2. The position of the physician in multilingual communication
The physician’s professional concerns are first to gather the correct information for adequate diagnosing and secondly to advise the patient in a understandable way. A common language with good proficiency of both physician and patient is necessary. Multilingualism (both of physician and patient) is a benefit in this connection. Very often the mediation of a multilingual person is necessary to bridge the gap in understanding between patient and physician. The use of interpreters varies. Very often it is a family member or acquaintance, sometimes a multilingual colleague or other healthcare professional and some countries have free professional interpreter services. The use of informal interpreters (in a GP setting mostly family members) has some advantages. They are immediately and easily available mostly and therefore save time in practice. They are familiar with the physician and have a great commitment with the patient. But in complicated diseases and treatments or relationships it can also be a disadvantage. As a result professional interpreting is required.
Language is not the only barrier in contact and mutual understanding. The cultural context of a person defines their views on health and illness, expectations towards healthcare and also the general accepted communication rules, as Arthur Kleinman1 has demonstrated so clearly. So for the medical consultation in a multiethnic patient population especially the way healthcare issues are communicated should be subject of attention. Patient’s communication needs are also different. The shared decision-making model, as a standard of good patient-physician communication during the consultation, may be applicable to the well-educated western patient but not be good patient centred communication for all (especially the non-western) patients. This requires cultural awareness of the physician, attentiveness for misunderstanding and linguistic barriers. So even the use of interpreters does not release the physician from being aware of cultural gaps. A mutual understanding between physician and migrant patient is the key word for bridging barriers in the consultation. Experiences with training physicians in multicultural communication shows that is a willingness to bridge the gaps but also lack of knowledge and often lack of competence to do so. Training of physicians has proven to be effective in improving mutual understanding between physician and patient. But also patients should be empowered to express their needs to physicians and not accept misunderstanding. Differences in patterns and perceptions of multiculturalism and multilingualism in western European countries in their impact on problems with and problem solving of are interesting and should be explored more. They extend the view over the border of the national healthcare system and its’ ‘national cultural’ solutions. In this respect it offers the opportunity to come to more cultural diverse input of solutions. Shared international solutions can be tested in their efficacy and efficiency for the local situation. This process empowers a common European approach of multiculturalism and multilingualism in healthcare and is therefore already interesting.
Hans Harmsen, PhD, MD
1. Kleinman MA. Patients and Healers in the context of culture. London: University of California Press, 1980.