Relación médico-paciente en atención primaria : comunicación no verbal en la atención a pacientes inmigrantes en una población del Vallés Occidental

Abstract

The linguistic and cultural differences of patients from other countries stand out as additional aspects within the doctor-patient relationship, which may lead to disparities when offering a satisfactory quality of attention. In communication, there are underlying non-verbal aspects that reflect substantial information about this relationship and in parallel about the quality of the medical assistance. Objectives: To analyse by measuring aspects of non-verbal communication whether there are differences between the medical assistance given to immigrants and that given to the native population. Secondly, to analyse differences in medical assistance according to measurable data such as frequency of attendance, consultation time, number of additional tests and referrals requested as well as demographic and medical visit characteristics, communication barriers and the style of behaviour adopted by doctors and patients. Thirdly, to contrast these results with the data expressed in a session of focus groups with the doctors' opinions. Methods: This study was undertaken at a primary-care centre in Terrassa. A single observer attended the medical visits of immigrants and natives selected randomly, to doctor in the centre. Data was gathered concerning non-verbal communication, demographic and health aspects of the patients, medical-visit motives, additional tests and referrals required, therapeutic prescriptions, communication barriers, styles of behaviour adopted by doctors and patients, as well as the total time spent with each patient. Subsequently, at the centre, there was a focus-group session with the doctors to contrast results. Results: A sample of 123 immigrants and 119 natives was analysed. The immigrant sector was younger (p 0,0001). There were no differences in the number or type of motives for the consultation; in the native population there were more often certain chronic-pathology types (bone degeneration, hypertension, dyslipidemia, depression/anxiety and chronic pulmonary disease). There were no differences in the time spent in medical visits. A higher number of further tests requested was registered in the immigrant group, but not so in the annual total or in the number of referrals. The natives had the higher annual attendance figures (p=0,003) owing to the existence of more chronic pathologies (p=0,003). A major barrier in communication with immigrants was detected, mostly related to language and social culture (p 0,0001). There were more non-verbal communication mistakes registered with the natives; on analyzing each category a difference was observed only in "looking straight in the eye" a more frequent failing with the natives (p=0,016). The doctors interacted well with the patients, whose manner was neutral towards the doctors. The focus groups revealed that attending to immigrants causes the doctors anxiety, impatience and demands a greater effort. Conclusions: The immigrant patients are younger, have a lower rate of chronic pathologies, consult for similar reasons and require fewer consultations annually. The time spent in each medical visit is similar but a higher number of additional tests is requested. There is a greater linguistic and socio-cultural barrier. There are more failures in non-verbal communication in the native group. The doctors have difficulties when attending immigrant patients but interact and collaborate in the quality of assistance which they offer to all patients.

Date of Award	12 Nov 2015
Original language	Spanish
Supervisor	Miquel Sabria Leal (Director), Irma Casas Garcia (Director) & Mónica Rodríguez Carballeira (Director)