Illness experience, meaning and help-seeking among Chinese immigrants in Canada with chronic fatigue and weakness

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Abstract
Clinically significant symptoms and disorders of medically unexplained chronic fatigue and weakness constitute a serious problems for primary care with considerable cost, patient dissatisfaction, and clinician frustration. Such problems are likely to be more troublesome when cultural differences make if difficult for patients and clinicians to communicate adequately to establish an effective alliance for treatment. This research studied 50 Chinese immigrant patients in Toronto with problems characterized by prominent, medically unexplained fatigue and weakness. The EMIC, a semi-structured interview for research in cultural epidemiology, was adapted for study of the experience and meaning of patients' problems, self-perceived stigma, and prior help-seeking. The impact of migration was the predominant theme in narrative accounts of illness, which typically included multiple somatic symptoms. Patients were troubled by anticipated stigmatization and social effects of their condition on themselves and their families. Interpersonal conflicts and underemployment were prominent among perceived causes. Although patients had typically sought prior help from other health care providers, they had relied mainly on self-help. Prior experience with clinicians had been unsatisfactory, because it seemed to patients that the doctors who appreciated so little about the social context of their lives did not really understand the nature of their problems. Practitioners of traditional Chinese medicine (TCM) would understand better, but financial constraints and the higher cost of TCM deterred patients from using them more. Findings indicate the value of studying the cultural epidemiology of these conditions in a culturally distinctive immigrant population, and its contribution to cultural sensitivity in clinical care.