As a general practitioner (GP) in inner city London, the majority of my work is with patients who are first- or second-generation migrants to the UK. My interest in this area of work was initially sparked as a new GP, some two decades ago, finding consultations with patients from different cultures fascinating but also frustrating. I would often end a consultation with the feeling that despite my best efforts and the use of an interpreter when required, I had somehow failed to meet my patient’s expectations, or to understand something they had been telling me. Sometimes patients were clearly cross and frustrated with me; sometimes I just had a feeling that communication had not gone well, and sometimes patients returned without following my advice. I realized that although my education as a doctor had been comprehensive biomedically, and my training as a GP had covered a more holistic ‘bio-psycho-social’ approach (Brody, 1999) as well as considering the interrelationship between doctor and patient (Balint, 1957), I had very little education on working across cultures. About this time, I took a course in systemic approaches to working in general practice and developed an interest in narrative and systemic approaches in the consultation, initially under the tutelage of John Launer, who has written widely in this area (Launer, 1995, 1996, 2002).
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