A patient sent me a complaint about her general practitioner who was of Middle Eastern origin. She said the doctor was offended by the questions she put and responded in a rude tone that offended her and her dignity. It happened during an aptitude test for some kind of job. The complainant felt that the doctor behaved in this way because she was a woman. In the heat of the argument, the doctor threw her out of his consulting room without attending to her.
I contacted the physician by phone and asked for information on the case, I informed him about the patients’ rights. He also talked to me in an unacceptable tone. An intense debate broke out with the doctor about what kind of rights patients have in general and women patients have, particularly in Hungary, and how these rules apply to him as well according to Hungarian law, especially in a public institution and in general when he treats a patient.
1. Identities of the actors in the situation
Patient’s advocate: A woman in her 30s, hungarian, lawyer, specialised in health related cases (educated in Hungary, after the change of the regime), working as a patient’s advocate. Speaking Hungarian as mother tongue and English as a second language. Not married, no children, born and living in Budapest. Religion: catholic.
Medical doctor: Middle Eastern, country unknown. We do not know how he got to Hungary. He has the Hungarian citizenship but his non official status is migrant. He speaks perfect Hungarian, although with a slight accent. He speaks Arabic as his mother tongue. He probably speaks more languages, though we do not know. He is in his 50s, working as a General Practitioner. He went to the University in Hungary (before the change of the regime). He works and lives in a little town near Miskolc (countryside in Hungarian terms). We do not know anything about his family. Religion: assumed Muslim? Religion unknown
Almost everything divides the two actors, some of these things are very evident and well perceived by the two of them, some of these are more hidden (like the fact that the two persons were socialised in the same educational system but in two radically different eras). There is not only sheer distance but also a strange hierarchy in which both actors are entitled to question each other’s primacy of social position:
The doctor is a man and he is elder. He has a more esteemed profession: he is a GP.
The woman is younger and professionally lower in hierarchy but she is from the capital (she “calls down” to Miskolc) and in her present role she can cause trouble for the doctor.
She is also Hungarian, while he is a migrant and although this fact does not necessarily impact primarily on the situation, their mutual perception of the other as “different” (and positioned accordingly in a symbolic social hierarchy) may have an impact.
2. Context of the situation
The more remote context of the situation: a lot of students from Middle Eastern countries were given scholarships in Hungary in the 1970s and 1980s. Many of these students remained in Hungary and became totally integrated. Although integration is never easy and they had to fight the ignorance of Hungarians in terms of migration (as Hungary was not an immigration country), many of these people have Hungarian families and respectable social positions. The panic caused by last year’s new wave of migration threatens the older (already integrated) immigrants and in this situation they also become more sensitive of what they might judge as xenophobia.
Closer context: the communication does not happen in the physical space. The interlocutors only speak on the phone. It is the woman who calls the doctor (this is her first call and the doctor learns about the case from her)
The case: the patient went to see the doctor for a certificate for an aptitude test for a job. He refused to give a positive opinion and thus made it impossible for the patient to get the job she had applied for. The patient said the doctor did not justify the reasoning behind his decision, which she qualified as retention of information.
3. Emotional reaction
Scandalised, angry (both because of the original case and because she feels the doctor is also rude to her). She feels she is not respected as a woman (or more precisely she is treated disrespectfully because she is a woman. She feels that her professional role is interpreted as “trouble maker” by the doctor. She feels rejected, not recognised.
4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
The professional is not aware of the doctor’s cultural background (she does not even know which country he comes from).
She assumes he comes from a Muslim country and she believes in Muslim countries women are oppressed. She believes that this is enough for her to know about Muslim religion in order to interpret the situation as a culturally motivate one.
For her the equality of the women is a basic value but she recognizes that this right is often not respected even in our society.
She believes in democracy and she is convinced that monitoring the respect of basic human rights is essential for democracy. The patients’ rights belong to basic human rights for her.
Her most important values are: human rights, democracy, the rule of law, human dignity.
She views the patient as a right bearing person. For her the relation between a patient and her doctor must be based on partnership and mutual recognition.
She also values integration and acceptance of migrants. She would be very frustrated if she was treated as “xenophobic” or as somebody having prejudices against migrants.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?
Negative, not very realistic.
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.
The doctor might have experienced a burn out.
He might feel threatened by the woman and see her as somebody who makes his job difficult.
He feels offended in his professional identity.
He might feel that a younger woman who is not even a doctor does not have the right to question his professional competence.
For him the patient represents a professional problem to be solved, the patient’s social identity and feelings are not important for him.
For him a good doctor is somebody who is unfaltering, makes good decisions quickly and he considers his main duty to cure the patients (filling in certificates is somewhat unimportant).
He expects total trust from the patients, that is why transparent communication is not important with them. He takes it for granted that the doctor –patient relationship should not be equal, as he possesses the knowledge that the patient lacks.
(Note that none of these plausible hypotheses demand acultural explanation.)
He might perceive his interlocutor as openly judgmental and prejudiced against migrants. He sees himself as a well-integrated immigrant, not different from Hungarians. Being reminded that he has to respect the Hungarian laws while in Hungary might sound as an insult addressed to his foreign origin and the denial of his integration.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
- The doctor might have abused the woman, or might not. There is very little objective information confirming (or contradicting) the complaints the patients’ advocate receives.
- This is a very strange position because in principle both she and the doctor are interested in enhancing the quality of the health system and to make sure that there are as few complaints as possible (they are colleagues in some sense), however in the facts the doctor is pushed in a defensive position little conducive to cooperation. Trust building would be essential but there is no time for that, neither is this important in the advocate’s specialized education.This seems to a be a systemic problem.
- Neither of the above points suggests that if the doctor was rude to the patient in this case, he necessarily did that because he is of Arab origin.
- This seems to be a case of authentic culturalisation of the difference, when culture becomes the evident explicative principle for a perceived strangeness in behavior, superseding all other possible explanations. This happens very often when the otherness of the other is easily categorizable (a migrant, an Arab, a Gypsy, etc.) and there are (usually negative) stereotypes attached to the category.
- Negative stereotypes usually motivate negative reactions, which in turn provoke negative responses. In this way, stereotypes rigidified as stereotypes easily turn to be self-fulfilling prophesies.
- In delicate intercultural situations face-work might be even more important than in general, a telephone conversation does not facilitate face-work, thus it is a bad substitute for face to face interaction.