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

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.