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Cross-cultural Communication Between Healthcare Professionals and Hispanic Patients in the United States

Giselle Lopez Mentor: Dr. Roberta Lavine Department of Spanish and Portuguese College of Arts and umanities !niversit" of Mar"land College Par#$ MD

INTRODUCTION &he follo'ing 'eb site is intended for health(are professionals 'ho 'ould li#e to in(rease their (ultural (ompeten(" 'ith regard to ispani( patients. )t is not meant to tell health(are providers ho' to do their *obs. Rather$ the purpose of this 'ebsite is to ma#e them a'are of (ertain (ultural (onsiderations that are important. Contained 'ithin are suggestions not onl" of 'a"s of dire(tl" intera(ting 'ith patients$ but on other methods that (an be used to improve patient (are for patients of ispani( des(ent. &his is espe(iall" helpful and relevant for ne' immigrants$ and those 'ho ma" have been born here$ but have been edu(ated in traditional 'a"s. &his information 'ill also relate more so$ although not entirel"$ to patients of lo' so(io+e(onomi( status ,S-S. and a lo' level of edu(ation. )n addition$ lin#s to useful 'ebsites have been put in the appropriate pla(es$ if "ou 'ould li#e additional information regarding a topi( ,'e hold no responsibilit" for the (ontent of outside 'ebsites.. )n addition$ there are relevant resour(es found at the end of ea(h se(tion. As 'ith all information regarding an" (ulture$ remember that man" details refle(t the (ulture as a 'hole and 'ill not appl" to ever" person. Different (ultures have different beliefs$ as do those from different so(io+e(onomi( levels or 'ith different levels of edu(ation. )n addition$ ea(h person 'ill have a different degree of a((ulturation to the !nited States. As a result$ it is ne(essar" to treat ea(h patient as an individual and dis(over 'hat his or her o'n beliefs and (on(erns are. &han# "ou. TH ! "# TH DOCTOR-P$TI NT R %$TIONSHIP Case Stud& A ne' patient$ Mr. Morales (omes in$ 'ith s"mptoms ,as des(ribed b" the nurse. (learl" fitting the profile for appendi(itis. /ou go in to see the patient$ introdu(e "ourself$ and begin to des(ribe "our theor" of appendi(itis to him$ e0amining him to as(ertain 'hether this theor" is indeed (orre(t. 1hile the ph"si(al s"mptoms do appear to suggest appendi(itis$ it is diffi(ult to get an a((urate des(ription from the patient of his o'n s"mptoms. )n fa(t$ the patient seems ver" 2uiet in "our presen(e$ and "ou have trouble even getting the basi( information that the nurse 'as able to get and put into the (hart. o'ever$ being a ne' patient$ it is diffi(ult to determine the (ause of his silen(e. 1hat are some possible reasons 'h" he ma" be un(omfortable3 !ain Points# + Ma#e an effort to get names right. + Dress appropriatel" for "our position as a do(tor. + Address patients formall" unless permitted b" patient to do other'ise. + Spea# (learl"$ and at level appropriate for that parti(ular patient. + Spend time to ma#e patient (omfortable+tal# about famil" first$ illness se(ond. + Go through the illness and treatment in a slo' and methodi(al manner. Introducin' (ourself to the Patient 4ne of the easiest things to do is to ma#e a (on(erted effort to pronoun(e the name of "our patient (orre(tl". )f "ou are unsure ho' to pronoun(e the name of "our patient$ feel free to

as# them. &he" 'ill feel more (omfortable 'ith someone 'ho ma#es at least an effort to pronoun(e their name right. Also$ "ou 'ant to sho' the (orre(t amount of respe(t to the patient$ espe(iall" if the patient is older. 1ith older patients$ "ou ma" 'ant to address them formall" until the" give "ou permission to do other'ise$ as a sign of respe(t. Dr. Le6n also re(ommends giving patients a handsha#e$ or even a hug$ 'hen introdu(ed to them. e states$ 7&he" appre(iate the 'armth right up front. &hat 'ill help8 it9s *ust a (ultural thing.: Again$ he 'arns that not all ispani( patients prefer this$ but that it is generall" true. Tal)in' with the Patient Although the follo'ing is true 'ith all patients$ this is espe(iall" true for patients for 'hom -nglish is a se(ond language. &r" to spea# (learl"$ and if ne(essar"$ to slo' do'n "our spee(h. )t is not ne(essar" to slo' do'n to the point of being (ondes(ending$ but tal#ing a little slo'er (an help in(rease (omprehension. Also$ be a'are that patients (oming in have ver" different levels of edu(ation. 1hile some ma" have (ollege degrees$ other 'ill have onl" a fe' "ears of s(hooling. &r" to ta#e this into (onsideration 'hen spea#ing 'ith a patient. 1hile "ou do 'ant to avoid sounding (ondes(ending$ it is important to ma#e sure that the patient understands 'hat "ou are tr"ing to tell him or her. Also$ it is important to not ma#e an" assumptions 'hen tal#ing 'ith a patient. &his is espe(iall" true in (ases of patients of lo' S-S. /ou (an9t assume a (ertain level of h"giene. /ou (an9t assume that the" understand the basis of diseases. /ou reall" (an9t assume an"thing. As a result$ it is ver" ne(essar" to as# a lot of 2uestions. 4ne do(tor re(ommends$ 7A lot of times "ou have to prod;"ou9re tr"ing to get the info not be(ause "ou9re (urious or tr"ing to pr" into their life$ but be(ause "ou are tr"ing to understand them.: Getting this a(ross to the patient ma" help them open up. The Time Issue Although time spent 'ith patients is often at a premium$ it is espe(iall" important 'ith ispani( patients to spend a bit of e0tra time 'ith them. Patients intervie'ed e0pressed over and over again the desire to have do(tors spend more time 'ith them. -ven a fe' minutes at the beginning as#ing about the famil" or life or their *ob (an ma#e a huge differen(e. )n man" ispani( (ultures$ business and other intera(tions among ispani(s is never begun until the t'o people have gotten to #no' ea(h other or (at(h up. As a result$ ispani( patients ma" not feel (omfortable tal#ing 'ith "ou about their health (ondition until "ou have had a (han(e to (hat about other topi(s first. )t is also useful to (onsider that dis(ussing these other topi(s ma" help in determining the (ause of some health (onditions. Ma#e it a goal to find out at least one personal detail about a patient$ (ompletel" unrelated to their illness$ before pro(eeding to dis(uss 'hat ails them. )n addition$ if possible$ e0tra time should be ta#en to dis(uss the health of the patient and the steps the" must ta#e to improve it. &his is stressed not onl" in the literature$ but also in intervie's b" both Marsigli and the author 'ith both patients and health(are providers. Patients lost faith in do(tors 'ho didn9t spend time 'ith them. &he" 'eren9t as li#el" to trust those do(tors. Dr. Ale0 Le6n points out that$ 7)f "ou9re frustrated and irritable$ and in a rush$ and "ou thin# that it9s going to be fifteen minutes$ in and out$ then "ou9re not going to be therapeuti(;so the fifteen minute appointment *ust be(ame a fort"+five minute appointment. And if "ou (an9t <do that=;at least get some referrals so the" don9t fall through the (ra(#s.: As (an be seen$

