care provided between Western and non-Western patients. DESIGN OF STUDY: A randomised controlled trial with randomisation at the GP level and outcome measurements at the patient level. SETTING: General practice in Rotterdam. METHOD: Thirty-eight Dutch GPs in the Rotterdam region, with at least 25% of inhabitants of non-Western origin, and 2407 visiting patients were invited to participate in the study. A total of 986 consultations were finally included. The GPs were educated about cultural differences and trained in intercultural communication. Patients received a videotaped instruction focusing on how to communicate with their GP in a direct way. The primary outcome measure was mutual understanding and the secondary outcomes were patient's satisfaction and perceived quality of care. The intervention effect was assessed for all patients together, for the ‘Western’ and ‘non-Western’ patients, and for patients with different cultural backgrounds separately. RESULTS: An intervention effect was seen 6 months after the intervention, as improvement in mutual understanding (and some improvement in perceived quality of care) in consultations with ‘non-Western’ patients. CONCLUSIONS: A double intervention on intercultural communication given to both physician and patient decreases the gap in quality of care between ‘Western’ and ‘non-Western’ patients