J.A.M. Harmsen

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (16)14.21 Total impact

  • J A M Harmsen
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    ABSTRACT: This revised practice guideline appears to concern a relatively arbitrarily chosen group of liver diseases. Why not choose for hepatitis alone or for a complete liver practice guideline? The approach to non-alcoholic fatty liver disease and non-alcoholic steatohepatitis does not differ from that of other lifestyle diseases. The elaboration on hepatitis misses the importance of the ethnic risk factor even though there is much literature evidence to support this association. This is not in accordance with the new policy of the Dutch College of General Practitioners to pay more attention to ethnic factors in practice guideline development. Apart from these criticisms, the practice guideline is well structured and well written, notably with respect to the strategy for hepatitis A, B and C.
    Nederlands tijdschrift voor geneeskunde 01/2009; 152(49):2656-7.
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    ABSTRACT: Increased migration implies increased contacts for physicians with patients from diverse cultural backgrounds who have different expectations about healthcare. How satisfied are immigrant patients, and how do they perceive the quality of care? This study investigated which patient characteristics (such as cultural views and language proficiency) are related to patients' satisfaction and perceived quality of care. Patients (n=663) from 38 general practices in Rotterdam (The Netherlands) were interviewed. General satisfaction with the general practitioner (GP) was measured by a report mark. Perceived quality of care was measured using the 'Quote-mi' scale (quality of care through the patient's eyes-for migrants), which contains an ethnic-specific subscale and a communication process subscale. Using multilevel regression techniques, the relation between patient characteristics (ethnicity, age, education, Dutch language proficiency, cultural views) and satisfaction and perceived quality of care was analysed. In general, patients seemed fairly satisfied. Non-Western patients perceived less quality of care and were less satisfied than Dutch-born patients. The older the patients and the more modern cultural views they had, the more satisfied they were about the GP in general, as well as about the communication process. However, non-Western patients holding more modern views were the most critical regarding the ethnic-specific quality items. The poorer patients' Dutch language proficiency, the more negative they were about the communication process. It is concluded that next to communication aspects, especially when the patient's proficiency in Dutch is poor, physician awareness about the patient's cultural views is very important during the consultation. This holds especially true when the immigrant patient seems to be more or less acculturated. Medical students and physicians should be trained to become aware of the relevance of patients' different cultural backgrounds. It is also recommended to offer facilities to bridge the language barrier, by making use of interpreters or cultural mediators.
    Patient Education and Counseling 08/2008; 72(1):155-62. · 2.60 Impact Factor
  • J. A. M. Harmsen
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    ABSTRACT: Voor goede interculturele communicatie is een simpel lijstje tips en trucs voor in de spreekkamer helaas onvoldoende. Het vergt ook inzicht, kennis, attitude en vaardigheden. De huisarts moet zich allereerst bewust zijn van zijn eigen culturele normen, waarden en opvattingen, en van mogelijke verschillen met die van de patiënt. De arts moet vooral ook bereid zijn deze eigen opvattingen en die van de patiënt serieus te nemen en zo mogelijk te bespreken. Het vereist vaardigheid om al deze inzichten te incorporeren in een aangepaste communicatie en werkstijl. Deze bijdrage behandelt tips, valkuilen, kicks en katers in deze materie. Keywordscommunicatie-intercultureel
    02/2008; 24(2):20-25.
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    ABSTRACT: Consultations of ethnic-minority patients tend to result in poor mutual understanding between doctor and patient, which may have serious consequences for health care. For good communication, physicians have strong devices at their disposal to manage the information, such as agenda-setting and structuring the interview into segments. What are the cultural differences in the managing of information in medical conversation? What is the relation with level of mutual understanding? Data of 103 transcripts of video-registered medical interviews (56 non-Western and 47 Dutch patients) were sequentially analysed, focusing on relevant segments of the medical interview (medical history, diagnosis and conclusion) and on agenda-setting. Physicians set the agenda and lead the conversation firmly forward, while a considerable number of patients (mainly Dutch) 'put on the brakes'. The majority of the medical conversations was traditional (37%) or cooperative (37%), while another 25% was more or less conflicting or complaintive in nature. Interviews of ethnic-minority patients were mostly traditional or cooperative, while Dutch patients showed a variety of types, especially in cases of poor mutual understanding. Further, conversational symmetry between patient and physician has increased over the years, due to the importance attached to patient autonomy. Physicians receive different conversational clues from Dutch and ethnic-minority patients in case of poor mutual understanding. This points to the necessity for physicians as well as patients to become culturally competent.
