When expectations clash: understanding the doctor–patient relationship among first-generation Chinese immigrants in New Zealand

The dynamics of the doctor–patient relationship (DPR) are crucial for healthcare outcomes. In New Zealand, the Chinese population has grown significantly over recent decades. In the 2023 Census, it reached 279,039 individuals (5.6% of the total population), making them the fourth-largest ethnic group in the country.¹ Despite this, the healthcare experiences of Chinese immigrants, particularly their interactions with doctors, remain poorly understood. A key reason for this gap is the tendency to aggregate data from various Asian nationalities into a broad “Asian” category, which fails to capture critical cultural differences that influence healthcare expectations and behaviours.² Furthermore, there is an under-representation of Asian communities in health research and policymaking, alongside gaps in culturally appropriate healthcare services.²

The term “immigrant” is used in this study to emphasise long-term settlement in the host country context, rather than temporary or transitional mobility. This is particularly appropriate for examining DPRs, which are shaped by sustained engagement with the healthcare system.

Although there are no documented widespread conflicts between Chinese immigrants and their doctors in New Zealand, studies show they have much lower rates of enrolment with primary health organisations and access primary healthcare services less frequently compared with other ethnic groups.^2,3 Additionally, Chinese immigrants report lower satisfaction with the medical care they receive and are less likely to recommend it to others in need of similar treatment, compared with other ethnic groups. ³ They also report the lowest level of life satisfaction among Asian groups in New Zealand.⁴ Existing research on Chinese communities in New Zealand further highlights persistent unmet healthcare needs and structural inequalities in service access. Studies point to growing demand for healthcare—particularly mental health services—alongside barriers such as language difficulties, cultural stigma and limited culturally appropriate care.⁵ More critically, Chinese populations remain marginalised in mainstream health discourse, where misconceptions about their needs contribute to their relative invisibility in service design and delivery.⁶ These findings suggest potential issues within the DPR for Chinese immigrants, possibly related to cultural differences and their challenges in integrating into the New Zealand healthcare system.^2,3 However, as the DPR has not been explicitly studied within the Chinese community in New Zealand, these interpretations remain speculative.

The DPR is a critical component of healthcare, with productive relationships forming when patients’ expectations are met and respected.⁷ O’Connor et al. differentiate between two types of consumer expectations: one that reflects what is likely to occur and another that reflects what consumers believe should happen.⁸ This study adopts the latter, which describes patients’ expectations as “beliefs or attitudes that interact with perceived occurrences to produce care-related evaluations”.⁹

As recognition of the importance of understanding patient expectations grows, numerous studies have explored various aspects of these expectations, from general views on healthcare accessibility to specific expectations regarding healthcare providers’ interpersonal and clinical skills.¹⁰ Previous studies have also highlighted how cultural differences shape patient expectations.¹¹ However, findings from other populations may not directly apply to Chinese immigrants, given the distinct socio-cultural contexts of this group and the particular dynamics of the healthcare system in China.

Chinese communities in New Zealand are not homogeneous. They include individuals with diverse migration histories, regional origins, linguistic backgrounds (e.g., Mandarin, Cantonese and other dialects) and consequently varied healthcare needs and preferences. Such differences may shape healthcare expectations, communication styles and medical experiences. Consequently, this study focusses on a more defined sub-group, first-generation immigrants from mainland China, which allows for a more focussed analysis and reduces heterogeneity. First-generation immigrants—adults who migrate from one country to another¹²—tend to experience lower levels of acculturation than second-generation immigrants or those who migrated before adulthood, largely due to more recent migration and language barriers.¹³ Therefore, the findings of this study should not be generalised to all Chinese populations in New Zealand.

Against this background, this study examines how healthcare-related expectations among first-generation Chinese immigrants influence their relationship with physicians. It identifies barriers and opportunities for improving the DPR in culturally diverse contexts and informs culturally appropriate health promotion strategies.

