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The Doctor–Patient Relationship

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International Medical Graduate Physicians

Abstract

Several factors align to make it more difficult for some international medical graduate (IMG) physicians to form the patient-centered doctor–patient relationship expected by most patients in the United States. Fortunately, most of these factors can be significantly improved with deliberate action by a residency training program. This chapter discusses specific techniques for improving the doctor–patient relationship. These techniques include efforts to enhance communication skills and management of patients’ affect. Through vignettes, role-playing, and taped interactions, IMG physicians can expand their repertoire of interview skills. Through didactic and experiential learning, IMG physicians can become increasingly in tune with the culture that surrounds them and become more familiar and comfortable with the typical expectations of the patients they will be seeing.

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References

  1. Weber LR, Mathews KB. Exploratory study on the international medical graduate - patient relationship: patient’s perceptions of the quality of care delivered by his or her non-native doctor. Ethn Dis. 2012;22:79–84.

    PubMed  Google Scholar 

  2. Boulet JR, Cassimatis EG, Opalek A. The role of international medical graduate psychiatrists in the United States healthcare system. Acad Psychiatry. 2012;36(4):293–9.

    Article  PubMed  Google Scholar 

  3. Rao NR. International medical graduates. In: Kay J, Silberman E, Pessar L, editors. Psychiatric education and faculty development. Washington, DC: American Psychiatric Publishing, Inc.; 1999.

    Google Scholar 

  4. Rao NR, Yager J. Acculturation, education, training, and workforce issues of IMGs: current status and future directions. Acad Psychiatry. 2012;36(4):268–70.

    Article  PubMed  Google Scholar 

  5. Weerasekera P. Psychotherapy training for IMGs: attending to the “how to” and “what to” teach. Acad Psychiatry. 2012;36(4):288–92.

    Article  PubMed  Google Scholar 

  6. AMA code of medical ethics [Internet] 2014 Jun 1. Available from http://www.ama-assn.org.ezproxy.libraries.wright.edu:2048/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page?

  7. Goold SD, Lipkin Jr M. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med. 1999;14 Suppl 1:S26–33.

    Article  PubMed Central  Google Scholar 

  8. Haidet P, Dains JE, Paterniti DA, Hechtel L, Chang T, Tseng E, Rogers JC. Medical student attitudes toward the doctor-patient relationship. Med Educ. 2002;36(6):568–74.

    Article  PubMed  Google Scholar 

  9. van Zanten M, Boulet JR, McKinley DW, DeChamplain A, Jobe AC. Assessing the communication and interpersonal skills of graduates of international medical schools as part of the United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills (CS) exam. Acad Med. 2007;82(10 Suppl):S65–8.

    Article  PubMed  Google Scholar 

  10. Greenson RR. The technique and practice of psychoanalysis. New York, NY: International Universities Press; 1967.

    Google Scholar 

  11. Schouten BC, Meeuwesen L. Cultural differences in medical communication: a review of the literature. Patient Educ Couns. 2006;64(1-3):21–34.

    Article  PubMed  Google Scholar 

  12. USMLE step 2 CS [Internet] 2014 June 1. Available from http://www.usmle.org/step-2-cs/.

  13. Jain P, Krieger JL. Moving beyond the language barrier: the communication strategies used by international medical graduates in intercultural medical encounters. Patient Educ Couns. 2011;84(1):98–104.

    Article  PubMed  Google Scholar 

  14. Dorgan KA, Lang F, Floyd M, Kemp E. International medical graduate-patient communication: a qualitative analysis of perceived barriers. Acad Med. 2009;84(11):1567–75.

    Article  PubMed  Google Scholar 

  15. Hall P, Keely E, Dojeiji S, Byszewski A, Marks M. Communication skills, cultural challenges and individual support: challenges of international medical graduates in a Canadian healthcare environment. Med Teach. 2004;26(2):120–5.

    Article  PubMed  Google Scholar 

  16. Pilotto LS, Duncan GF, Anderson-Wurf J. Issues for clinicians training international medical graduates: a systematic review. Med J Aust. 2007;187(4):225–8.

