Mötet mellan patienten och läkaren - erfarenheter hos somaliska flyktingar och läkare under utbildning

Sammanfattning: The Meeting between the Patient and the Doctor Experiences among Somali refugees and medical trainees Kristian Svenberg Abstract Background and aim. The overall aim of the thesis is to explore the patient‐doctor encounter based on experiences among Somali refugees and medical interns in Sweden. Though research in this area is scarce, it has demonstrated that the transcultural meeting in health care suffers shortcomings. This applies to treatment and rapport as well as to outcomes of treatment and care. Starting from the experiences of medical students reflecting on a memorable consultation (paper I), the thesis illuminates the experiences of health and illness and of encounters with Swedish health care of one group of patients, Somali refugees (papers II, III). The thesis further explores the experiences among Swedish vocational trainees in general practice of their encounters with patients from Somalia (paper IV). Method. The thesis is based on four qualitative studies. In paper I, data was gathered from written reflective accounts. In paper II and III, data was collected through individual interviews and in paper IV through focus group interviews. Data was analysed using qualitative content analysis (paper I), a hermeneutic‐phenomenological methodology (paper II, III) and phenomenography (paper IV). Findings. Paper I. Involving students in writing reflective accounts stimulated them in articulating practice experiences of the consultation. Main themes of students’ learning experiences were “The person beyond symptoms”, “Facing complexity” and “In search of a professional role”. Paper II. Somali refugees were interviewed as to their experiences in relation to health and illness. One essential theme emerged: “a life in exile”. This was expressed in thematic aspects dealing with longing for the homeland, experience of pain, discrimination and the comforting role of religion. Paper III illuminates the experiences of Somali refugees encountering Swedish health care. Ambiguous feelings of high expectations and disappointment were expressed including sentiments of being rejected and not taken seriously, often resulting in a decision to go abroad for medical care. In paper IV, vocational trainees in Swedish general practice give voice to their experiences of meeting Somali patients. In meeting the patient, they faced high expectations and noticed a certain cultural distance. Perceptions of being both pleased and confused were articulated. Obstacles in the meeting were expressed by a majority of the informants, on a linguistic level as well as of intricacies in understanding the patients’ problem in general. To control this situation, some conformed to an authoritarian strategy, whereas others used approaches coined by curiosity. Conclusion. Somali refugee patients, with problems and complaints frequently caused by a life in exile, often experience rejection in the medical encounter. A major finding of the thesis is the importance of seeing the patient as a person, thus throwing light on the complex web of factors influencing the patients’ symptoms. To promote this, strategies of curiosity and an interest in the patients’ personal history should be encouraged among health care providers. Key words. Medical encounter, experience, medical student, vocational trainee, Somali, refugee, health, illness ISBN 978‐91‐628‐8339‐3 http://hdl.handle.net/2077/27961