Method

In-depth interviews were conducted between 7 August 2023 and 10 November 2023. This method was selected to obtain comprehensive insights and detailed information from participants.¹⁴ Ethics approval was granted by the University of Canterbury’s Human Research Ethics Committee (HREC: 2022/52) prior to participant recruitment and data collection.

Data collection

As part of the author’s doctoral research,¹⁵ an initial survey was conducted. Interview participants were subsequently recruited from the survey respondents using purposive sampling (see Table 1 for eligibility criteria). At the end of the survey, respondents were invited to follow the researcher’s WeChat Official Account for interview recruitment details and the information sheet. All interviews were conducted in Mandarin, the participants’ native language, to facilitate comfort and encourage open and detailed responses. They were held online via Zoom, Tencent Meeting or WeChat Meeting, according to participant preferences, and lasted 45 to 70 minutes.

View Table 1–2.

A semi-structured interview guide was developed with three key aspects: participants’ expectations of doctors, their experiences during medical visits and their perceptions of doctors and the healthcare system. This structure enabled a comprehensive exploration of participants’ healthcare encounters, including initial expectations, practical experiences and subsequent reflections on the DPR.

Data analysis

Data analysis was primarily inductive, while informed by an initial conceptual framework derived from the literature and interview guide.

After completing all interviews, the audio recordings were transcribed verbatim into documents and checked for accuracy. Transcripts were read through to develop familiarity, and notes were taken on initial impressions, recurring themes and interesting quotes. The data were then imported into NVivo (Lumivero, version 20) for further analysis. All texts were written in Chinese. Only quotes included in this article were translated into English by the bilingual researcher.

Coding followed a structured qualitative approach, using open and axial coding.¹⁶ Open coding identified meaningful segments of data, while axial coding organised these into higher-order categories by examining relationships among codes.

Analysis was iterative and comparative, involving continuous refinement of codes and categories across transcripts. Final themes were developed through repeated cross-case comparison, capturing patterns that extended beyond initial conceptual expectations and reflecting context-dependent dynamics.

Data reporting

Quotes presented in the results were selected through a systematic and reflexive process to ensure they illustrate broader thematic patterns rather than isolated instances. Following established strategies in qualitative research,¹⁷ the entire dataset was actively examined for negative cases—participant accounts that diverged from or nuanced dominant patterns—to reduce the risk of presenting an overly uniform or decontextualised narrative. The final quotes were selected for their interpretive richness and ability to contextualise participants’ experiences.

This study does not aim for statistical generalisability. Instead, the findings are presented to support transferability, allowing readers to assess the extent to which the insights may resonate with or be applicable to their own contexts.

Results

Fourteen people responded to the recruitment message, with three declining participation. The final sample consisted of 11 participants (eight female, three male), with a mean age of 40.64 (range 25–66). Of these, 54.6% (n=6) had a bachelor’s degree or higher and 36.4% (n=4) reported having a chronic illness. In addition, approximately 82% (n=9) of the participants reported living, working or studying in New Zealand for over 3 years. They were recruited from four locations across New Zealand, specifically Wellington, Christchurch, Palmerston North and Queenstown. See Table 2 for detailed demographic information.

1. Reluctance to participate in medical decision making

This theme explores participants’ varying levels of engagement in medical decision making and its implications for the DPR. Overall, many participants described a preference for doctors to take the lead in clinical decision making; however, accounts were not uniform, and some variation was observed across participants.

Reliance on doctors’ expertise

Many participants emphasised doctors’ expertise as central to the DPR and expected doctors to take responsibility for final clinical decisions. For example, one participant stated that they did not view shared decision making positively, as “the key point is his [doctor’s] expertise” (male, 32). Another similarly expressed a preference for physician-led decision making, noting, “I would, instead, have doctors make the decision directly, based on their expertise” (female, 34). In addition, modern diagnostic technologies were seen as reinforcing doctors’ competence and participants’ trust in their decisions. As one participant explained, “I prefer to follow the doctor’s advice… More importantly, today, numerous advanced diagnostic and therapeutic tools aid in the assessment and treatment of diseases” (female, 31).

