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Role dilemmas among health-workers in cross-cultural patient encounters around dietary advice

Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, Norway, r.a.fagerli{at}medisin.uio.no

Marianne E. Lien

Department of Social Anthropology, University of Oslo, Norway

Grete S. Botten

Department of Health Management and Health Economics, University of Oslo, Norway

Margareta Wandel

Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, Norway

Aim: The aim of this paper is to explore Norwegian health workers' experiences from cross-cultural patient encounters, and how they understand and enact their role when meeting patients with Pakistani background to whom they give dietary advice related to type 2 diabetes. Methods: Qualitative in-depth interviews have been performed with six hospital dietitians and six general practitioners in Oslo. Results: The health workers consider themselves to be patient-centred and stress the importance of the two dimensions, empathy and equality. However, they often experience that patients want them to be more authoritarian, a way of acting that would be totally in disagreement with their convictions, although some occasionally do adopt an authoritarian style. More striking is that some health workers' moral engagement to involve and empower patients actually leads them to be authoritarian. For others, a fear of insulting the patient results in their advice being too diffuse. Conclusions: A possible explanation for such ways of responding to the patient may be that the health workers, in their articulation of patient-centredness, draw on a repertoire of social conduct that involves an effort to level out, or tacitly deny, hierarchic structures, and that this becomes more pronounced in cross-cultural encounters. Patient-centredness and empowerment are results of long ongoing processes in Western countries, based on ideals of equality and individual freedom. The results from this study indicate that these approaches may pose intricate dilemmas for the health workers in their cross-cultural encounters, and need further attention.

Key Words: Cross-cultural encounter • diabetes • dietary advice • minority patients • patient-centredness • physician—patient relationship

Scandinavian Journal of Public Health, Vol. 33, No. 5, 360-369 (2005)
DOI: 10.1080/14034940510005888


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