Niet-westerse allochtonen met SOLK

Los AM, Cents RAM, Harmsen JAM, Bindels PJE.Non-western migrants with medically unexplained physical symptoms. Huisarts Wet 2016;59(4):172-5. Medically unexplained physical symptoms (MUPS) are often complex, and general practitioners may be reluctant to discuss possible psychological factors, because they think that patients have little insight into these factors and their relevance. The situation is even more difficult with patients of non-western origin, because of possible communication problems and differences in ideas and concepts regarding ill health. Many GPs assume that there is a stigma about mental health problems in non-western cultures, but this is less strong than thought. Although non-western migrants may present with physical complaints, this does not necessarily mean that they are unaware that their complaints may have a psychological basis - in many cultures the distinction between mind and body is not so clear-cut as in western culture. It is possible, and even advised, to discuss psychological factors during the consultation. The Dutch College of General Practitioners’ guideline on MUPS is helpful and provides a model for structuring the patient’s history, by asking about somatic, cognitive, emotional, and social, behavioural aspects in this order. However, with non-western migrants it is better to use a different sequence, focusing on social, behavioural, somatic, cognitive, and emotional aspects, so that the behavioural and social consequences of the problems are given prominence. It is important to build a relationship of trust with patients, for example, by using the ‘cultural interview’. When discussing mental health symptoms, it may help to begin with basic emotions (anger, fear, happiness, sadness), to use metaphors, and, where possible, to describe the problem in the patient’s own words. It is also important to emphasize the confidentiality of the patient-doctor relationship.