Overview

As for any new patient accepted in a family physician’s practice, a complete medical history should be performed for new refugee patients. However, some specific elements should be included in their initial medical history. Most of the following recommendations are based on the CMAJ Evidence-based clinical guidelines for immigrants and refugees (Pottie et al., 2011).

The key elements of the initial medical history in refugee patients are summarized below:

GENERAL INTERVIEW

Use a professional phone or in-person interpreter if required
Inform patients about confidentiality of medical appointments/records
Ask about country of origin and transition countries, as well as any refugee camp history

INFECTIOUS DISEASES

History of hepatitis, HIV, TB or recent malaria episode?
Previous latent TB screening?
- especially if came from USA or another Canadian province
Any immunization records from the IOM?
- need at least 1 MMR, 3 DTaP-IPV doses and serologic proof for hepatitis B and varicella to be considered adequately immunized

WOMEN’S HEALTH

Ask about contraception history and desire for a contraceptive method
- with patient alone in the room
Offer cervical cancer screening if indicated
Consider screening for female genital cutting if from prevalent country (see Map)

MENTAL HEALTH

Do not routinely screen for depression or PTSD
- be alert however for any potentially associated symptoms

SOCIAL HISTORY

Do not routinely screen for child abuse, and only screen for intimate partner violence in prenatal patients
- be alert however for any symptoms/signs of IPV or child abuse in all refugee patients
Inquire about current family and housing situation

ORAL AND VISION HEALTH

Inquire about dental pain, and refer patients with dental pain or obvious caries to a dentist
Refer all school-age children and adults with vision complaints to an optometrist

>> Also refer to the following links for additional resources to help facilitate the interview process:

The Canadian Collaboration for Immigrant and Refugee Health (CCIRH) website provides useful clinical checklists to help physicians welcome new refugee patients in their practice.
Conducting an effective and culturally sensitive interview with refugee patients is sometimes challenging. The Cultural Formulation Interview tool by the American Psychiatric Association can help physicians explore the patient’s problem from his/her point of view.