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forming a positive relationship 'ith the patient is vital to gaining their trust and en(ouraging them to follo' "our re(ommendations. Patients are also not going to be(ome (ompletel" trusting over the (ourse of one visit. )t is important to (ontinue e0pressing interest in the life of the patient$ and spending time 'ith them$ over the (ourse of man" visits. &his helps build up confianza, or trust. Also$ man" do(tors re(ommended (ontinuall" as#ing the patients 2uestions$ and 7pulling and pulling$: to get information. )ntervie's 'ith patients suggested that the" responded 'ell to this. 1hen as#ed 'hi(h (hara(teristi(s the" preferred in a do(tor$ the" mentioned$ 'ithout prompting$ that the" appre(iated the do(tor 'ho #ept as#ing 2uestions over and over again. 4ne do(tor a(tuall" sa"s that she gets into her 7slo' mode. &hat means that the" understand that )9m ta#ing time 'ith them. &he" resist a lot of times the fa(t that people don9t ta#e time 'ith them. &he" feel brushed a'a". And so "ou have to$ even though "ou have a million people 'aiting$ "ou have to ma#e a (ons(ious effort to slo' do'n$ and then "ou have to$ step b" step$ in a ver" deliberate 'a"$ sa"$ ?4#$ this is 'hat "ou have9;"ou have to go from step one$ 'hat does this <disease= mean. -0plain the illness to them in a ver" simple 'a". &hen "ou have to go on into e0plaining the treatment;reassure them that there is treatment$ and go into the treatment in a ver" step+b"+step manner. &he"9ll as# "ou$ for e0ample$ ?1here (an ) get that medi(ine39 /ou have to go through the spe(ifi(s. ?/ou 'ill get it in this pla(e. &he" 'ill give it to "ou. /ou 'ill present "our little (ard.9 And "ou have to go step+b"+step sa"ing$ ?&his is going to be the diet. &his is going to be the position of the (hild. &his is going to be;et(.9 )f "ou don9t do those things$ the"9re going to be ba(# at "our offi(e the ne0t da"$ or the"9re going to be on the phone the ne0t da". /ou #ind of have to hold their hands a little bit more;if "ou (an9t do that$ "ou (ertainl" have to find a group of people 'ho are going to be "our support in doing that.: &his is not to suggest that these patients (annot normall" handle it. A large part of this is due to the fa(t that the" are not "et ver" a'are of ho' medi(ine is done in the !.S.$ and some ma" not have been e0posed to mu(h traditional 1estern medi(ine in the past. Again$ it is not that the patients are not intelligent. )t is simpl" that the" don9t have the e0perien(es needed$ or the familiarit" 'ith 1estern medi(ine. )n addition$ it is going to ta#e longer 'ith man" of the lo'+in(ome patients regardless$ sin(e the" 'ill often onl" (ome in 'hen the" are reall" si(#. @irst$ the" 'ill often ta#e longer to get to the point$ and go into mu(h more detail about the s"mptoms than an Ameri(an patient might. As one do(tor dis(usses$ 7&he"9re over'or#ed$ underpaid$ undervalued$ and the" *ust li#e to be listened to.: Sometimes$ those e0tra details (an be used to relate ba(# to the patient. 4ne provider gave the e0ample of someone diagnosed 'ith diabetes$ 'hose brother had previousl" suffered from diabetes. She sa"s$ 71hat ) did is b" revie'ing her brother9s situation$ ) managed to (onvin(e her ho' important it is to ta#e diabetes seriousl".: Listening to the patient (an prove useful later in being able to better relate to the patient. )n addition$ man" patients of lo' S-S have a lot more health issues that need to be (overed$ sin(e the" onl" (ome in 'hen the" are ver" si(#. As one health(are provider states$ 7&he" start at the head and end at the toes 'ith a list of (omplaints$ 'hi(h "ou (an9t (over in that one visit. So sometimes it9s reall" hard to get those patients to narro' do'n 'hat is their (hief (omplaint.: As another do(tor puts it$ on(e the (ommuni(ation is there$ 7"ou not onl" hear the reason 'h" the"9re there$ but all the other a(hes and pains and (on(erns and sensitivities that all of a sudden start bubbling out$ and it9s hard to (ontain them and dire(t them 'ithout the feeling that "ou9re tr"ing to re*e(t them.: )n man" (ases$ it is ne(essar" not onl" to spend e0tra time 'ith