    Patient Education and Counseling 08/2007; 67(1-2):183-90. · 2.60 Impact Factor
  • J.A.M. Harmsen, R.L. Hulsman, L. Meeuwesen
    01/2007;
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    ABSTRACT: The aim of this study was to gain deeper insight into relational aspects of the medical communication pattern in intercultural consultations at GP practices in the Netherlands. We ask whether there are differences in the verbal interaction of Dutch GPs with immigrant and Dutch patients. Data were drawn from 144 adult patient interviews and video observations of consultations between the patients and 31 Dutch GPs. The patient group consisted of 61 non-Western immigrants (Turkish, Moroccan, Surinamese, Antillean, Cape Verdian) and 83 Dutch participants. Affective and instrumental aspects of verbal communication were assessed using Roter's Interaction Analysis System (RIAS). Patients' cultural background was assessed by ethnicity, language proficiency, level of education, religiosity and cultural views (in terms of being more traditional or more modern). Consultations with the non-Western immigrant patients (especially those from Turkey and Morocco) were well over 2 min shorter, and the power distance between GPs and these patients was greater when compared to the Dutch patients. Major differences in verbal interaction were observed on the affective behavior dimensions, but not on the instrumental dimensions. Doctors invested more in trying to understand the immigrant patients, while in the case of Dutch patients they showed more involvement and empathy. Dutch patients seemed to be more assertive in the medical conversation. The differences are discussed in terms of patients' ethnic background, cultural views (e.g. practicing a religion) and linguistic barriers. It is concluded that attention to cultural diversity does matter, as this leads to different medical communication patterns. A two-way strategy is recommended for improving medical communication, with implications for both doctor and patient behavior.
    Social Science [?] Medicine 12/2006; 63(9):2407-17. · 2.73 Impact Factor
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    ABSTRACT: Due to increased migration physicians encounter more communication difficulties due to poor language proficiency and different culturally defined views about illness. This study aimed to develop and validate a 'patient's cultural background scale' in order to classify patients based on culturally conditioned norms instead of on ethnicity. A total of 986 patients from 38 multi-ethnic general practices were included. From a list of 36 questions, non-contributing and non-consistent questions were deleted and from the remaining questions the scale was constructed by principal component analysis. Comparing the scale with two other methods of construction assessed internal validity. Comparing the found dimensions with known dimensions from literature assessed the construct validity. Criterion validity was determined by comparing the patient's score with criteria assumed or known to have relationship with cultural background. Criterion validity was reasonably good but poor for income. A valid patient's cultural background scale was developed, for use in large-scale quantitative studies.
    Journal of Immigrant and Minority Health 05/2006; · 1.16 Impact Factor
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    ABSTRACT: Mutual understanding between physician and patient is essential for good quality of care; however, both parties have different views on health complaints and treatment. This study aimed to develop and validate a measure of mutual understanding (MU) in a multicultural setting. The study included 986 patients from 38 general practices. GPs completed a questionnaire and patients were interviewed after the consultation. To assess mutual understanding the answers from GP and patient to questions about different consultation aspects were compared. An expert panel, using nominal group technique, developed criteria for mutual understanding on consultation aspects and secondly, established a ranking to combine all aspects into an overall consultation judgement. Regarding construct validity, patients' ethnicity, age and language proficiency were the most important predictors for MU. Regarding criterion validity, all GP-related criteria (the GPs perception of his ability to explain to the patient, the patient's ability to explain to the GP, and the patient's understanding of consultation aspects), were well-related to MU. The same can be said of patient's consultation satisfaction and feeling that the GP was considerate. We conclude that the Mutual Understanding Scale is regarded a reliable and valid measure to be used in large-scale quantitative studies.
