Objective: This study explores refugees' perspectives regarding the nature of communication barriers that impede the exploration of trauma histories in primary care. Method: Brief interviews were conducted with 53 refugee patients in a suburban primary care clinic in the Midwest USA. Participants were asked if they or their doctors had initiated conversations about the impact of political conflict in their home countries. Qualitative data analysis was guided by grounded theory. Peer debriefings of refugee healthcare professionals were incorporated into the analysis. Results: Two-thirds of refugee patients reported that they never shared how they were affected by political conflict with their doctors and that their doctors never asked them about it. Most refugees stated that they would like to learn more about the impact of trauma on their health and to discuss their experiences with their doctors. Conclusion: Refugees are hesitant to initiate conversations with physicians due to cultural norms requiring deference to the doctor's authority. They also lack knowledge about how trauma affects health. Physicians should be educated to inquire directly about trauma histories with refugee patients. Refugees can benefit from education about the effects of trauma on health and about the collaborative nature of the doctor-patient relationship. © 2012 Radcliffe Publishing.

war trauma Refugee Doctor-patient relationship Cross-cultural communication

personal experience doctor patient relation political system primary medical care refugee health care personnel conflict human communication disorder injury war interview United States male female qualitative analysis clinical article cultural factor medical education peer group Article adult grounded theory physician data analysis authority