these patients$ but to also s(hedule more appointments do'n the line$ be(ause it is almost impossible to (over ever"thing in one appointment. elpful hint: &r" 'riting do'n some of the basi( personal information in the patient9s re(ord so that "ou (an re(all it later$ as a 'a" of maintaining that sense of familiarit" 'ith the patient. Patient Compliance )n man" ispani( (ultures$ the idea of preventive medi(ine is not as (ommon. &his is espe(iall" prevalent in those of lo' S-S. As a result$ do(tors have tried man" te(hni2ues to get patients to ta#e preventive measures to #eep a disease from be(oming 'orse. 4ne of the most (ommon re(ommendations given b" do(tors and nurses intervie'ed is to e0plain ever"thing ver" slo'l" and go through it as a step+b"+step pro(ess. Man" patients 'ho are ne'l" arrived$ lo' S-S immigrants 'ill e0pe(t "ou to be more paternalisti(. &he" often prefer to have things spelled out for them$ be(ause the" simpl" are not a'are of ho' to do things in the !nited States. Another te(hni2ue is to simpl" be pra(ti(al about 'h" one should do 'hat the do(tor re(ommends. 4ne nurse points out to patients that if the"9re not going to do 'hat the do(tor sa"s$ then 7it9s a(tuall" a 'aste of three people9s time: theirs$ the do(tors$ and the person (aring for them. 1aste of time$ 'aste of mone". 1h" (ome to the do(tor if "ou9re not going to do 'hat "ou are told3: 4ther health(are providers suggest simpl" dis(ussing the (onse2uen(es$ espe(iall" to patients of a lo' edu(ational ba(#ground. 4ne sa"s$ 7@ear of death. -ven if "ou tr" to e0plain things to them$ a lot of times the" *ust don9t have the edu(ational level to understand. So "ou have to e0plain things$ ?&his is 'hat "ou have to do. )f "ou don9t do this$ bad things are going to happen to "ou.9: e does urge do(tors to be realisti( about 'hat 'ill happen$ but to be firm nonetheless. Another provider uses a slightl" different famil"+oriented approa(h. She9ll tell patients$ 79/ou 'ant to be here for "our grand#ids. /our famil" 'ants "ou around.9 )f it9s a man$ )9ll sa"$ ?/ou9re going to be providing for the house. 1hat9s going to happen to "our famil" if something happens to "ou39: Almost all the do(tors point to edu(ation as a ver" important means of helping patients. 4ne provider ma#es patients (ome to diabetes edu(ation (lasses$ giving them free glu(ometers and test strips after'ards as an in(entive. She finds that those patients 'ho (ome to the (lasses tend to have a better (ontrol over their diabetes. @inall"$ a ver" important te(hni2ue re(ommended b" man" health(are providers is to involve famil" members themselves. Man" pointed out that the Latino (ulture is mu(h more famil"+oriented. As a result$ famil" members are often present 'ith the patient$ or (ome 'ith the patient for the visit. &he" (an be(ome greatl" involved in the (are of the patient. &his is dis(ussed further under 7@amilismo: in &heme A. Respect for &our position )t is e0pe(ted that people from (ertain areas of so(iet" are to be treated in (ertain 'a"s. &his 'or#s t'o 'a"s. @irst$ as a do(tor$ "ou 'ill usuall" be treated 'ith a great deal of respe(t. /ou should (ome dressed and a(ting in a 'a" that deserves that respe(t. @or e0ample$ do not 'ear *eans. 1ear an appropriate business outfit as a bare minimum8 a 'hite (oat is also ver" helpful in #eeping up the appropriate appearan(e that befits "our position. Li#e'ise$ other health (are professionals should ma#e an effort to dress appropriatel".

&his level of respe(t for the do(tor (an also (ome 'ith some problems. Coth literature and intervie's have brought up the degree of respe(t as inhibiting a patient from as#ing 2uestions. Man" times patients 'ill simpl" nod "es to ever"thing the do(tor sa"s as a 'a" of being polite. Dr. )z2uierdo states$ 7Latinos$ espe(iall" the little a((ulturated ones$ still have the do(tor up there on the pedestal;the" 'ill never 2uestion "ou. &he" 'ill be un(omfortable 'ith 'hat "ou sa"$ but the" 'ill never 2uestion "ou. And 'hat happens 'ith that;is that the" 'ill go home and not do it. And the" 'ill (ome ba(# and not tell "ou that the" did not do it$ be(ause the" are s(ared of sa"ing that. So it9s important 'hen "ou give an instru(tion$ re(ommend a medi(ine$ 'hen "ou re(ommend a life (hange$ to loo# in their e"es$ to loo# in their fa(e and *ust as# them$ ?1hat are "our 2uestions3 Do$ reall"$ 'hat are "our 2uestions3 )9m here to ans'er 2uestions9;) thin# that it9s important8 "ou need to ma#e sure the" reall" understand.: As a result$ others also re(ommended that do(tors as# patients to repeat 'hat the" need to do to improve$ or to des(ribe their (ondition$ to assure that there is (omprehension. Case Stud& Re*iew A ne' patient$ Mr. Morales (omes in$ 'ith s"mptoms ,as des(ribed b" the nurse. (learl" fitting the profile for appendi(itis. /ou go in to see the patient$ introdu(e "ourself$ and begin to des(ribe "our theor" of appendi(itis to him$ e0amining him to as(ertain 'hether this theor" is indeed (orre(t. 1hile the ph"si(al s"mptoms do appear to suggest appendi(itis$ it is diffi(ult to get an a((urate des(ription from the patient of his o'n s"mptoms. )n fa(t$ the patient seems ver" 2uiet in "our presen(e$ and "ou have trouble even getting the basi( information that the nurse 'as able to get and put into the (hart. o'ever$ being a ne' patient$ it is diffi(ult to determine the (ause of his silen(e. 1hat are some possible reasons 'h" he ma" be un(omfortable3 Possible Causes of this Patients Discomfort /es$ it is al'a"s possible that Mr. Morales is simpl" reti(ent b" nature. o'ever$ did "ou introdu(e "ourself to him in Spanish$ and as# if he 'ould prefer to spea# in Spanish rather than -nglish3 Are "ou dressed as a do(tor 'ould dress$ or is there a possibilit" that Mr. Morales doubts "our (ompeten(e due to "our appearan(e ,although he 'ould never sa" so to "our fa(e.3 More importantl"$ have "ou been treating Mr. Morales as a disease or as a person3 Did "ou as# a fe' 2uestions about his famil"E*ob before pro(eeding on to dis(uss the illness3 Does it appear that Mr. Morales is being 2uiet as a sign of respe(t3 ave "ou tried posing 2uestions as a 'a" of getting him to open up3 &hese are *ust some of man" possible reasons for the dis(omfort of "our patient$ espe(iall" in the (ase of a ne' patient 'ho has not "et formed a strong 'or#ing+ relationship 'ith "ou. Re*iew of !ain Points + + + + + + Ma#e an effort to get names right. Dress appropriatel" for "our position as a do(tor. Address patients formall" unless permitted b" patient to do other'ise. Spea# (learl"$ and at level appropriate for that parti(ular patient. Spend time to ma#e patient (omfortable+tal# about famil" first$ illness se(ond. Go through the illness and treatment in a slo' and methodi(al manner.

