Cultural reasons for visiting GP
I was a singlehanded GP for six years in Sparkbrook, Birmingham, where 90 per cent of my practice was from a minority ethnic group. After leaving I took an MPhil degree at the University of Birmingham on aspects of social anthropology of the same population.
I learned lots about how different cultures view doctors and use the service they provide. Members of ethnic groups may consult their GPs for reasons that may be entirely different from the reasons given by native British.
· In some religious groups women are secluded and places they may visit outside the home are quite severely restricted. Within these groups it may be that the surgery is the only public place they may go to without men. It follows that many women will make use of this facility, attending much more frequently, spending longer there, and using it as a meeting place.
Frequently a group of women will attend the surgery with their children as a social outing. The consultation is a part of this event and it is sometimes hard to discover which person, if any, is ill.
Attempts to get people to use the surgery merely as a rendezvous do not work as people laughingly explain they need a prescription to justify their visit.
· There is little concept of 'minor illness'. In many homes in our practice area mothers were expected by the family to attend the surgery whenever a child was unwell. Attending surgery is routinely used a sign to the family that mother was caring properly for an unwell child.
· Women often hold a subordinate position in a matriarchy. It may well be the oldest woman, perhaps the mother-in-law, who dictates whether the child should see the doctor or not. The mother then has to account for the consultation to her mother-in-law and perhaps other members of the family, and may need to obtain an outcome that will satisfy them.
· Many members of ethnic minorities originate from countries with poor heath facilities and high infant mortality. There is often a high level of anxiety about children's health among older people who spent their youth in countries where these circumstances obtain, leading to what might on other criteria be judged as inappropriate consultations.
· Mothers will frequently bring all their children to the surgery and want all children seen when only one is actually ill.
These are some of the many social and cultural factors that lead to a high consultation rate. They are also the reasons why cross-cultural general practice is so fascinating and such fun.
There are also reasons of morbidity which are well documented but in my view are far less important when it comes to frequency of consultation.
Dr Robin Fisher