Cultural differences and doctors’ uncertainty

Some participants described challenges in communicating health beliefs shaped by traditional Chinese medicine (TCM), which were often not shared or fully understood in the New Zealand healthcare context. One participant described difficulties in expressing culturally grounded explanations of illness, such as “internal heat” (a TCM concept referring to an imbalance of internal energy) (male, 32). In some cases, difficulties in communication were also linked to perceived uncertainty in clinical decision making. For example, one participant reflected on a consultation in which the GP appeared uncertain and sought the patient’s input, noting, “I have gout… My GP [general practitioner] asked me what to do. I suggested taking half a dose, and he agreed. It feels like the GP relies too much on the patient for decisions” (female, 66).

Indifference to shared decision making

For some participants, shared decision making was not actively sought and was perceived as a procedural requirement rather than a meaningful practice. One participant noted, “I am indifferent about participating or not… Them [doctors] involving me in decision making is just part of their job requirements, I think” (female, 31). However, other participants expressed discomfort when required to make decisions without sufficient perceived expertise. As one described, “It’s frustrating when they [doctors] seem unsure or when I have to make decisions I’m not qualified for” (female, 34). Overall, responses to shared decision making varied across participants depending on expectations of professional authority and clinical responsibility.

2. The lack of guanxi (关系) based medical connections with doctors

This theme reflects participants’ experiences of the absence of guanxi-based relationships in New Zealand and its perceived influence on healthcare interactions. Guanxi refers to interpersonal connections characterised by ongoing exchanges of favours and mutual obligations to assist when requested, distinguishing it from simple interpersonal relationships.¹⁸ In China, guanxi-based networks permeate society and shape its relationship-oriented structure, extending from close family to wider circles of friends and acquaintances.¹⁹

Doctors with guanxi vs doctors without guanxi

Many participants described guanxi in China as enabling more personalised and familiar interactions with doctors, often involving extended consultation time and tailored advice. One participant explained that access to known doctors provided reassurance through multiple trusted opinions, as having “multiple opinions from guanxi doctors helps you feel confident about the diagnosis and treatment” (male, 25).

This personalised care through guanxi contrasted sharply with participants’ experiences in New Zealand. First-generation immigrants reported a lack of such networks, and the health system emphasises equity,²⁰ making guanxi largely irrelevant.

“In-group” members vs “out-group” members

In the absence of guanxi networks in New Zealand, some participants reported relying heavily on Chinese community networks for health information, suggesting that trust was often shaped through in-group social ties rather than direct clinical relationships with out-group healthcare providers. Social identity theory explains this tendency by proposing that individuals derive part of their self-concept from group membership, where an in-group refers to the group with which an individual identifies and an out-group refers to those perceived as different.²¹ However, this reliance also introduced variability in perceptions, as second-hand accounts sometimes reinforced uncertainty or anxiety. For instance, one participant noted, “When I visited the hospital a couple of days ago, the doctor said there was nothing wrong with me. However, after considering the incidents I had heard, I couldn’t help but think that there is probably little hope in the hospitals here. I do not have much confidence in the doctors here” (female, 64).

3. Differences in healthcare systems: no comparison, no harm

Comparisons between Chinese and New Zealand healthcare ran through the interviews. Participants frequently talked about differences in efficiency, diagnostic practices and treatment expectations. Some of them used the phrase “no comparison, no harm” to reflect their views.

Diagnostic expectations and conflict

Many participants expressed expectations for extensive diagnostic testing, a norm shaped by prior experiences in China. When tests were not used, particularly in cases involving uncertainty or discomfort, frustration surfaced. As one participant put it, “I am feeling uncomfortable in my head. Actually, in China, wouldn’t I get a CT scan? However, my GP did not recommend that I get a CT scan. Oh, this is frustrating” (female, 60). For some, laboratory tests provided objective and quantifiable data essential for accurate diagnosis, monitoring and treatment decisions. One said, “It should not rely solely on doctors’ personal experiences for judgment. They should utilise diagnostic devices” (female, 31).

