title: Health-care outcomes in ethnoculturally discordant medical encounters: the role of physician transnational competence in consultations with asylum seekers.
abstract: In this mobility-upheaval era, many health outcomes are shaped by transnational interactions among care-providers and recipients who meet in settings where nationality/ethnic match is a diminishing option. This exploratory study compares health-care outcomes in ethnoculturally discordant medical encounters according to patient national/ethnic identity, frequency (intensity) of medical consultation, and physician transnational competence (TC). Analysis is based on interviews with 35 political-asylum seekers and their ethnoculturally discordant clinicians at five reception centres in Finland. The three medical-encounter outcomes considered are patient-reported adherence with medication instructions, satisfaction, and confidence in the principal attending physician's recommendations. The intersubjectively assessed overall transnational competence of the attending physician provided the strongest association with all three outcome measures. The results of exploratory study suggest that preparing medical students with skills that can be applied effectively in variable transnational-encounter contexts would help close disparities in certain health-care outcomes.
authors.affiliation: Department of Political Science, University of Montana, Missoula, 59812, USA. peter.koehn@umontana.edu
authors.forename: Peter H
authors.initials: PH
authors.lastname: Koehn
mesh_terms: D000328:Adult; D018864:Cultural Diversity; D017050:Episode of Care; D005006:Ethnicity; D005260:Female; D005387:Finland; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011361:Professional Competence; D012017:Referral and Consultation; D012036:Refugees