"The Happy Migrant Effect": perceptions of negative experiences of healthcare by patients with little or no English: a qualitative study across seven language groups.

BACKGROUND: The subjective experiences of patients with little or no English who either attended the Emergency Department or were admitted to the wards of a tertiary referral hospital were explored. SETTING AND METHODS: The reports of experiences from 49 patients of a tertiary referral hospital were analysed using grounded theory methods applied to translated transcriptions from focus groups held with discharged patients in seven languages. RESULTS: Inability to communicate in English, poor patient and family involvement with staff, a lack of control or powerlessness, staff shortages, staff negligence or incompetence, and treatment delays were reported by some patients. Others tended to discount or minimise the significance of similar experiences, suggesting a construct, "The Happy Migrant Effect," in which there is reluctance to assert healthcare rights. Patients appear "happy" and satisfied, despite problems with their hospital care. Explanatory factors for the construct include extreme powerlessness related to being unable to communicate, a positive comparison of healthcare in the new country compared with the old, patriotism for the new country, cultural norms that proscribe acceptance, politeness or social desirability, self-denigration for not having learnt English and, for a few, a fear of reprisals if they spoke out in complaint. CONCLUSIONS: Some immigrant patients with poor language skills might not report serious problems with healthcare delivery. In all patients in this study where problems with healthcare were reported, the events were considered to be largely preventable by appropriate language facilitation, patient and family involvement, and provider respect and compassion.

Integrating public health and medicine: first steps in a new curriculum.

CONTEXT: Recent outbreaks of infectious diseases and humanitarian crises highlight the need for an understanding of public health issues in medical progams. However, public health teaching is perceived as peripheral in current Australian university medical programs. OBJECTIVE: To integrate public health into clinical and biomedical teaching throughout the new medicine program at the University of NSW. METHODS: The medicine program has been designed with three phases and with clinical experiences introduced early in the program. The approach is to trigger learning with scenarios and with vertical integration to reinforce lifelong learning. Public health teaching and understanding has been integrated into all the scenarios. DISCUSSION: As the program is only in its 4th year, there has been no summative evaluation of the impact of this approach. However, formative evaluation through Phase 1 student portfolios has demonstrated a good understanding of public health concepts in the satisfactory way students have addressed one of the eight graduate capabilities: Social and Cultural Aspects of Health and Disease. Another indicator of an appreciation of public health issues in medicine has been the choice of social and cultural topics in students' independent learning projects. CONCLUSION: Summative evaluation will occur when the University's new program graduates work in the existing health care system. It is proposed that they will be followed up to see whether they apply the public health values in their practice.