[Asylum seekers and refugees in ambulatory health care: communication between physician and patient]

Communication between asylum seekers/refugees and general practitioners/physicians of the three main outpatient sectors for the Swiss national Health System (general practice, medical outpatient and accident & emergency departments) are being described and analysed. The data have been collected during three cross-sectional studies investigating the health status of asylum seekers and refugees and the health services provided to them. These studies addressed the problem exclusively from the point of view of the health care providers. Data on language capabilities, sociocultural aspects of communication and the necessity and availability of interpreters have been collected with questionnaires. The main results of the questionnaires have been followed up in group discussions with general practitioners. The majority of general practitioners/physicians felt that most of the communication problems were related to speaking a common language. Only about one out of two adult asylum seekers/refugees knew German, French, Italian or English. Particularly during the group discussions it was brought forward that cultural and social factors additionally complicate communication during patient-doctor interactions. When the data of the outpatient consultations of the main studies were analysed, it became obvious that interpreters were significantly more often present in consultations with patients with psychological/psychosocial diagnoses than those with somatic diagnoses (72% vs. 55%). This can be interpreted in two ways: (1) if a patient suffers from a psychological/psychosocial problem, it is more likely that an interpreter will be asked to assist during the consultation or (2) if an interpreter is present during a consultation, it is more likely that a psychological/psychosocial problem will be detected. With the exception of children, most of the general practitioners/physicians felt that non-professional interpreters (relatives, friends) were adequate for coping with most of the tasks. The following areas for improvements were identified: (1) availability of professional interpreters and quality as well as organisational issues related to interpretation, (2) language training for asylum seekers and refugees and (3) creation of awareness among general practitioners/physicians towards cultural and socioeconomic determinants of patient-doctor interactions and training.