‘If there were doctors who could understand our problems, I would already be better’: dissatisfactory health care and marginalisation in superdiverse neighbourhoods.

Abstract

How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi-structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.

“It's the First Barrier” – Lack of Common Language a Major Obstacle When Accessing/Providing Healthcare Services Across Europe

“…For non-migrants and for others who could speak the local language confidently, it was nonetheless important that the service providers did not "treat me like a number." Even when using the same language as their healthcare providers, residents sometimes felt deeply frustrated and disappointed with the care that they received (Bradby et al, 2020). The language barriers observed in our study not only contributed to residents delaying or avoiding going to the doctor, but also to their being handled brusquely and unfairly.…”

The (Co)Production of Difference in the Care of Patients With Cancer From Migrant Backgrounds

“…This account, and others within the patient interviews, reflected intersections between public health care, assumed costs of being non-White/foreign, or assumptions about cultural groups (e.g., literacy). That is, the experience of being an intruder , as articulated in our participants’ accounts, is a complex mix of power relations when entering the clinical milieu (Charles et al, 1997; Gwyn & Elwyn, 1999), further overlaid (in the context of the migrant experience) with a broader sense of nonbelonging and threats to self (e.g., feeling disempowered, dismissed, or devalued; Bradby et al, 2020; Coyle, 1999). This was, in turn, intermingled with a sense of class/wealth stratification in Australia:I notice a lot more out [in the Western Suburbs of Sydney], they won’t get treated as well as some from the more affluent areas .…”

“…This speaks to the evolving moralities of (cancer) care and how difference often inflects the offerings of care (interpersonally and economically). There exists within this underlying morality a subtle bigotry of deservedness, with the “normal Australian” not needing to be grateful (but deserved by default) vis-à-vis the “lucky migrant.” Patients marginalized by migration, gender, language, employment status, education, and xenophobia with their entitlement to services questioned are likely to find it extremely difficult to express dissatisfaction with the public health care system (Bradby, 2020).…”

Epistemic injustices in clinical communication: the example of narrative elicitation in person‐centred care

“…1994) and racialised people (Bradby et al . 2020). On the other hand, being encouraged to tell one’s own story, articulate a life‐world goal (not necessarily a medical one) and make this documented in the records may be a gateway to more inclusive communication, self‐knowledge and awareness in both the patients and professionals.…”

“…While patient groups mobilise and vociferate their discontent towards healthcare institutions and professionals that fail to hear their voice (Bradby et al . 2020), a myriad of models and interventions seek ways to encourage patients to construe and express their idiosyncratic experiences of illness and make use of their own capabilities and resources.…”