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Onzichtbare pijn bij migranten : hoe kan de huisarts helpen?

Rijpkema, M. (2013) Onzichtbare pijn bij migranten : hoe kan de huisarts helpen?

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Abstract:Background: The GP (general practitioner) care for medically unexplained physical symptoms (MUPS) is troublesome for GPs and causes pressure on the doctor-patient relationship. When the patient with MUPS is a non-Western migrant, the care process is often even more challenging since the possible language barriers and cultural differences. Current guidelines provide some advice, but no concrete actions for GPs’ daily practice. As a consequence, GPs face uncertainty in which approach they should take in these care processes. This study aims at exploring the success factors in the GP care process aimed at non-western patients with MUPS. The focus is especially on factors regarding building a doctor-patient relationship, discussing psychosocial backgrounds, explaining MUPS to patients and reaching an agreement. Methods: A qualitative approach, interviewing a purposive sample of twelve non-western migrants with MUPS individually and fifteen healthcare providers (including ten GPs and five practice supporters mental health care*) within three focus groups. Data were analyzed according to the principles of 'theoretical coding' established by Strauss and Corbin (1998). Results: This study has provided a list of practical success factors, including advice, formulations and materials for GP care for non-western migrant patients with MUPS. The most important factors for building and maintaining a good doctor-patient relationship are ‘taking the complaints seriously’ and ‘employing an open and friendly attitude’. Regarding discussing the psychosocial backgrounds a set of questions related to the complaints can be managed. Discussing ‘themes not related to the complaints’ are important as well. For these themes adaptation to the needs of the patient is necessary. Several patients judge cultural themes as not important to discuss. Several formulations and materials have been given for explaining MUPS to the patient, some of them are more applicable to high and others to low language and education levels. Regarding reaching an agreement most important factors are ‘determine whether the patient is afraid of something related to the complaints’, ‘shifting the focus of somatic to psychosomatic' and 'providing ‘follow-up actions’’. In addition, a number of factors have emerged which are important throughout the whole process, such as acknowledging the symptoms and continuing physical examination. Conclusion: This study provided a few conclusions which were already known from the literature regarding doctor-patient communication and are particularly important for migrants with MUPS. Next to that new conclusions specifically for non-western migrants with MUPS have emerged. For doctor- patient communication the most important factor during the whole care process is adaptation to the patient regarding educational level, language level, needs and preparedness. It is also important to take the patient seriously which can be achieved by acknowledging the symptoms, taking time and providing follow-up actions. Specifically for the GP-care aimed at non-western migrants with MUPS this study also provides some conclusions. Discussing cultural themes should be adapted to the needs of the patient since the study showed that some patients did not judge this as important, or even judged it as being negative. This study shows that a good relationship, respect, patience and an open attitude are more important than detailed knowledge about the culture of the patient. It can be concluded that most of the patients were open to the explanations in which the term ‘stress’ or ‘psychosocial complaints’ is used, provided that nothing has come up from investigations and 'stress' is not used too often. This study also shows that professional interpreters are barely used, notwithstanding that this is recommended in the guidelines. Ultimately, an extensive follow-up study is necessary to determine whether the results from this study can be generalized to all non-western migrants with MUPS. *a relatively new profession in the Netherlands, whose job is to support the GPs on the psychological track.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
Link to this item:http://purl.utwente.nl/essays/64207
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