+urther Resources -spino DG$ 4a#es SL$ Grever )A$ 4livares 4$ Alford CL$ Mouton CP. 7 ealth Care for ispani( -lder Patients.: Caring for Hispanic Patients. 5HHA8%:5H+55. enderson$ George and Martha Primeau0. &rans(ultural ealth Care. Reading$ MA: Addison+ 1esle"$ %IJ%. Lipton RC$ Lose" LM$ Gia(hello A$ Mendez K$ Girotti M . Attitudes and issues in treating latino patients 'ith t"pe 5 diabetes: vie's of health(are providers. The Diabetes Educator. %IIJ85A:FL+L%. Poon$ A1$ Gra" MG$ @ran(o GC$ Cerruti DM$ S(hre(# MA$ Delgado -D. 7Cultural Competen(e: Serving Latino Patients.: J Pediatric Orthopaedics. 5HH>85>:BAF+BAI. TH ! ,# +O%- ! DICIN !ain Points + Ce a'are that different (ountries have man" different belief s"stems. + &r" to respe(t the beliefs of "our patients 'hen possible$ and steer them a'a" from dangerous pra(ti(es as ta(tfull" and respe(tfull" as possible. + Remember$ do not (ome in e0pe(ting patients to have (ertain beliefs$ as it 'ill var" from patient to patient$ even 'ithin the same (ountr". Let them e0press their beliefs$ and respe(t them a((ordingl". Case Stud& A mother (omes in 'ith her >+"ear+old female (hild$ (omplaining that her (hild has a fever and (ough that started a fe' da"s ago$ and that the (ause is a neighbor$ 'ho loo#ed at a (hild 'ith the evil e"e a fe' da"s ago. /ou believe the (ause of the (hild9s distress ma" be ba(terial. o' do "ou pro(eed3 O*er*iew -a(h (ulture has a lot of 7old 'ives9 tales: that get passed on from generation to generation. Man" in the !S remember hearing stories that going outside 'ith "our hair 'et 'ill (ause "ou to get a (old. Similar stories are (ommon in ever" (ountr" around the 'orld. )t is important to tr" to be a'are of some of the (ommon beliefs of other (ultures$ so that "ou are not surprised 'hen "ou (ome a(ross them. Ceing a'are of these beliefs 'ill also help "ou prepare responses to different belief s"stems that both respe(t the belief and allo' "ou to pro(eed 'ith the best patient (are possible. Note: Please be a'are that belief s"stems var" greatl" from one (ountr" to the ne0t$ and from one region to the ne0t. &he follo'ing beliefs (annot be applied to ever" patient. )n addition$ the beliefs 'ill be altered depending on the a((ulturation of a parti(ular person to the (ulture of the !nited States. Patients 'ith higher edu(ational levels and higher a((ulturation 'ill not be as

li#el" to hold these beliefs. Please do not assume that a patient has an" of the follo'ing beliefs. As stated previousl"$ these beliefs are mentioned here so that "ou are a'are of them in (ase a patient does believe it. .amples of Belief S&stems Causes of Creast Can(er &here are man" beliefs as to the (ause of breast (an(er. &hese in(lude trauma to the breast$ and not breast+feeding a (hild. )t is believed that not breast+feeding (auses the mil# to go bad in the breast$ (ausing the (an(er. -mpa(ho &his is an illness of the intestines believed to be (aused either b" star(h" foods or b" foods getting stu(# in the intestines. 4ne (ure is to rub oil of the stoma(h of the person suffering from empacho. ot+Cold &heor" )n man" (ountries$ there is a belief that diseases are often asso(iated 'ith either heat or (old. &hese diseases (an then be (ombated b" eating medi(ine or food of the opposite temperament. &he same disease ma" be given a different temperament in different (ountries$ ma#ing it hard to predi(t 'hat one parti(ular person ma" (onsider to be hot or (old. &he follo'ing are e0amples of foods and illnesses that are generall" (onsidered hot and (old among Puerto Ri(ans.
Caliente (hot) Illnesses or bodily conditions Fro (cold

constipation Diarrhea Rashes tenesmus (pujo) Ulcers Alcoholic beverages chili peppers chocolate Co ee corn meal evaporated mil! #arlic !idney beans $nions

arthritis colds menstrual period pain in the joints pasmo avocado bananas coconut lima beans sugar cane "hite beans

Foods

+i'ure "/ ot+(old (lassifi(ation among Puerto Ri(ans ,Adapted from enderson and Primeau0. Transcultural Health Care. Addison+1esle": Reading$ %IJ%..

