English - World Health Organization Regional Office for Europe

Differences in language, religious beliefs and culture 209
a gynaecological consultation (compared to 87% agreeing for female medical
students to be present), and only 69% said they would agree to a male medical
student participating in a consultation involving examination of the face. The
authors concluded that it will be very difficult to overcome these religious and
cultural beliefs (McLean et al. 2010).
In most European countries, patients in primary care services can choose
whether they want to be seen by a male or female physician. However, in
hospitals, especially emergency departments and maternity wards, the issue
may be more difficult. Most of the time, an open-minded attitude of medical
staff can resolve the situation if it is not possible to reschedule the consultation.
Some of the gestures with which health professionals can demonstrate goodwill
and cultural know-how include allowing a same-sex chaperone to participate in
the consultation if the patient so wishes, explaining through an interpreter or
cultural mediator what will be done during the examination, agreeing that the
patient only partially undresses, and discussing the medical procedures with
patients and their families before and after the consultation.
Female genital mutilation (FGM) is another issue that illustrates challenges
in providing culturally responsive care. It is estimated that, globally, 100–140
million women have been victims of some form of FGM and that every year
3 million girls are at risk of being submitted to this practice (Kaplan-Marcusán
et al. 2010). Primary health care professionals, paediatricians and gynaecologists
in host countries can be instrumental in dealing with and preventing FGM and
should be trained appropriately (Kaplan-Marcusán et al. 2009). This will allow
them to tackle the subject with their patients during routine consultations, to
identify the different types of FGM, to evaluate consequences for health, and
to offer adequate support for women with FGM, as well as to their relatives.
However, so far, FGM is not routinely included in the curricula of most medical
schools in Europe.
Conclusions
In their interactions with migrant patients, health professionals need to be aware
and prepared to address differences in language, religious beliefs, culture and
origin (Gijon Sanchez et al. 2009). Many so-called “ethnic misunderstandings”
are linked to poor linguistic comprehension. Where patients and health
professionals do not share a common language, the use of trained interpreters
is therefore an essential prerequisite for bridging cultural differences.
It is, however, important to avoid making assumptions based on “ethnic”
considerations without discussing them with the patient. A common problem
facing medical practitioners when dealing with migrant patients is how to
achieve a balance that avoids going too far in cultural interpretations (for
example, when confronted with an apparent aggressive attitude of a male
patient towards a female doctor) and also avoids a reluctance to take up sensitive
subjects (for example, alcohol use or sexuality) altogether, for fear of causing
“cultural offence”. Indeed, the application of cultural generalities based on
language, religion, country of origin, and cultural or socioeconomic grouping
of patients can easily degenerate into stereotyping (Fiore 2008). It is necessary