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Programme: accepted abstracts

Abstract ID: 965

Part of General Poster Session (Other abstracts in this session)

Multilingual medical settings: puzzling links between difficulties in verbal interaction and physician-patient agreement on causes and treatment of musculoskeletal pain

Authors: Weber, Orest; Stiefel, Friedrich; Guex, Patrice; Singy, Pascal
Submitted by: Weber, Orest (Lausanne University Hospital, Switzerland)

Background and aims: Agreement between doctors and patients on causes and treatment of musculoskeletal illnesses is critical for positive clinical outcomes. Given the increasing linguistic diversity in Western health care settings, many patients suffering from chronic musculoskeletal pain are currently migrants with various levels of fluency in the language used for communication in their medical visits. Our still ongoing qualitative study screens exolingual clinical encounters without interpreters for various difficulties of comprehension detectable in interaction (mainly repaired and unrepaired misunderstanding and non-understanding). It further investigates the links between those difficulties and the emergence or perpetuation of disagreement on pain causes and treatment between patient and physician. Comparable research has already been carried out on linguistically diverse family practice settings (e.g. Roberts et al., 2005), but, to the best of our knowledge, not on specialists’ encounters.

Methods: Fifteen medical visits with allophone migrant patients (with various levels in French) suffering from musculoskeletal pain were videotaped in the pain clinic and the spine re-education unit of the Lausanne University clinic and submitted to discourse analysis. Data on physician-patient agreement were collected in semi-structured post hoc interviews with the physicians and patients of the videotaped consultations.

Results: Doctor-patient disagreement is mainly related to surgical/analgesic interventions, medication, physical re-education, return to work, social insurances and psychological aspects. With some migrant patients having low proficiency in French, extended misunderstandings massively obstruct patient information on causes of pain and treatment. With patients with medium to very good French, several non-clarified comprehension difficulties also impact on agreement, mostly when complex issues are discussed. In these cases, linguistic sources of misunderstanding/non-understanding are often closely intertwined with a lack of adaptation from the physicians to patient’s level of health literacy. However, difficulties in comprehension are not the only source of doctor-patient disagreement. Relational aspects – establishing “rapport” in consultations – and overt or covert resistance to the other’s ideas also play an important role.

Conclusion: An adequate use of interpreters appears crucial in medical communication on chronic musculoskeletal pain. Patient education is also decisive and has to be adjusted to the patient level of health literacy.

Ref. Celia Roberts et al. (2005), “Misunderstandings: a qualitative study of primary care consultations in multilingual settings, and educational implications”, Medical Education, 39(5), 465-75.