Mal de o*o+the evil e"e &his is believed to be (aused 'hen someone loo#s at someone else in the 'rong 'a". )t is often believed to be (aused b" loo#ing at someone 'ith *ealousl". al de o!o is most often dire(ted against (hildren. A variet" of s"mptoms (an be attributed to mal de o!o$ in(luding fever$ diarrhea$ (r"ing$ loss of appetite$ and vomiting. 4ne person e0plains that mal de o!o is most often (on*un(tivitis. &here are man" 'a"s believed to rid a (hild of mal de o!o$ and these methods var" greatl" from one (ountr" to the ne0t. Some methods in(lude using an amulet$ or 7s'eeping: a (hild 'ith one of a variet" of ob*e(ts$ in(luding an egg or lemon$ 'hi(h pi(#s up the effe(ts of the mal de o!o and dra's it a'a" from the (hild. Mollera (aida+sin#ing of the soft palate in babies )t is believed in some pla(es that boun(ing a bab" to roughl" or too often 'ill (ause the soft palate to sin#. 4ther rough movements (an also be a (ause of this. Curanderos )n man" (ultures and (ountries 'here do(tors are s(ar(e$ (ommunities 'ill rel" on a curandero for their health needs. &he curandero ma" have some medi(al training$ but more often than not the curandero is an older 'oman 'ithin the (ommunit" 'ho has had mu(h e0perien(e in dealing 'ith various diseases. &his faith in the lo(al curandero ma" also translate over to the !nited States. )f there is someone e2uivalent to a curandero in the (ommunit" in 'hi(h a person lives$ that person ma" go to see the curandero first$ before going to see the do(tor. )f "ou believe that this ma" be the (ase$ "ou ma" 'ant to (onsider as#ing the patient if the" have tried an"thing "et to get rid of the health problem. Her0s and Teas &he most (ommon beliefs are in the use of herbs and teas to (ure illnesses. &his is e0pressed rather strongl" in both the literature and in intervie's 'ith health(are providers. Dr. Ale0 Le6n points out that a (ommon belief is in ta#ing (hamomile tea$ or manzanilla$ 'hen a person has (ramps. Respectin' a person1s 0eliefs )t is valuable for a do(tor to #no' 'hat alternative pra(ti(es a patient is using. o'ever$ patients 'ill not often bring up these pra(ti(es in the presen(e of their do(tor unless prompted to do so. )t ma" therefore be 'orth'hile to as# ea(h patient if the" have tried an"thing "et to resolve their health issue. 4ne report points out$ 7)f "ou don9t as#$ "ou don9t #no'.: ,Lipton et al.. )t is important to health (are professionals to not immediatel" dismiss a person9s beliefs upon first hearing them. &he person ma" feel ashamed in front of the do(tor$ or lose faith in the abilit" of the do(tor 'ho does not appear to listen to them. &here are man" different options for dealing 'ith the beliefs of the patients. 4ne option is to respe(t that belief and allo' it to (ontinue. &his is espe(iall" important in the (ase of elderl" patients or those held in a position of respe(t 'ithin the famil". )t is a sign of disrespe(t to (ontradi(t an older famil" member$ and it ma" be more useful to find 'a"s of not dire(tl" (ontradi(ting 'hat that person signs$ as a 'a" of maintaining a sign of respe(t for them. Man" do(tors re(ommend not (hallenging the belief 'hen it is something benign and 'ill not harm the patient9s health. &he" re(ommend telling the patient to tr" their te(hni2ues in addition to 'hat

the" are (urrentl" doing. )n the end$ man" patients 'ill often use a (ombination of traditional and 1estern medi(ine 'hen treating illness. 4ne provider states$ 7)f it9s something that9s harmless$ that the" don9t seem to be the 'orse for it$ ) 'on9t sa" an"thing. )t9s not ne(essar". &he" do it and the" feel better be(ause the" felt that the" are doing something.: )n some (ases$ not seriousl" (onsidering the beliefs of a patient ma" lead to a patient losing faith 'ith the do(tor. &his ma" be dangerous for the patient$ sin(e the patient ma" not be (omfortable in telling the do(tor ever"thing about a disease$ or all of the methods the" are ta#ing to prevent it. 1ithout all of the information$ it is mu(h more diffi(ult to ma#e a diagnosis. o'ever$ this ma" not be the best (ourse of a(tion if the patient is doing something that is harmful to their health. 4verall$ three different possible (ourses of a(tion 'ere re(ommended in these (ir(umstan(es. @irst$ one resour(e re(ommended as#ing the patient if the method the" 'ere (urrentl" using had "et improved their health. &he patient 'ould sa" no ,sin(e if it had improved their health$ the" 'ouldn9t (urrentl" be visiting the do(tor.. &hen the do(tor (an then sa"$ sin(e that method hasn9t 'or#ed so far$ 'h" don9t "ou tr" this. @rom there the do(tor (an then re(ommend 'hat he or she believes 'ill help the patient improve. Several people re(ommended ta#ing time to e0plain to a patient 'h" that parti(ularl" te(hni2ue 'ill not 'or# out. 4ne health(are provider re(ommends$ 7&a#e the time to tal# to them. Ce(ause if "ou *ust give them a 2ui(# lesson in something$ the" 'ill (ontinue to do it their o'n 'a".: Again$ this goes ba(# to having patien(e and e0plaining things step+b"+step$ and sho'ing that interest in the patient. &his has to be done (arefull"$ so as to not insult the patient. en(e$ that is part of 'h" the e0tra time is needed. 4ne do(tor states$ 7Depending on ho' severel" it is going to interfere$ )9ll be more or less strident in tr"ing to advise against doing it$ 'hatever it is;And if the" don9t seem to a((ept that$ then "ou give them alternatives.: @or e0ample$ he re(ommends that instead of rubbing a (hild do'n 'ith al(ohol <for breathing problems=$ 'hi(h ma#es breathing 'orse$ rubbing them do'n 'ith Gapor rub$ or 'arm 'ater. @inall"$ another do(tor stated that if she 'asn9t familiar 'ith a parti(ular herb or tea or treatment$ she 'ould tr" to 7e0press to them <patients= the fa(t that ) understand that in their (ountr" the" use it. Cut be(ause ) don9t #no' e0a(tl" 'hat is in it$ ) 'ould re(ommend that the" not use it$ *ust be(ause of m" ignoran(e. &he" seem to understand that. And ) sa"$ ?Let9s tr" this plan. )t9s not that ) don9t thin# that9s good. )t9s *ust that ) don9t #no'.9 And the" seem to a((ept that.: Again$ this method respe(ts the patients9 beliefs$ 'hile still tr"ing to steer them to'ards something the do(tor is more (omfortable 'ith. How to Phrase 2uestions &he follo'ing list of 2uestions$ ta#en from the Ameri(an Medi(al Student Asso(iation 'ebsite$ (ontains good 'a"s of as#ing 2uestions so as to gain a feel for the beliefs of "our patients. %. 5. >. A. B. F. L. J. 1hat do "ou thin# (aused "our problem3 1h" do "ou thin# it started 'hen it did3 1hat does "our si(#ness do to "ou3 o' does it 'or#3 o' severe is "our si(#ness3 o' long do "ou e0pe(t it to last3 1hat problems has "our si(#ness (aused "ou3 1hat do "ou fear about "our si(#ness3 1hat #ind of treatment do "ou thin# "ou should re(eive3 1hat are the most important results "ou hope to re(eive from this treatment3

