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

Abstract

Objective: To confront the views of refugee patients and general practitioners in the Netherlands, focusing on medically unexplained physical symptoms (MUPS). Methods: The study is based on in depth interviews with refugees from Afghanistan (n = 36) and Somalia (n = 30). Additionally, semistructured interviews were conducted with 24 general practitioners. Text fragments concerning the relationship between mental worries and health or physical ailments were subject of a secondary analysis, the results of which are presented. Results: Medically unexplained physical symptoms were a key issue for both refugees and GPs. The GPs saw MUPS as a significant part of the illness presentation by refugee patients. Refugees felt GPs were often prejudiced, too readily using their difficult background as an explanation for physical symptoms. A 'general narrative' circulating in the refugee communities undermines trust. The GPs applied different strategies in dealing with MUPS presented by their refugee patients. A 'human interest strategy' is distinguished from a 'technical strategy'. The results are discussed in the wider context of the literature on MUPS and patient satisfaction. Conclusion: No fundamental difference in paradigms was found between refugees and GPs as to the negative influence worries and bad experiences can have on health. For a fruitful cooperation to develop, based on trust, GPs need to invest in the relationship with individual refugees, and avoid actions based on prejudice. Practice implications: The importance of (a lack of) trust is underestimated in medical practice. Phenomena undermining trust are often out of sight for practitioners. Critical reflection is needed on the strategies practitioners employ to deal with MUPS. #

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.…”

“…18,21,28,29,31 Some were afraid to go to a doctor because they felt unwanted or a burden on resources: 25 'Sometimes I feel they'll be fed up with me, especially a foreigner …' 25 Refugees appreciated doctors who spent extended amounts of time with them in history taking, physical examination, and explanation. 19,21,31,32,39 Continuity with the same doctor was helpful in building mutual familiarity and trust; 19,25,28,29 they expressed dissatisfaction at being given a different doctor or interpreter at each visit: 25,28,34 'I used to go to [a former health centre] but I didn't like that. Cause I didn't see the doctor.…”

“…A gallstone has nothing to do with a psychological problem.' 32 Prescription medicines were welcomed by many refugees, 19,21 although some were disappointed when they were not prescribed antibiotics, particularly when antibiotics were readily available in their country of origin. 28 Sometimes prescriptions were seen as a replacement for serious professional attention: 29,31,32 'They gave me just antibiotics and didn't take time.'…”

“…32 Prescription medicines were welcomed by many refugees, 19,21 although some were disappointed when they were not prescribed antibiotics, particularly when antibiotics were readily available in their country of origin. 28 Sometimes prescriptions were seen as a replacement for serious professional attention: 29,31,32 'They gave me just antibiotics and didn't take time.' 29 Referrals to other health services were valued; however, limitations in the types of services referred to and delays in being referred to specialist doctors caused frustration: 22,24,26,28,31 ' [In Bosnia] if the primary care physician is giving you a referral for a specialist, you can go the same day to see the other doctor, the specialist.…”

“…19,42 Distinctive refugee experiences related to stereotyping and identity where refugees felt they were overdiagnosed with psychological conditions or felt they were an unwanted burden on health services on account of being a refugee. 25,31,32 Implications for research and practice Future research should include publishing more studies of refugee experiences of GP services in each of the settlement countries. Focusing on specific ethnic groups would assist to elucidate cultural differences.…”