Noura A. Abouammoh

6.5.3 Summary

In summary, in order to improve communication and interaction between IMGs and patients, the participants both identified strategies for doctors and patients and identified potential measures that needed the support of policy makers or the clinic’s administration.

It appears that most of the strategies emerging from the findings that IMGs and patients have used revolved around overcoming linguistic and cultural challenges and empowering IMGs to be better able to effectively conduct medical consultations.

Chapter 7

Discussion

7.0 Introduction

This study has explored the experiences of IMGs when delivering care to local patients and of Saudi patients with T2DM receiving care from IMGs. The aim of the study was to identify and understand possible facilitators and challenges to cross-cultural communication faced by IMGs and local patients in SA. The importance of exploring this issue lies in the fact that most physicians who work in SA are IMGs (MOH, 2012) who do not share the same culture and language, or dialect as their local patients. T2DM was chosen as an example to demonstrate their experiences, as it is a prevalent chronic health condition in SA, which needs long-term follow up by general practitioners and requires lifestyle modifications that are culturally defined.

The first part of this chapter highlights key findings and the original contribution to knowledge in the field represented by these findings. These findings are then discussed in detail in the context of other literature using the following themes: IMGs’ language and cultural competency; patients’ attitude towards IMGs; the effect of prejudice on care provision; strategies to overcome language and cultural barriers and support systems.

The second part of the chapter outlines the strengths and limitations of the study; implications for policy and practice and future research priorities. The final section summarises the overall contribution of this study and the implications for provision of more effective health care in SA.

7.1 Key findings in relation to the research questions

The current study is the first study aiming to understand cross-cultural medical care in SA. Comparing the perspectives of both IMGs and patients has contributed in showing a mismatch between IMGs’ and patients’ expectations which may have a detrimental impact on the quality of care if due consideration is not given to the needs of both physicians and patients. This study found that effective use of cultural competence theory to inform practice requires consideration of patient as well as professional understanding and attitudes in dealing with patients from different cultures. Training physicians to become culturally competent without paying equal attention to improving patients’ attitude towards their physicians may not lead to the intended overall results sought from these programmes.

Identifying challenges and facilitators to cross-cultural medical communication is required to achieve good patient-physician relationships and target efforts to improve the quality of health care appropriately. The study has identified some sensitive issues regarding patients’ attitude to IMGs and recognized some weak links in the system that hamper the provision of quality health care by IMGs in SA. For example, it identified the existence of prejudice in the cross-cultural medical encounter and lack of support system for IMGs. The lack of effective communication between IMGs and patients, as a result of language and cultural differences, has led to the persistence of IMGs’ approaches to patients, despite patients’ lack of satisfaction with these approaches, for example, dealing formally with patients and avoiding explicit SDM.

Furthermore, the study has identified a number of barriers and facilitators to effective cross-cultural communication between IMGs and local patients with T2DM in SA. Cultural differences between IMGs and patients, in addition to some IMGs’ limited awareness relating to Arabic and its dialects, were identified as critical issues that negatively affect the quality of care. Cultural discordance lead to prejudice and stereotyping amongst local patients towards IMGs, and vice versa, and the current study identified that these were important factors influencing their relationship and communication. For example, most patients did not acknowledge the IMGs’ knowledge and ability to provide appropriate lifestyle advice to local patients with chronic diseases, for reasons related to language and prejudice, which were in turn found to be related to the local culture. IMGs’ stereotypical view of local patients made some follow inflexible approaches in advising patients. For example, advising patients not to consume dates.

Moreover, the lack of appropriate support systems for IMGs added to the difficulty of IMG-patient communication and hampered effective communication and hence effective medical care, due to the nonexistence of training and interpretation services that target IMGs.

Furthermore, the current findings showed that patients refrained from disclosing health-related information to IMGs if they believed that they might not be able to assist them because they come from a different cultural background. For example, the current study showed that patients might not wish to share information about using herbal remedies to treat their own health condition, as using alternative medicine is deeply rooted in the culture, and they believe that IMGs may find it difficult to advise patients in this regard. However, patients’ safety might be compromised if thorough information about their health practices is not disclosed to their physicians.

IMGs and patients identified self-adopted strategies to overcome certain barriers to effective communication, such as using facial expressions and hand signals to express the intended meaning. In addition, written information, including booklets and brochures, written in Arabic, were often given to patients by non-Arabic speaking IMGs who were not usually familiar with their contents. The need to improve written information to be more culturally appropriate was identified.