Experiences of International Medical Graduates Caring for Type 2 Diabetes Patients in Saudi Arabia: Perspectives of Physicians and Patients

Background
Around 80% of the physicians working in Saudi Arabia providing primary health care are international medical graduates from other countries. They may not share their patients’ cultural background or language, yet are expected to deal with local patients with chronic health conditions, such as type 2 diabetes mellitus, who need culturally sensitive lifestyle advice.
Study aim
To explore and understand challenges and facilitators to effective communication between international medical graduates and patients with type 2 diabetes mellitus and how this may influence care provision in Saudi Arabia.
Methods
Data were collected in three phases: i) A focus group discussion with 6 international medical graduates from one hospital and 13 semi-structured interviews with international medical graduates from the hospital as well as 8 primary health care centres. ii) Semi-structured interviews with 16 Saudi patients with type 2 diabetes mellitus and iii) follow-up interviews with 5 international medical graduates. Data were analyzed with the aid of NVivo using thematic analysis.
Findings
Most of the international medical graduate participants reported that dealing with local patients was challenging because patients did not trust them for culturally-related reasons. Prejudice among local patients towards international medical graduates was identified, and this contributed to patients not acknowledging international medical graduates’ ability to provide culturally sensitive advice. Furthermore, some international medical graduates had a stereotypical view of local patients, which had led to an inflexible approach when advising patients. Both groups of participants identified contrasting expectations regarding relationship-building style. Participants also identified self-adopted strategies to overcome communication barriers and suggested new ones.
Conclusion
Findings suggest that efforts need to be targeted towards changing patient attitudes, as well as addressing the training needs of international medical graduates, in order to enhance the effectiveness of diabetes management and improve overall the delivery of health care in Saudi Arabia.