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

Research has shown that the use of health care in theNetherlands is not evenly distributed among the indigenous people andimmigrants (Stronks, Ravelli,Reijneveld, 2001). Part of these differences can be accounted for by a lowersocioeconomic status, but not all. For example, an investigation revealed thatfor Turkish and Moroccan immigrants, the amount of use of general practitionercare is the same as for the indigenous people, but specialised health care isused less (Stronks, Ravelli,Reijneveld, 2001). There have not been found any socioeconomic causes to explain thisdifference during the medical process. This suggests that ethnic background initself may be a factor that contributes to these differences.

The underuse ofmore specialised services may indicate limited health access for ethnicminority groups. As 9% of the Dutch population is of non-Western origin, asubstantial group of the population is affected by this. Therefore, it isimportant to further research the relation between ethnic origin andimpediments during the medical process.Studies fromAmerica about medical contentment among patients have also shown differencesbetween ethnic groups: Afro-American and Hispanic patients declared to be lesspositive about the care they received from their doctor than CaucasianAmericans (Smedley, Stith, Nelson, 2002). The Caucasian patients shared thesame race or ethnicity with their doctor, while the patients from ethnicminority groups did not.

This suggests racial discord is the cause of negativemedical experiences. The beneficial effects of racial or ethnic concordancebetween doctor and patient have been studied broadly. Research has shown thatracial concordance is associated with more patient involvement (Cooper-Patricket al., 1999), longer consultations, more affectionate behaviour towards thepatient (Cooper et al., 2003) higher utilisation of health care (LaVeist, Nuru-Jeter, Jones, 2003) and overall moresatisfied patients (LaVeist &Nuru-Jeter, 2002). A clarification for these effects could be that shared race orethnicity increases the perception of a shared identity. This mainly regardspersonal beliefs and values. Patients who believe they are more similar totheir doctor reported more satisfaction, trust, and are more likely to followthe doctor’s recommendations (Street,O’Malley, Cooper, Haidet, 2008).

Most immigrants inthe Netherlands are first generation immigrants, therefore they are still stronglyconnected to their original culture and language. Because of these culturaldifferences, it can be assumed that immigrant patients do not have a greatperception of shared identity with their doctor. This could be the cause of aless positive experience during the medical process. However, culturaldifferences are paired with different communication manners. The cross-culturalcommunication between doctors and immigrant patients has been studied in theNetherlands. Patient consultations with Dutch patients and immigrant patientswere videotaped and the verbal communication was analysed. The analysis of thetapes showed that consultations with immigrant patients were shorter than thosewith 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 moreassertive, while immigrant patients showed a submissive attitude. Doctors alsoshowed less empathy and involvement towards the immigrant patients, butfocussed on mutual understanding (Meeuwesen,Harmsen, Bernsen, Bruijnzeels, 2006). The lack of affective behaviour is the maindifference 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 maywonder what the effect on the communicative behaviour of doctor and patientwould be if the doctor belongs to an ethnic minority group himself.

The communicationbetween immigrant patients and a doctor of foreign origin, might differconsiderably from the communication with a white doctor. There may be a greaterperception of shared identity, which could lead to more openness and affectivecommunication. Because there have not been done any previous experiments oranalyses of the communication between immigrant patients and doctors of foreignorigin in the Netherlands, it would be of scientific relevance to furtherresearch this topic.

This leads to the research question: How does theethnicity of a doctor affect the doctor-patient communication with patientsfrom ethnic minority groups in the Netherlands?