Afghan refugees and their general practitioners in The Netherlands: to trust or not to trust?

Abstract

In-depth interviews with Afghan refugees living in The Netherlands about their experience of healthcare, have led to a series of narratives. This article focuses on the relationship between the refugee-patients and their general practitioners (GPs) from the participants' point of view. It was possible to distinguish four different types of narrative, by analysing the individual interviews into critical episodes. Building trust was identified as the crucial issue. A number of possible explanations are given for the differences found. Links are made to participant expectations in respect of health and healthcare and to their personal and social resources. The GP has a key role in the Dutch healthcare system, but is a novel phenomenon for refugees arriving from Afghanistan. The development of a relationship of trust is sometimes compromised by negative personal experience and also by stories relating such experiences circulating in the Afghan community.The elements that constituted positive and negative episodes and led to the development or undermining of trust were identified in the narratives. Negative experience tended to be interpreted as a sign of prejudice on the part of the healthcare professional. The findings of this study are discussed in the wider context of research into patient priorities in general practice.

Worries are the mother of many diseases: General practitioners and refugees in the Netherlands on stress, being ill and prejudice

“…The use of the software programme enhanced the consistency of the coding process, and facilitated cross-sectional comparison and the recoding of text fragments. After initial coding and cross-sectional comparison, a schematic presentation in short quotes was made of each refugee interview [1,2]. Using this method facilitated analysis along the time axis.…”

“…Personal experiences appeared to be intermingled with stories about other people's experiences. In the personal narratives 'critical episodes' could be distinguished, encounters with healthcare providers that left a positive or a negative mark in the participant's memory [1,2]. Participants also provided explanations for their negative experiences.…”

“…The results of the refugee interviews and the GP interviews separately are being published elsewhere [1][2][3].…”

Refugee experiences of general practice in countries of resettlement: a literature review

“…The studies were conducted in the US, [17][18][19][20][21][22][23] Canada, 24 England, [25][26][27] Scotland, 28,29 Ireland, 30 Netherlands, 31,32 Norway, 33 Sweden, 34 Finland, 35 Switzerland, 36 New Zealand, 37,38 and Australia. 39 Thirteen papers focused on refugees, three on asylum seekers, and seven combined both.…”

Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice

“…• Mobility of populations and lack of continuity 51,58,64 • Unwillingness to divulge address (for personal safety, for example, women living in domestic violence shelters, or fear of legal repercussions, for example, failed asylum seekers) 65 • Patients' lack of knowledge about health service structure and how to access services 47,50 Communication technology facilitates continuity of care 13,66,67 Anonymity provided by digital communication could encourage populations who wish to remain hidden to seek help 66,68 No evidence found on the impact on patient knowledge about health services related to the availability of digital communication for clinician-patient communication 44,55,[69][70][71] • Difficult relationships with GPs 51,[71][72][73] • Negative perceptions of GPs' knowledge, skills, and empathy for mental health problems 34,60,61,74,75 • Distrust in GPs and their abilities 51 • Communication difficulties due to mental health problems 62 • Service-wide lack of awareness of patients' rights and acceptance of official documentation 52,58 Patients try to see trusted GPs for mental health issues rather than the most available GP, 77,78 prioritising relationship continuity over convenience Text-based communication leaves much room for interpretation, therefore communication between patients and clinicians with well-established relationships is likely to be more successful than that between strangers 37,79 To build the therapeutic relationship, clinicians and patients need to have face-to-face contact for the richness of stimuli available, for example, auditory, visual, tactile and olfactory 37 Social presence the...…”