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Case Stud& Re*iew A mother (omes in 'ith her >+"ear+old female (hild$ (omplaining that her (hild has a fever and (ough that started a fe' da"s ago$ and that the (ause is a neighbor$ 'ho loo#ed at a (hild 'ith the evil e"e a fe' da"s ago. /ou believe the (ause of the (hild9s distress ma" be ba(terial. o' do "ou pro(eed3 "nal#sis At this point$ "ou should be familiar 'ith the idea of the evil e"e. )t ma" be 'orth'hile to as# the mother 'hat she has done to tr" to remed" the problem. As# 'h" she thin#s the problems e0ists$ 'hat about it in parti(ular (on(erns her$ andEor 'hat she thin#s should be done. )n this 'a"$ "ou ma" be more a'are of 'hat their beliefs are$ so that "ou 'ill not disrespe(t them$ and "ou 'ill also be able to find out if an" harmful things have been tried. Give the patient "our honest opinion of 'hat "ou believe to be 'rong 'ith the patient$ but tr" not to disrespe(t the mother9s beliefs. 1hen "ou offer suggestions$ tr" to e0plain 'h" "ou re(ommend that parti(ular treatment$ and offer options$ 'hen possible. +inal Ca*eat Ce a'are that people 'ill (ome to the do(tor 'ith var"ing degrees of a((ulturation to Ameri(an (ulture$ var"ing degrees of edu(ation$ and var"ing degrees of so(ioe(onomi( status. &here are man"$ man" fa(tors even be"ond those *ust listed that determine 'hi(h beliefs a person ma" hold. )t is imperative that "ou ma#e no assumptions about the beliefs a person ma" or ma" not have$ but rather are open to the beliefs the" ma" share 'ith "ou. !ain Points + Ce a'are that different (ountries have man" different belief s"stems. + &r" to respe(t the beliefs of "our patients 'hen possible$ and steer them a'a" from dangerous pra(ti(es as ta(tfull" and respe(tfull" as possible. + Remember$ do not (ome in e0pe(ting patients to have (ertain beliefs$ as it 'ill var" from patient to patient$ even 'ithin the same (ountr". Let them e0press their beliefs$ and respe(t them a((ordingl". +urther References Corra"o -$ Ken#ins SR. 7@eeling frugal: so(ioe(onomi( status$ a((ulturation$ and (ultural health beliefs among 'omen of Me0i(an des(ent. Cultural Di$ersit# and Ethnic inorit# Ps#cholog#. 5HH>8I:%IL+5HF. -spino DG$ 4a#es SL$ Grever )A$ 4livares 4$ Alford CL$ Mouton CP. 7 ealth Care for ispani( -lder Patients.: Caring for Hispanic Patients. 5HHA8%:5H+55. enderson$ George and Martha Primeau0. &rans(ultural ealth Care. Reading$ MA: Addison+ 1esle"$ %IJ%. Lipton RC$ Lose" LM$ Gia(hello A$ Mendez K$ Girotti M . Attitudes and issues in treating

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latino patients 'ith t"pe 5 diabetes: vie's of health(are providers. The Diabetes Educator. %IIJ85A:FL+L%. Loue$ San. ed. andboo# of )mmigrant ealth. De' /or#$ D/: Plenum Press$ %IIJ. Poon$ A1$ Gra" MG$ @ran(o GC$ Cerruti DM$ S(hre(# MA$ Delgado -D. 7Cultural Competen(e: Serving Latino Patients.: J Pediatric Orthopaedics. 5HH>85>:BAF+BAI. Risser AL$ Mazur LK. 7!se of @ol# Remedies in a ispani( Population.: "rchi$es of Pediatrics and "dolescent edicine. %IIB8%AI:ILJ+IJ%. TH ! 3# DI$B T S4 DI T4 $ND 5 RCIS !ain Points# + Create a (he(#list for ea(h patient. + -0plain the reasons behind ea(h test patients undergo and ea(h (hange in behavior. + Ad*ust "our re(ommendations to refle(t the realit" of ea(h person9s 'a" of life. Case Stud& /ou have a FH+"ear+old female ispani( patient 'ho has had diabetes for several "ears. /ou have (onsistentl" told the patient to s'it(h to a diet lo'er in fats and sodium$ and to in(rease e0er(ising$ "et "ou have had diffi(ult" in getting through to the patient. 1hat other 'a"s (an "ou thin# of to help3 Dia0etes Diabetes is a ver" large problem for ispani(s in the !nited States$ and is something that an" health(are professional treated ispani(s should be a'are of. )t is often helpful to give the patients a feeling of empo'erment over the situation. )n referen(e to diabetes$ a (he(#list of dail" a((omplishments$ as 'ell as a 'a" to monitor 'ee#l" and monthl" improvements ma#es it easier to for the patient to see ho' the a(tions the" ta#e help them. )f "ou tr" to (hange "our 'a" of thin#ing from 7in(reasing patient (omplian(e: to 7patient empo'erment$: patients ma" be more li#el" to ta#e a more a(tive role in their (are. Man" providers also re(ommend setting smaller long+term goals. @or e0ample$ a patient ma" have a goal of losing BH pounds. Cut the provider ma" re(ommend lose %H pounds b" si0 months$ 55 pounds in one "ear. &his ma#es it mu(h easier to realize their goals. )f possible$ it 'ould be useful to have a person 'hose *ob it is to ta#e (are of monitoring the diabeti( patients$ train them$ and give them the information ne(essar" to be better able to ta#e (are of themselves. As stated in the previous se(tion$ different patients 'ill have different levels of a((ulturation to Ameri(an beliefs. )t is important to tr" to determine 'hat beliefs a patient ma" have regarding diabetes$ and to respe(t those beliefs and ad*ust re(ommendations regarding diet$ e0er(ise$ and (are$ so as to be appropriate to ea(h person and situation. @inall"$ tr" to e0plain to the patient the purpose behind ea(h a(tion ta#en$ espe(iall" different tests that ma" be re2uested. @or e0ample$ it ma" be a good idea to e0plain 'h" e"e e0aminations are ne(essar" even for patients 'ho appear to (urrentl" have good e"e vision.

