How is ‘culture’ made relevant in consultations between General Practitioners and ethnic minority patients?: a conversation analysis

Abstract Background General Practitioners (GPs)—usually the first points of healthcare in the UK—are required to provide ‘whole person care,’ by considering patients’ cultural backgrounds. Previous research suggests that doctors’ interactional behaviour can contribute to ethnic health disparities in clinical consultations, and culturally competent care may be a solution to address these disparities. Although research has shown how people make ‘culture’ or aspects of it (e.g., language, country of ethnic origin, and religion) interactionally visible, we know very little about how culture is signalled or managed in primary care interactions. In this study, we examine what counts as an orientation to culture, how it is made relevant, and its interactional functions in GP consultations with ethnic minority patients. This is considered with the view to better understand what culturally informed communication looks like in real-life clinical settings. Methods Data were from two datasets: (i) video/audio recordings of 38 consultations involving ethnic minority patients, their companions, GPs and GP Trainees across 4 UK general practices, and (ii) 16 GP-patient consultations from the publicly broadcasted documentary GPs: Behind Closed Doors , where patients’ ethnic minority backgrounds are made relevant in interaction. Forty instances of cultural orientations were identified, and transcripts were analysed using conversation analysis. Results Participants make culture relevant by signalling their group/identity membership related to a cultural category/practice (such as country of ethnic origin or eating specific types of food). Membership signalling is achieved using the following interactional practices: (i) explicitly or implicitly referencing a cultural category, and using insertions to secure recognition of the reference, (ii) offering assessments related to the cultural category, and (iii) code-switching. By deploying these practices, speakers show how they establish shared understanding with regards to cultural knowledge, such as in displays of affiliation. Conclusion We demonstrated how doctors’ and patients’ cultural orientations signal their identity/group memberships, which in turn display their affiliative stance in interaction. Implications include considering the use of cultural membership signalling practices in clinical practice as part of demonstrating culturally informed communication, and developing continuing relationships with ethnically diverse patients.