title: Cultural differences in managing information during medical interaction: how does the physician get a clue?
abstract: OBJECTIVE
  Consultations of ethnic-minority patients tend to result in poor mutual understanding between doctor and patient, which may have serious consequences for health care. For good communication, physicians have strong devices at their disposal to manage the information, such as agenda-setting and structuring the interview into segments. What are the cultural differences in the managing of information in medical conversation? What is the relation with level of mutual understanding?
  
  
  METHODS
  Data of 103 transcripts of video-registered medical interviews (56 non-Western and 47 Dutch patients) were sequentially analysed, focusing on relevant segments of the medical interview (medical history, diagnosis and conclusion) and on agenda-setting.
  
  
  RESULTS
  Physicians set the agenda and lead the conversation firmly forward, while a considerable number of patients (mainly Dutch) 'put on the brakes'. The majority of the medical conversations was traditional (37%) or cooperative (37%), while another 25% was more or less conflicting or complaintive in nature. Interviews of ethnic-minority patients were mostly traditional or cooperative, while Dutch patients showed a variety of types, especially in cases of poor mutual understanding. Further, conversational symmetry between patient and physician has increased over the years, due to the importance attached to patient autonomy.
  
  
  CONCLUSIONS
  Physicians receive different conversational clues from Dutch and ethnic-minority patients in case of poor mutual understanding.
  
  
  CONCLUSIONS
  This points to the necessity for physicians as well as patients to become culturally competent.
authors.affiliation: Utrecht University, Interdisciplinary Social Science Department, Research School Psychology and Health, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands. l.meeuwesen@uu.nl
authors.forename: Ludwien
authors.initials: L
authors.lastname: Meeuwesen
authors.forename: Fred
authors.initials: F
authors.lastname: Tromp
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Schouten
authors.forename: Johannes A M
authors.initials: JA
authors.lastname: Harmsen
mesh_terms: D000328:Adult; D002637:Chest Pain / Q000175:diagnosis; D003144:Communication Barriers; D018864:Cultural Diversity; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D008913:Minority Groups; D009426:Netherlands; D010817:Physician-Patient Relations