Research Stith, Nelson, 2002). The Caucasian patients shared the

Research has shown that the use of health care in the
Netherlands is not evenly distributed among the indigenous people and
immigrants (Stronks, Ravelli,
Reijneveld, 2001). Part of these differences can be accounted for by a lower
socioeconomic status, but not all. For example, an investigation revealed that
for Turkish and Moroccan immigrants, the amount of use of general practitioner
care is the same as for the indigenous people, but specialised health care is
used less (Stronks, Ravelli,
Reijneveld, 2001). There have not been found any socioeconomic causes to explain this
difference during the medical process. This suggests that ethnic background in
itself may be a factor that contributes to these differences. The underuse of
more specialised services may indicate limited health access for ethnic
minority groups. As 9% of the Dutch population is of non-Western origin, a
substantial group of the population is affected by this. Therefore, it is
important to further research the relation between ethnic origin and
impediments during the medical process.

Studies from
America about medical contentment among patients have also shown differences
between ethnic groups: Afro-American and Hispanic patients declared to be less
positive about the care they received from their doctor than Caucasian
Americans (Smedley, Stith, Nelson, 2002). The Caucasian patients shared the
same race or ethnicity with their doctor, while the patients from ethnic
minority groups did not. This suggests racial discord is the cause of negative
medical experiences. The beneficial effects of racial or ethnic concordance
between doctor and patient have been studied broadly. Research has shown that
racial concordance is associated with more patient involvement (Cooper-Patrick
et al., 1999), longer consultations, more affectionate behaviour towards the
patient (Cooper et al., 2003) higher utilisation of health care (LaVeist, Nuru-Jeter, Jones, 2003) and overall more
satisfied patients (LaVeist &
Nuru-Jeter, 2002). A clarification for these effects could be that shared race or
ethnicity increases the perception of a shared identity. This mainly regards
personal beliefs and values. Patients who believe they are more similar to
their doctor reported more satisfaction, trust, and are more likely to follow
the doctor’s recommendations (Street,
O’Malley, Cooper, Haidet, 2008).

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Most immigrants in
the Netherlands are first generation immigrants, therefore they are still strongly
connected to their original culture and language. Because of these cultural
differences, it can be assumed that immigrant patients do not have a great
perception of shared identity with their doctor. This could be the cause of a
less positive experience during the medical process. However, cultural
differences are paired with different communication manners.

The cross-cultural
communication between doctors and immigrant patients has been studied in the
Netherlands. Patient consultations with Dutch patients and immigrant patients
were videotaped and the verbal communication was analysed. The analysis of the
tapes showed that consultations with immigrant patients were shorter than those
with Dutch patients. Different communicative behaviour was observed as well.
During consultations with immigrant patients, the doctor was verbally dominant,
while there was verbal symmetry with Dutch patients. Dutch patients were more
assertive, while immigrant patients showed a submissive attitude. Doctors also
showed less empathy and involvement towards the immigrant patients, but
focussed on mutual understanding (Meeuwesen,
Harmsen, Bernsen, Bruijnzeels, 2006). The lack of affective behaviour is the main
difference and could be the cause of a lower satisfaction among patients.

In …’s research,
the doctors that were subject of the analysis were all white. However, one may
wonder what the effect on the communicative behaviour of doctor and patient
would be if the doctor belongs to an ethnic minority group himself. The communication
between immigrant patients and a doctor of foreign origin, might differ
considerably from the communication with a white doctor. There may be a greater
perception of shared identity, which could lead to more openness and affective
communication. Because there have not been done any previous experiments or
analyses of the communication between immigrant patients and doctors of foreign
origin in the Netherlands, it would be of scientific relevance to further
research this topic. This leads to the research question: How does the
ethnicity of a doctor affect the doctor-patient communication with patients
from ethnic minority groups in the Netherlands?