Understanding Health Care Workers' Anxieties in a Diversifying World

Perspectives W e live in an age of evidence-based medicine [1], and with good reason. It is important to be able to evaluate the likely impact of various interventions, and it is no longer acceptable to practice health care on the basis of received wisdom and anecdotal evidence, which has convincingly been shown to be subject to serious bias [2]. One of the dangers of the evidence revolution in health care, however, is that the emphasis on an actuarial approach (see Glossary) to evaluating health interventions may obscure the influence of more complex interactions between patients and health professionals [3]. The impact of these interactions upon health care outcomes may be idiosyncratic and rather difficult to measure. Two important ways in which evidence-based medicine has attempted to account for these interactions are (1) the increasing emphasis on what is variously called effectiveness (as opposed to efficacy) research, and (2) the project to turn evidence into clinical practice guidelines so that patients receive consistent care. What is clear, however, is that neither of these developments can ever account fully for the nuances in style and attitude that may differentiate one clinician from another, or one group of clinicians from another. We know, for example, that users of services may prefer to be treated by clinicians of a particular gender or background [4,5], and that they may at different times and in different contexts wish to be treated by someone very similar to or very different from oneself [6]. Qualitative research is the best way to access the nuances of difference that may occur across different contexts and individuals. A new qualitative study of how health professionals respond to ethnic diversity among their patients, by Joe Kai and colleagues, provides an excellent example of the contribution that qualitative research can make to our understanding of the messier, more complex side of health care [7]. The study involved 18 focus groups that included 106 health professionals from a variety of disciplines working with an ethnically diverse patient population in the Midlands region of the United Kingdom. Using the constant comparison method to analyze the interview transcripts, a number of themes emerged. Professionals experienced discomfort and uncertainty in responding to the needs of patients whose ethnicity was different to that of the professional, and they worried about the possibility of showing culturally inappropriate behaviour. Kai and colleagues' study provides a useful way to think …