Communication between expatriate physicians and patients in Saudi Arabia-A qualitative study

Abstract

<p>Over two-thirds of physicians in Saudi Arabia are expatriates who received their medical education outside the country. This qualitative study explores the impact of this situation for these physicians and their Saudi patients. The study focusses on communication between nonSaudi physicians and their Saudi patients in the context of medical consultations in Saudi outpatient clinics. Using an approach informed by Interpretive Description and Ethnography, interviews were conducted with seven non-Saudi physicians and eight Saudi patients. A preliminary focus group was conducted with five key hospital personnel to ascertain their views and to inform them about the study.</p> <p>Data was collected between June and September 2016, and analysed applying an iterative interpretive process to develop a thematic description of patient and physician experiences. Patient experiences provide an account of what it is like for them to meet with a physician who does not share their language and culture. Analysis of patients’ data revealed two main themes along with associated sub-themes. Theme One - <i>Encountering Difference</i> - was characterised by sub-themes of <i>Being Different, Being Disconnected,</i> and <i>Being Culturally Acknowledged</i> . Theme Two -<i>Absence of Partnering</i> - encompasses sub-themes of <i>Being Powerless</i> , <i>Being Unnoticed</i> and <i>Neglected, Reluctant to Trust</i> , and <i>Being Denied Adequate Time</i> . This theme highlights the lack of reciprocity and partnering that the patients experienced during their medical consultation, which ultimately prevented the establishment of a rapport and effective communication with the physician.</p> <p>Non-Saudi physicians’ experiences highlight challenges they face in providing healthcare and advice in a foreign country and culture. Their experiences are characterised by Theme One – <i>An Absence of Trust</i> with sub-themes of <i>Being a Stranger</i> and <i>Being Fearful</i> . This theme demonstrated the lack of mutual trust from the physicians’ perspective. Theme Two – <i>Being Constrained in Practice</i> illustrates that language difference, as well as the conflict with specific cultural customs and values which limited the physicians’ ability to practice freely and communicate with patients effectively, constrained their professional practice. This second theme was characterised by sub-themes of<i> Struggling to Connect, Gender Sensitivity</i> , and <i>Organizational Constraints</i> . The third and final theme – <i>Being Aware and Responsive to the Patients’ Culture</i> – highlights how the physicians’ knowledge of the patients’ culture and, more importantly, being able to incorporate this in the consultation, made a difference to physicianpatient communication and interaction.</p> <p>The patient and physician shared experiences can be understood, conceptualised, and characterised by the perception of differences, manifested through the concepts of othering, scepticism, constraint, and impasse. These four inter-related concepts highlight the essential nature of the intercultural encounter in the context of Saudi Arabian healthcare.</p> <p>The significance of the study lies in its illumination of the complex nature of intercultural communication in the context of seeking and providing care in Saudi outpatient clinics. The study reveals the fundamental and significant role of culture, and how communication between patient and physician may be impeded or enhanced. Improving communication outcomes for patients and physicians involves building trust, providing information and support, and modifying organisational structural processes that constrain the relationship.</p> <p>This study is the first to explore the experiences of both patients and physicians in the context of intercultural healthcare consultations in Saudi Arabia. It provides insights that will inform conversations on how to protect vulnerable patients, ways to improve patient satisfaction, ways to improve health provider communication practice and satisfaction with the potential to reduce workforce turnover, as well as systems reform.</p>