    Patient Education and Counseling 12/2005; 59(2):171-81. · 2.60 Impact Factor
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    ABSTRACT: Little is known about the causes of problems in communication between health care professionals and ethnic-minority patients. Not only language difficulties, but also cultural differences may result in these problems. This study explores the influence of communication and patient beliefs about health (care) and disease on understanding and compliance of native-born and ethnic-minority patients. In this descriptive study seven general practices located in a multi-ethnic neighbourhood in Rotterdam participated. Eighty-seven parents who visited their GP with a child for a new health problem took part: more than 50% of them belonged to ethnic-minorities. The consultation between GP and patient was recorded on video and a few days after the consultation patients were interviewed at home. GPs filled out a short questionnaire immediately after the consultation. Patient beliefs and previous experiences with health care were measured by different questionnaires in the home interview. Communication was analysed using the Roter Interaction Analysis System based on the videos. Mutual understanding between GP and patient and therapy compliance was assessed by comparing GP's questionnaires with the home interview with the parents. In 33% of the consultations with ethnic-minority patients (versus 13% with native-born patients) mutual understanding was poor. Different aspects of communication had no influence on mutual understanding. Problems in the relationship with the GP, as experienced by patients, showed a significant relation with mutual understanding. Consultations without mutual understanding more often ended in non-compliance with the prescribed therapy. Ethnic-minority parents more often report problems in their relationship with the GP and they have different beliefs about health and health care from native-born parents. Good relationships between GP and patients are necessary for mutual understanding. Mutual understanding has a strong correlation with compliance. Mutual understanding and consequently compliance is more often poor in consultations with ethnic-minority parents than with native-born parents.
    The European Journal of Public Health 04/2002; 12(1):63-8. · 2.52 Impact Factor
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    ABSTRACT: To assess the change in general practitioners' (GPs') workload during the period 1992-1997, calculated as consult frequency and GP-patient contact time, and to estimate the workload in 2005. Descriptive. During the period 1992 to 1997, data from all GP-patient contacts from nine general practices in and around Rotterdam, the Netherlands, were registered and stored in a central database. The yearly GP-patient contact time in 1992 and 1997 was calculated using the measured contact frequencies and known figures from the medical literature on the distribution and average duration of the different contact types (consultation, home visit, telephonic consultation, other). The contact time in 2005 was estimated by extrapolating the contact time for the period 1992 to 1997, whilst bearing in mind the expected population composition in 2005. The number of GP consultations increased from 4.26 in 1992 to 5.16 in 1997 (+21%). Compared with 1992, the yearly GP-patient contact time in 1997 was at least 90 hours higher. Extrapolation to 2005, revealed a further increase in this contact time of 667 (+36%) hours compared to 1997. This predicted increase in the workload could mostly be attributed to an increase in the number of elderly patients and the number of contacts with these patients. The number of hours worked by GPs increased by 20% over a six year period and is expected to increase by about a third over the next few years.
    Nederlands tijdschrift voor geneeskunde 07/2001; 145(23):1114-8.
  • L. Meeuwesen, J.A.M. Harmsen
  • S. Twilt, J.A.M. Harmsen, B.C. Schouten, L. Meeuwesen
  • L. Meeuwesen, S. Twilt, J.A.M. Harmsen, B.C. Schouten

Publication Stats

201 Citations
14.21 Total Impact Points

Institutions

  • 2005–2009
    • Erasmus MC
      • Department of General Practice
      Rotterdam, South Holland, Netherlands
  • 2007
    • Universiteit Utrecht
      • Department of Interdisciplinary Social Science
      Utrecht, Provincie Utrecht, Netherlands
  • 2001
    • Erasmus Universiteit Rotterdam
      • Department of General Practice
      Rotterdam, South Holland, Netherlands