General practitioners' perspective on poverty: a qualitative study in Montreal, Canada.

Background: Social inequalities in healthcare systems persist worldwide. Physicians' prejudices and negative attitudes towards people living in poverty are one of the determinants of healthcare inequalities. We know very little about general practitioners' (GPs) perceptions of poverty, which shape their attitudes. Objective: To identify the perceptions of poverty of GPs who deal with it in everyday practice. Methods: A qualitative study based on interviews with GPs working in deprived urban neighbourhoods. In-depth semi-structured interviews were conducted with physicians working in disadvantaged neighbourhoods in Montreal, Canada. Interviews were audio-recorded and transcribed verbatim. Analysis consisted of interview debriefing, transcript coding, and thematic analysis using an inductive and iterative approach. Results: Our study revealed two contrasting perceptions of poverty. The global conception of poverty referred to social determinants and was shared by the majority of physicians interviewed, while the moral conception, centring on individual responsibility, was shared by a minority of participants. Conclusion: The moral judgments and misunderstandings evidenced by GPs regarding poverty suggest avenues for improving general medical training. Understanding social determinants of health should be an important component of this training, to improve access to care for people living in poverty.

[Not Available]. / Pratique réflexive et responsabilité sociale en médecine de famille: Les impacts de l'expérience des stages internationaux menés dans les pays en voie de développement.

OBJECTIF: Explorer les retombées perçues d'un stage électif en santé internationale dans le processus d'apprentissage des résidents en médecine de famille. TYPE D'ÉTUDE: Étude qualitative de type collaborative reposant sur des entrevues semi-dirigées. CONTEXTE: Québec. PARTICIPANTS: Un total de 12 résidents en médecine de famille et 9 superviseurs de stages internationaux (N = 21). MÉTHODES: Entrevues semi-dirigées menées auprès de résidents et de superviseurs de stages. PRINCIPALES OBSERVATIONS: Tous les participants ont tiré des avantages tant sur le plan technique que sur le plan relationnel. Sur le plan technique, ils ont renforcé leurs connaissances des pathologies tropicales; ils ont également appris à élargir leur examen clinique. Sur le plan relationnel, ils ont bénéficié d'une expérience riche du point de vue des interactions avec d'autres milieux de soins et avec des populations vivant majoritairement dans des conditions précaires. C'est au niveau des compétences relationnelles (communication, empathie, etc.) avec les patients vulnérables que l'impact du stage a été le plus bénéfique. Tous les participants ont en effet été confrontés à d'autres formes de thérapies locales et à d'autres interprétations de symptômes et d'étiologie des maladies. CONCLUSION: L'impact de cette étude au niveau des retombées pédagogiques est important puisque nous avons pu situer la façon dont les résidents vivaient un tel stage et ce qu'ils en retiraient en matière de compétences médicales et d'approche pédagogique dans la rencontre avec les patients. Une approche collaborative avec des superviseurs de stages nous a permis d'effectuer une triangulation des données et de mieux situer les apports d'un stage international dans la formation universitaire. Enfin, les résultats obtenus permettraient de soutenir et de renforcer les programmes académiques en médecine sociale et préventive et de mieux préparer les futurs médecins de famille à agir dans des contextes socioculturels pluriels.

Reflective practice and social responsibility in family medicine: Effect of performing an international rotation in a developing country.

OBJECTIVE: To explore the perceived effect of an elective international health rotation on family medicine resident learning. DESIGN: Qualitative, collaborative study based on semistructured interviews. SETTING: Quebec. PARTICIPANTS: A sample of 12 family medicine residents and 9 rotation supervisors (N = 21). METHODS: Semistructured interviews of residents and rotation supervisors. MAIN FINDINGS: Residents and supervisors alike reported that their technical skills and relationship skills had benefited. All increased their knowledge of tropical pathologies and learned to expand their clinical examinations. They benefited from having very rich interactions in other care settings, working with vulnerable populations. The rotations had their greatest effect on relationship skills (communication, empathy, etc) and the ability to work with vulnerable patients. All of the participants were exposed to local therapies and local interpretations of disease symptoms and pathogenesis. CONCLUSION: The findings of this study will have a considerable effect on pedagogy. The residents' experiences of their international health rotations and what they learned in terms of medical skills and pedagogic approaches in working with patients are described. Using a collaborative approach with the rotation supervisors, the data were triangulated and the benefits of an international rotation on academic training were more accurately defined. The findings can now be used to enrich academic programs in social and preventive medicine and more adequately prepare future family physicians for work in various social and cultural settings.

Providing care to vulnerable populations: a qualitative study among GPs working in deprived areas in Montreal, Canada.

BACKGROUND: Communication barriers between persons living in poverty and healthcare professionals reduce care effectiveness. Little is known about the strategies general practitioners (GPs) use to enhance the effectiveness of care for their patients living in poverty. OBJECTIVE: The aim of this study was to identify strategies adopted by GPs to deliver appropriate care to patients living in poverty. METHODS: We conducted in-depth semi-structured interviews with 35 GPs practising in Montreal, Canada, who regularly provide care to underprivileged patients in primary care clinics located in deprived urban areas. Analysis consisted of interview debriefing, transcript coding, thematic analysis and data interpretation. RESULTS: GPs develop specific skills for caring for these patients that are responsive to their complex medical needs and challenging social context. Our respondents used three main strategies in working with their patients: building a personal connection to overcome social distance, aligning medical expectations with patients' social vulnerability and working collaboratively to empower patients. With these strategies, the physicians were able to enhance the patient-physician relationship and to take into account the impact of poverty on illness self-management. CONCLUSIONS: Our results may help GPs improve the health and care experience of their vulnerable patients by adopting these strategies. The strategies' impacts on patients' experience of care and health outcomes should be evaluated as a prelude to integrating them into primary care practice and the training of future physicians.