Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Blog
    • eLetters
    • Feedback
    • Librarian information
    • Alerts
    • Resilience
    • Video
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
Advertisement
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Blog
    • eLetters
    • Feedback
    • Librarian information
    • Alerts
    • Resilience
    • Video
Out of Hours

South-west Scotland to West Bengal: where does patient expectation fall?

Samantha Hallam and David Arnot
British Journal of General Practice 2016; 66 (642): 35. DOI: https://doi.org/10.3399/bjgp16X683209
Samantha Hallam
Scotland Deanery, NHS Education for Scotland, Glasgow.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
David Arnot
Health & Social Care Directorate, Scottish Government, Edinburgh.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading

There is firm evidence that the NHS is treating an increasingly diverse population with a service built from an equally diverse global workforce.1

In addition to attaining linguistic competencies, a challenge to international medical graduates (IMGs), is adjusting to patient expectations, which can vary widely across patient populations. One PCT, NHS Dumfries and Galloway offer a generous Travelling Fellowship to doctors in training. One of its central objectives is to improve understanding of the challenges faced by international colleagues coming to the UK.

We had the opportunity as part of the Travelling Fellowship 2014 to undertake a 2 week project in Kolkata, (formerly Calcutta), India. We studied clinic-level doctor–patient interaction looking at communication and shared decision-making. One aim was to compare patient expectations of a medical consultation in the private (pay at delivery) urban environment of Kolkata with that of a NHS regional hospital in semi-rural Southwest Scotland.

Patients were requested to quantify on a scale of 1 (lowest) to 10 (highest), their expectations prior to scheduled clinic consultations, based on five key statements (a modified ‘CARE’ questionnaire):2

Our results (Table 1) demonstrate lower expectations of involvement in decision-making in the Indian cohort compared to their Scottish counterparts. As clinic-observers, these results correlate with our first-hand experiences. For example, many patients would confer respect to the doctor by remaining standing until invited to sit down, and would only speak when spoken to. Often gifts were given in addition to full cash payment to court favour.

View this table:
  • View inline
  • View popup
Table 1.

Patient expectation by clinic venue

We believe cultural diversity plays a significant role in the dissimilarity of patient expectation. Lower mean scores reflect a more deferential patient attitude to the Indian medical professional, in keeping with inherent class-based societal norms.

Wider socioeconomic and educational inequalities in India, might explain lower expectations of patient contribution to consultations and treatment plans. Moreover, this disparity could underpin a belief that ‘Doctor knows better’: explaining why Indian doctors operate under lower expectation to elaborate on their patient management styles.

Differing expectations may have its roots in the medical undergraduate curriculum. Until the 2012 Revision by the Medical Council of India Medical Education Regulations,3 communication skill assessment was largely informal — often centred on a ward-round debrief.4 Though yet to impact the UK medical workforce, successful medical undergraduates must now: ‘demonstrate an ability to communicate with patients, colleagues, and families in a manner that encourages participation and shared decision-making’.3

Our survey and observations illuminate some of the additional challenges IMGs can face on arrival to the UK. These include the need to develop:

  • broader treatment options independent of patient affordability;

  • cultural awareness;

  • a less paternalistic attitude;

  • an appreciation of patient autonomy; and

  • working relationships with new colleagues.

While the GMC have well-established linguistic and clinical competency assessment units, do individual hospitals do enough to prepare new IMGs to their locale? A tailored induction, focusing on ‘soft skills’ would improve the clinical effectiveness of IMGs, particularly in the clinic or primary care setting. This is supported by earlier studies linking patient-centred consultations to improved patient outcomes.5

Mentors of IMGs also play a crucial role in the provision of additional support: particularly where communication training has been in short supply. Enhanced communication skills have additional benefits, such as improving clinician wellbeing.6 In addition to reducing susceptibility to patient complaint, refined verbal connection can assist with integration into new cultural environments. In turn, wider appreciation of global variation in patient expectation and cultural diversity may enhance staff recruitment and retention by improving career progression for IMGs.

  • © British Journal of General Practice 2016

REFERENCES

  1. 1.↵
    1. General Medical Council
    The state of medical education and practice in the UK report: 2014, http://www.gmc-uk.org/publications/25452.asp (accessed 03 Dec 2015).
  2. 2.↵
    The Consultation and Relational Empathy Measure. http://www.caremeasure.org/ (accessed 22 Oct 2015).
  3. 3.↵
    1. Medical Council of India
    Regulations on graduate medical education, 2012, http://www.mciindia.org/tools/announcement/Revised_GME_2012.pdf (accessed 03 Dec 2015).
  4. 4.↵
    1. Shukla AK,
    2. Yadav VS,
    3. Kastury N
    (2010) Doctor-patient communication: an important but often ignored aspect in clinical medicine. JIACM 11:208–211.
    OpenUrl
  5. 5.↵
    1. Little P,
    2. Everitt H,
    3. Williamson I,
    4. et al.
    (2001) Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 323(7318):908–911.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Agarwal A,
    2. Agarwal A,
    3. Nag K,
    4. et al.
    (2011) Doctor patient communication — a vital yet neglected entity in Indian medical education system. Indian J Surg 73(3):184–186.
    OpenUrlPubMed
View Abstract
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 66 (642)
British Journal of General Practice
Vol. 66, Issue 642
January 2016
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
South-west Scotland to West Bengal: where does patient expectation fall?
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
Citation Tools
South-west Scotland to West Bengal: where does patient expectation fall?
Samantha Hallam, David Arnot
British Journal of General Practice 2016; 66 (642): 35. DOI: 10.3399/bjgp16X683209

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
South-west Scotland to West Bengal: where does patient expectation fall?
Samantha Hallam, David Arnot
British Journal of General Practice 2016; 66 (642): 35. DOI: 10.3399/bjgp16X683209
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • REFERENCES
  • Figures & Data
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Every home should have one: the critical role of the research librarian
  • Fakery and science
  • Viewpoint: Redundant subjectivity?
Show more Out of Hours

Related Articles

Cited By...

Advertisement

 

Register by 10 December and save 15% at the BJGP Research Conference, 12 March 2020

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Blog
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2019 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242