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Word of mouth recommendations in Healthcare: Expatriates should be cautious – Dr Franck Scola

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Doctor Franck Scola, 2012, SIETAR Revue


When Aristotle said, “Man is a social animal”, he described one of the most elementary human needs: that of belonging to a group, in the case of both sedentary and nomadic individuals. The social aspect is therefore one of the most important when it comes to migratory populations, as putting down new roots constitutes a physical, psychological and social act. The expatriate not only undergoes changes in their geographical environment but also their social, cultural and linguistic. In contrast to the traveller, they need to develop durable adaptive mechanisms and establish new links in the host country, identifying new social, professional and health networks in order to function properly.

Most expatriates, wherever they come from, will be anxious to find a place to live, send their children to school, deal with administrative and legal formalities, and obtain access to health care.

By going through all of these processes, the new arrivals will enter various networks and support systems. For example, by sending their children to school, they will find themselves in contact with other parents, who should constitute valuable sources of help, support and information.

Networks may be local or international, internet sites or Facebook pages, depending on the many reasons to belong to such a group. They may be made up of national communities abroad (the French of Hong Kong) or communities (such as the Corsicans in the USA or the Algerian-born French in Benidorm).

The influence of such networks is far from negligible; whether real-world or virtual, they may be a safe refuge, of identity reinforcement or sources of practical information, which would be associated for the most part with a positive emotion. Far from home, we tend to put our confidence more in those that we feel near to, rather than local institutions or even expert opinion. An expatriate might well feel able to share problems of a medical nature more readily with members of their network, even before having consulted a local medical professional. This is explained by a certain confidence placed in community solidarity and the lack of so called cultural bridges.

Local professionals able to act as a “passer” between the patient’s and the host culture, would able to help the patient to navigate the country’s medical systems. Unfortunately, these individuals are rather rare. Taking on an expatriate patient involves processes a professional cannot simply make up as they go along. Expat families will need the right information for their needs and accompaniment in their responses to their health requirements in the host country: costs and nature of coverage; the way their local health system works (gaining access to healthcare, the particularities of the local systems and cultural codes) and identifying health professionals and establishments for their specific needs.

The patient relationship in such an intercultural situation goes further than one of mutual linguistic understanding. Acting in a context of cultural complexity requires the professional to possess competencies in cross-cultural mediation. This is not to be found in basic training, whether it be medical, nursing, speech therapy or psychology; the medical professional must choose to follow an additional diploma course.

Migration brings about vulnerability stemming from several factors: the status of a foreigner; dealing with the host language; psychological stresses due to new environmental factors and the change of status within the family as well as in professional and societal contexts. These may be aggravated by a lack of knowledge of the host country’s cultural codes and the intricacies of the local health system. These may tend to allow a certain credulity in the patient when given non-expert medical advice or information. So some families might adopt unnecessary or mistaken preventive measures instead of the official recommendations. Others may be directed to “alternative” practices, not supported by medical rigour, and without full knowledge of what the implications might be for their situation.

These practices can bring about a number of consequences:

  • Coming to health care too late to prevent a potential aggravation of the pathology
  • Wrong diagnoses and treatments by incompetent individuals
  • Confusing and varying diagnoses due to the number of different practitioners
  • Uncoordinated and chaotic medical follow up
  • Negligent preventative practices
  • Bad treatment habits
  • Inexact medical information, sometimes from charlatans


Whatever the case, great vigilance is required with medical information found on the social medias. Word of mouth can never replace an expert local opinion; medical practice with a public of migrants requires real theoretic knowledge and know-how.

Before leaving, on arrival and during the entire stay in the host country, it is strongly recommended that the expatriate be guided and informed as to the way the local health system works and their options of medical coverage.

Doctor Franck Scola, 2012
Translated by Mark Manners