    PubMed  Google Scholar 

  17. Majumdar B, Keystone JS, Cuttress LA. Cultural sensitivity training among foreign medical graduates. Med Educ. 1999;33(3):177–84.

    Article  CAS  PubMed  Google Scholar 

  18. Rao NR. Psychodynamic psychotherapy training as acculturative experience for international medical graduates: a commentary. Acad Psychiatry. 2012;36(4):271–6.

    Article  PubMed  Google Scholar 

  19. Fiscella K, Roman-Diaz M, Lue BH, Botelho R, Frankel R. Being a foreigner, I may be punished if I make a small mistake: assessing transcultural experiences in caring for patients. Fam Pract. 1997;14(2):112–6.

    Article  CAS  PubMed  Google Scholar 

  20. Suurmond J, Seeleman C. Shared decision-making in an intercultural context. Barriers in the interaction between physicians and immigrant patients. Patient Educ Couns. 2006;60(2):253–9.

    Article  PubMed  Google Scholar 

  21. McGrath P, Henderson D, Tamargo J, Holewa HA. Doctor-patient communication issues for international medical graduates: research findings from Australia. Educ Health (Abingdon). 2012;25(1):48–54.

    Article  CAS  Google Scholar 

  22. Rao NR, Meinzer AE, Berman SS. Countertransference. Its continued importance in psychiatric education. J Psychother Pract Res. 1997;6(1):1–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. LaVeist TA, Carroll T. Race of physician and satisfaction with care among African-American patients. J Natl Med Assoc. 2002;94(11):937–43.

    PubMed  PubMed Central  Google Scholar 

  24. Laveist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43(3):296–306.

    Article  PubMed  Google Scholar 

  25. Malat J, Purcell D, van Ryn M. Factors affecting whites’ and blacks’ attitudes toward race concordance with doctors. J Natl Med Assoc. 2010;102(9):787–93.

    Article  PubMed  Google Scholar 

  26. Malat J, van Ryn M, Purcell D. Blacks’ and whites’ attitudes toward race and nativity concordance with doctors. J Natl Med Assoc. 2009;101(8):800–7.

    Article  PubMed  Google Scholar 

  27. Howard DL, Bunch CD, Mundia WO, Konrad TR, Edwards LJ, Ahinee Amamoo M, et al. Comparing United States versus international medical school graduate physicians who serve African- American and White elderly. Health Serv Res. 2006;41(6):2155–81.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sockalingam S, Hawa R, Al-Battran M, Abbey SE, Zaretsky A. Preparing international medical graduates for psychiatry residency: a multi-site needs assessment. Acad Psychiatry. 2012;36(4):277–81.

    Article  PubMed  Google Scholar 

  29. Rao NR, Kodali R, Mian A, Ramtekkar U, Kamarajan C, Jibson MD. Psychiatric residents’ attitudes toward and experiences with the clinical-skills verification process: a pilot study on U.S. and international medical graduates. Acad Psychiatry. 2012;36(4):316–22.

    Article  PubMed  Google Scholar 

  30. Chen PG, Curry LA, Bernheim SM, Berg D, Gozu A, Nunez-Smith M. Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training. Acad Med. 2011;86(11):1383–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mackinnon RA, Michels R, Buckley PJ, editors. The psychiatric interview in clinical practice. 2nd ed. Washington, DC: American Psychiatric Publishing, Inc.; 2006.

    Google Scholar 

  32. Coverdale JH, Balon R, Roberts LW. Which educational programs promote the success of international medical graduates in psychiatry training? Acad Psychiatry. 2012;36(4):263–7.

    Article  PubMed  Google Scholar 

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Correspondence to Randon S. Welton M.D. .

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© 2016 Springer International Publishing Switzerland

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Welton, R.S., Kay, J. (2016). The Doctor–Patient Relationship. In: Rao, N., Roberts, L. (eds) International Medical Graduate Physicians. Springer, Cham. https://doi.org/10.1007/978-3-319-39460-2_5

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  • DOI: https://doi.org/10.1007/978-3-319-39460-2_5

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  • Publisher Name: Springer, Cham

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