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People 'ill be more li#el" to be 'illing to undergo various tests if the" understand the importan(e of undergoing su(h tests. Diet 1hen re(ommending (hanges in diet or a(tivit"$ it is best to tr" to ma#e the (hanges fit the lifest"le of ea(h parti(ular person. 4ne 'a" of doing this is to as# ea(h person personall" ho' he or she 'ould go about fitting these (hanges into his or her life. &his 'ill help "ou see if there are an" immediate trouble spots. Also$ man" providers re(ommend that do(tors tr" to get a basi( familiarit" 'ith the general diet 'ithin ea(h (ountr". &hat 'a"$ the" understand 'hat the patients are tal#ing about 'hen the" sa" arroz, or tortillas. )n addition$ it ma" be useful to in(lude the famil" 'hen ma#ing these (hanges. )f a 'oman 'ith diabetes is told to (hange her diet$ she ma" not be 'illing to do so$ be(ause it 'ould involve (hanging the entire famil"9s diet$ and might be vie'ed as self+indulgent. )nvolving the famil" here 'ould en(ourage her to (hange her diet. Li#e'ise$ telling a man to (hange his diet ma" prove unsu((essful if the 'ife is the one doing all of the (oo#ing. C" telling his 'ife 'hat (hanges need to be made in his diet$ it is more li#el" that he 'ill be able to follo' the re(ommended (hanges. 4f (ourse$ as# patients if the" are 'illing to allo' "ou to spea# 'ith famil" members before doing so. Changes in diet should be done a little differentl" for (hildren. @irst$ it is fairl" (lear that an" (hanges in diet must be done through the parent$ 'ho is providing the food. Dr. Pierre+Louis points out that man" parents 7tend to let their (hildren eat 'hat the" 'ant rather than 'hat is health" for them.: Dr. )baNez e0plains further: 7&he" <parents= sho' love through sho'ing them that the"9re giving them those things that the" 'ere never able to have as (hildren. @or e0ample$ a((ess to (hips$ (andies$ (oo#ies$ @ren(h fries$ fast food;the" don9t even see it as part of their eating habit;the" don9t see it as food$ but it has su(h an impa(t on their diet. !ntil "ou ma#e them a'are of it$ "ou don9t get to the root of the problem.: Dr. Pierre+Louis e0plains that it9s important to e0plain to the parents that the" need to redu(e to (alories$ portions sizes$ sna(#s$ et(. and 7let them #no' that that9s o#. &hat9s not damaging to the (hild. &he" (an a(tuall" get a'a" 'ith not giving the (hild a sna(#.: All of these (hanges re2uire (hanging the thin#ing of the parents a little bit. .ercise &he lifest"le that patients$ espe(iall" ne'l" arrive patients 'ith lo' resour(es$ have 'ithin the !nited States is ver" different from the lifest"le the" had ba(# in their (ountr". Some providers that 'ere intervie'ed e0plained that in the patient9s home (ountr"$ a lot more 'al#ing 'as ne(essar". @or e0ample$ people had to 'al# to stores$ be(ause the" didn9t have a((ess to (ars or ta0is. -ven the use of buses involved a lot of 'al#ing be(ause the bus stops 'ere ver" far apart$ so it 'as 2uite a 'al# simpl" to get to the bus stop. @or man" patients$ this is different from life in the !nited States. )t is easier to get to bus stops$ be(ause the" are mu(h (loser together. )t is also easier to o'n a (ar. Man" of the lo' S-S patients 'or# all 'ee# and often 'or# on the 'ee#ends as 'ell. )t be(omes ver" diffi(ult for them to find a 'a" to fit in e0er(ise. 4ne health(are provider re(ommended as#ing men if the" pla" so((er. She states$ 7<if= the" sa" the" pla" on the 'ee#ends$ )9ll as# them to add one more thing <so((er mat(h= during the 'ee#$ or go for a *og 'ith someone the" pla" so((er 'ith. And for the 'omen$ some of them are bab"sitters$ and )9ll

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tr" to thin# of an e0er(ise that 'ill in(orporate 'hatever the" do$ ta#ing 'hoever the" (are for out for a 'al#$ pushing a stroller around$ tr"ing to 'al# 'ith a friend or a neighbor.: )n this 'a"$ she is able to ma#e her e0er(ise re(ommendations fit the lifest"le of the person$ so that the" are more li#el" to a(tuall" follo' through and in(rease their e0er(ise. Another provider also tries to 'or# to find a(tivities that don9t (ost a lot of mone". @or 'omen$ she loo#s for things that (an be done 'hile at home. /et another one tries to (onne(t her re(ommendations ba(# to the lifest"le the patient had in their (ountr" of origin. 7Do "ou remember 'hen "ou 'ere in "our (ountr" and in order to go to the store "ou needed to 'al# half an hour a da"3 1ell$ that9s 'hat "ou need to be doing;Do "ou understand that if "ou ta#e "our (ar to go to the shop that is ne0t door$ 'hen "ou (ould 'al# there in %B minutes$ "ou9re going to gain 'eight3: Man" health(are providers mentioned that the" don%t tell lo' S-S ispani( patients to go out and bu" a treadmill or a g"m membership$ be(ause it is not 'ithin their (ulture$ and this is more e0pensive. Again$ this is not to sa" that no ispani( person ever bu"s a treadmill. )f a patient alread" has one$ then obviousl"$ the do(tor 'ill re(ommend using it. Dr. )z2uierdo states$ 7Some people <do= have treadmills. And then "ou *ust sort of tea(h them ho' to use it;Cut ) thin#; it9s helpful to (orrelate it 'ith 'hat the" #ne' of their life before.: 4verall$ the providers tr" to be a'are of the means of ea(h patient and lifest"le of ea(h patient$ and 'or# 'ithin those. Case Stud& Re*iew /ou have a FH+"ear+old female patient 'ho has had diabetes for several "ears. /ou have (onsistentl" told the patient to s'it(h to a diet lo'er in fats and sodium$ and to in(rease e0er(ising$ "et "ou have had diffi(ult" in getting through to the patient. 1hat other 'a"s (an "ou thin# of to help3 &e$ie' 1hile telling the patient to e0er(ise more and inta#e less fat ma" be important$ it 'ill be diffi(ult to a(tuall" get a patient to follo' through if the" don9t #no' ho' to do so. )t might be 'orth'hile to spend some time 'ith the patient$ and go through 'a"s in 'hi(h she might e0er(ise$ and 'hen she (ould fit it into her s(hedule. &a#e a loo# at her diet$ and find things she might 'ant to ta#e out. Propose options ,or have her propose options. for better alternatives. As# if the patient is doing the (oo#ing$ or if someone else is. )t ma" be 'orth'hile to spea# 'ith the person 'ho is (oo#ing$ so that the" are involved in ma#ing sure that (hanges in diet ta#e pla(e. Realize that there ma" be resistan(e to not eating (ertain foods. @or e0ample$ in different (ountries it might be una((eptable to not serve ri(e or tortillas 'ith a meal. &here are e0pe(tations as to 'hat is appropriate for a meal. As# "our patient$ or the person (oo#ing$ 'hat #inds of (ompromises ma" be a((eptable to them. @inall"$ as# the patient if she 'ould li#e us to dis(uss things 'ith her famil"$ and see if there are 'a"s her famil" might be able to help her. )n terms of e0er(ise$ man" 'omen ma" spend the entire da" at home. )t is li#el" that this lad" is not a((ustomed to the idea or ne(essit" of e0er(ise$ so the entire pro(ess ma" have to be e0plained to her. 4f (ourse$ as# her 'hat her dail" regime is first$ so as not to ma#e assumptions. )f this proves to be the (ase$ ma#e sure to e0plain ever"thing (learl". &his refers not *ust to options available$ but also reasons 'h" that t"pe of e0er(ise should be done. Again$ tailor the options to her a(tual lifest"le. &e(hni2ues li#e this might help her be more su((essful in (ontrolling her diabetes. @inall"$ e0plain 'hat the (onse2uen(es might be if the patient does not (ontrol her diabetes. &his is a 'a" of 'or#ing around the relu(tan(e to'ards preventive medi(ine.