Conflicts between patients’ expectations and GP services

Some participants expressed dissatisfaction when GP consultations did not align with expectations of active intervention or treatment. One recalled, “When I visited the GP about my hair loss, he considered it normal for my age. He said, ‘Hair loss is not a problem; it is pretty normal’” (male, 32). Comparing this to care in China, he noted, “The doctor [in China] diagnosed me with male pattern baldness and prescribed medication… The difference is too significant. I am unsure if it was because of his lack of medical skills.” For some, GPs came to be seen as providers of reassurance and basic care rather than intensive treatment. As one stated, “The role of a GP is primarily to prescribe medications for free, so you do not pay for them out of pocket. That is their role” (female, 32).

Conflicts between patients’ expectations and the appointment system

Long waiting times for specialist referrals were often described as a major source of frustration. Some participants compared this unfavourably with perceived faster access in China, with one of them ultimately returning to China for treatment due to delays, noting, “I saw my GP for gynaecological issues, who referred me to a specialist. After waiting several months, I was told the doctor had retired and was advised to see one in Wellington, hours away… I went back to China for medical treatment instead” (female, 31). Another referred to a common saying in the Chinese community, “Xiaobing Kao Tuo, Dabing Hui Guo” (小病靠拖, 大病回国) (male, 29), literally meaning “put off minor illnesses; return to China for major ones” to reflect a response for these delays.

4. Differences in satisfaction between Western medicine and TCM practitioners

Participants’ expectations of Western medicine (WM) and TCM practitioners appeared to influence their satisfaction. While concerns were expressed about WM doctors, dissatisfaction with TCM practitioners was less commonly reported.

Instant relief vs gradual improvement

Many participants turned to WM expecting quick symptom relief, especially for acute conditions. When outcomes did not meet these expectations, some expressed dissatisfaction. For example, one said, “When medications or procedures failed to provide quick results, I felt disappointed with my doctor” (male, 29). In contrast, TCM was often viewed as more appropriate for chronic conditions requiring gradual improvement, with participants acknowledging the need for time and persistence. As one stated, “I sought TCM treatment for my arthritis, which includes acupuncture and massage. I have been doing it for 2 to 3 months now. There has been some improvement, but it takes time and requires persistence. It won’t happen overnight” (female, 53).

Limited interaction vs holistic advice

Many participants favoured TCM practitioners for offering broader lifestyle and holistic advice beyond symptom relief. By contrast, WM consultations were often described as more biomedical and symptom focussed. For instance, one said, “TCM practitioners provided me with a lot of additional information… WM doctors generally do not provide this level of detail. Even if they do, it is usually just a simple mention like ‘get plenty of rest’ or ‘drink more water’” (female, 32).

Personal research vs professional guidance

Participants generally found it easier to access information related to WM online, whereas TCM concepts were often seen as more complex and harder to navigate. These differences appeared to shape how participants conducted their own research and engaged with medical advice. “There are many different herbs in a single dose of medicine… However, I can quickly gain information online about WM diagnosis and drugs” (female, 64). As a result, they placed greater reliance on the professional guidance of TCM practitioners, while sometimes questioning the effectiveness or decisions of WM doctors.

Notably, a small number of participants also highlighted positive aspects of healthcare in New Zealand. Some pointed to strengths in GP services. As one remarked, “The advantage of GP service is that GPs maintain long-term relationships with patients, providing consistent care over time” (female, 32). Another added, “My GP reminds me of routine check-ups, vaccinations and other additional services like screenings regularly” (female, 60). Several valued the attentive manner of New Zealand doctors. One participant described being taught to use a breathing device: “He demonstrated it first, then let me try. When I got it wrong, he just showed me again. So patient, you know?” (male, 29). These less common accounts indicate that not all experiences of New Zealand healthcare were negative.

Discussion

This study reveals that the relationship between Chinese immigrants and doctors in New Zealand is shaped by disruptions to both cultural and systemic expectations formed in their home country.

