Meeting migrants in health care: An in-depth study of experiences related to patient and provider diversity (The MEMIHC studies)

This project has been running for six years, and has so far led to almost 30 conference presentations, six scientific articles and several mass media presentations. There are two parts, one in which we do detailed analyses of videotapes from real doctor-patient encounters, and one where foreign medical graduates and health providers who have worked with foreign medical graduates are interviewed about challenges during work. In the videotape study, the project has been focused towards detailed observation of how negotiations between doctors and patients about treatment are handled. One major observation is that difficulties in these processes seem to be rooted more in traditional doctor-centered communication style rather than in language difficulties. The negotiations tend to be ambiguous as to who actually owns the decision about treatment, and doctors tend to rephrase the patient's stance in ways that argues in the direction of the doctor's preferences. We also find that doctors who really try to involve immigrant patients in decisions, find it hard to understand whether resistance on the patient's side is due to lack of understanding or lack of willingness to comply. In this substudy the thesis was accepted in 2016. In the interview study we have found that foreign medical graduates are stressed by several factors when they start working in Norway. They struggle with language, but even more with understanding the system and how it works here, and they feel they get too little feedback on their work. Also, they regularly are afraid of losing their jobs, and some also decide to change their career plans following experiences related to clinical work in Norway. The thesis was submitted in 2018.

The focus of this study is the meeting between patients and providers in Norwegian health care, when the patient, the provider, or both are migrants. Our starting point is that situational uncertainty and epistemological distance (with all its potential c onsequences like e.g. different conceptualizations, expectations, preferences, value conflicts) are inherent in medical encounters. We distinguish between uncertainty defined as a concept describing a cognitive lack of information, and feeling unsafe as t he (possible) emotional response to uncertainty. Uncertainty and epistemological distance are not exclusive to meetings that involve migrants, but may be amplified in this setting. We will conduct two substudies focussing on a) foreign medical graduates working in hospital and b) the interaction between patient and provider in videotaped encounters. In study a involved providers, collaborating staff and superiors will be used as informants. In study b we will observe a material of 380 videotapes that ha s already been collected. Data collection will be performed at Akershus University Hospital, where the research group is situated. The research group comprises five senior researchers with expertise in medicine and social sciences (sociology, anthropolog y, political sciences, organizational sciences). National and international collaborators provide expertise in communication studies, migrant health, and health services management. The study relates to all main intentions of the research program; to red uce errors and increase patient safety, increase knowledge about delivery of services to patients with complex chronic problems, facilitate the integration of services, and explore the effect of leadership and delivery of services on quality. The proposal covers costs for two doctoral fellows and interpreters.