Culturally, trust in professional authority, reliance on guanxi-based networks and familiarity with TCM strongly influenced how participants interpreted medical interactions. Although shared decision making is a key principle in Western healthcare,²² participants often viewed physician-led decision making as appropriate, reflecting norms shaped in China. However, this study nuances earlier research portraying Chinese patients as generally passive in clinical encounters.²³ Participants demonstrated more differentiated and sometimes more active expectations regarding decision-making involvement, suggesting ongoing changes in contemporary Chinese healthcare culture. This may reflect the professionalisation of medicine and advances in medical technology, which have contributed to patients becoming more informed, rational and expectation-oriented healthcare users.²⁴

This study found that the absence of guanxi-based networks in New Zealand limited access to trusted interpretive resources, reinforcing reliance on in-group communication channels. Consistent with prior research,²⁵ guanxi in China facilitates access to preferred doctors and more personalised care, strengthening the DPR. However, the absence of guanxi in the host context reshapes expectations, with standardised and equity-oriented care often perceived as impersonal. In line with Wang,²⁶ reliance on co-ethnic networks further reinforces shared, and sometimes sceptical, interpretations of host-country healthcare.

Moreover, consistent with prior research,²⁷ this study confirms that participants associated TCM with more patient-centred communication, emotional support and holistic care. Such relational qualities fostered stronger trust, even when patients could not fully evaluate TCM diagnoses or treatments. In contrast, while WM was preferred for acute conditions, unmet expectations for rapid relief often led to dissatisfaction. These differing responses highlight how distinct epistemologies and treatment logics shape trust in the DPR.

In addition, age did not significantly shape reliance on doctors or preference for TCM, challenging prior assumptions that older immigrants in New Zealand are more likely to try traditional medical methods³ or that independence and autonomy are highly valued among this population.²⁸ Health beliefs and healthcare habits carried from the home country may be the more decisive factors.

Systemic expectations for timely, technologically supported care were often unmet in New Zealand, reflecting misalignments between the two healthcare systems. Accustomed to China’s walk-in, commercialised and capacity-driven system,²⁶ participants interpreted long wait times and limited access as neglect. Consistent with prior research,²⁹ tensions stemmed from mismatches between participants’ prior experiences and the practices of non-Chinese GPs. Expectations formed within China’s efficiency-oriented system led participants to view New Zealand care—characterised by limited diagnostics and gatekeeping structure—as inadequate. Unmet expectations generated frustration and eroded trust, and doctors often bore the brunt.

This research underscores the interplay of cultural and systemic factors in shaping the DPR for Chinese immigrants. For healthcare providers, this points to the need for culturally informed training that engages with patients’ communication preferences, prior medical experiences and health beliefs rooted in TCM. Culturally sensitive education initiatives, delivered through trusted channels such as language schools and community organisations, may help bridge existing gaps in understanding. At the system level, improving accessibility, offering clearer guidance and addressing inequalities linked to the lack of guanxi networks could help strengthen trust and equity. Community-based resources, including WeChat groups (widely used online chat platform among Chinese population for sharing information, asking questions and mutual support) and community liaison roles, may also support better engagement and create a more responsive healthcare environment.

Some limitations should be acknowledged. First, the observed differences in satisfaction between TCM practitioners and WM doctors, and the influence of online health information on these relationships, are derived from qualitative data and therefore cannot be generalised. Further quantitative research is needed to examine the wider applicability of these patterns. Second, the study relied on purposive sampling, which may introduce selection bias and limit the representativeness of the sample. In addition, treating “first-generation Chinese immigrants from mainland China” as a relatively homogeneous group may overlook internal differences in migration background, socio-economic status, education and other factors that may shape the DPR. Future research should adopt more stratified sampling strategies and incorporate sub-group analyses to improve the robustness and explanatory power of the findings.

This study sheds light on Chinese immigrants’ DPRs in New Zealand, emphasising the importance of healthcare services that are culturally sensitive and responsive to the prior experiences and expectations of immigrant patients. These findings offer practical guidance on enhancing cross-cultural interactions between healthcare providers and immigrant patients.