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!ain Points# + Create a (he(#list for ea(h patient. + -0plain the reasons behind ea(h test patients undergo and ea(h (hange in behavior. + Ad*ust "our re(ommendations to refle(t the realit" of ea(h person9s 'a" of life. +urther References Caban A$ 1al#er -A$ Sonszein K. 7Management of &"pe 5 Diabetes in the ispani( Communit": 4ver(oming Carriers.: Caring for Hispanic Patients. 5HHA8%:5>+5F. Lipton RC$ Lose" LM$ Gia(hello A$ Mendez K$ Girotti M . Attitudes and issues in treating latino patients 'ith t"pe 5 diabetes: vie's of health(are providers. The Diabetes Educator. %IIJ85A:FL+L%. TH ! 6# +$!I%( 7$%U S4 !$CHIS!O4 $ND !$RI$NIS!O !ain Points + @amilies are often ver" (lose+#nit. Consider allo'ing famil" members to remain present 'ith a patient for at least part of the e0am$ to ma#e the patient more (omfortable. + Continue to respe(t patient priva("$ and still give ea(h patient some time alone 'ith the do(tor. + Ce a'are that in some (ultures$ ma(hismo and marianismo are ver" strong. &his is not endorsing nor denoun(ing it$ but it is something that do(tors should be a'are of. Case Stud& A >A "ear+old female (omes in$ (omplaining of flu+li#e s"mptoms. She has brought her entire famil" 'ith her: her husband$ both her parents$ and an aunt visiting from out+of+to'n. Do "ou allo' the famil" to sta" in 'ith the patient$ or as# them to 'ait in the 'aiting room3 Compradra8'o Compadrazgo$ or compadre is the (onsideration of people 'ho are not immediate famil"$ in(luding some 'ithout blood ties$ as famil". -0amples in(lude godparents$ and distant relatives. &he" ma" be present and (ome along 'hen a famil" member is ill. )f there is enough spa(e and the famil" member desires it$ most do(tors re(ommend letting them sta" in the room$ and respe(ting the desires of the patient. Another thing mentioned b" man" do(tors is that ispani( patients often prefer to do things in groups$ or 'ith friends$ rather than individuall". So$ do(tors ma" re(ommend to patients to find someone 'ith similar health goals as themselves$ and to tr" doing the goals 'ith that other person$ as a sort of motivation. Machismo and Marianismo &here is an idea that is fairl" pervasive in man" (ountries regarding the roles of men and 'omen in so(iet". &here is often a belief that the men are the head of the household$ and the

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bread'inners. As a result$ the" deserve more respe(t$ and ma#e the important de(isions. &his is referred to as machismo. arianismo is the (omplement of this. 1omen are e0pe(ted to be the ones 'ho rear the (hildren and maintain the household ,laundr"$ dishes$ (oo#ing$ et(... &he" are also e0pe(ted to be submissive to their husbands and follo' their husbands9 'ishes. @or e0ample$ there are some husbands 'ho ma" not li#e to use (ondoms. &heir 'ives ma" be pressured not to have prote(tion during se0ual inter(ourse be(ause their husband does not desire it. )n some regions$ the use of (ondoms is (onsidered a sign of promis(uit". )t is re(ommended that do(tors al'a"s have some point during a session 'here the" are alone 'ith a patient$ espe(iall" if the" suspe(t domesti( violen(e. &hat 'a"$ the patient ma" feel more (omfortable e0pressing those (on(erns. -ven then$ the patient ma" still feel relu(tant to e0press (on(erns regarding domesti( violen(e. 4ne health(are provider states$ 7/ou 'ant to brea(h the (onversation;"ou (an tell that these things are bothering;them$ but the" 'ould not (ome up and tell "ou this$ be(ause it9s *ust not 'hat a 'ife 'ould do;So being a'are that the"9re not going to tell "ou these things$ ) have gotten to the point 'here )$ 'hen ) ma#e those 2uestions$ ) #ind of (larif" a little bit. ?/ou #no'$ sometimes 'e feel a little bit un(omfortable$ but 'e let other ladies #no' that there are numbers or resour(es that the" (an as#$ if the" feel that this is happening.9 So ) don9t sa"$ ?) feel that this is happening in "our life.9 ) #ind of open it up a bit broader$ so that the" feel the" (an be empo'ered to e0press 'hatever the" (hoose.: Pri*ac& &here are t'o (onsiderations that must be ta#en into a((ount 'hen (onsidering the priva(" of a ispani( patient. &he first is the importan(e of famil". &he illness of one person in a famil" affe(ts man" members of the famil". &he patient ma" 'ant to have those members present in the room during do(tor visits. )t ma" ma#e the patient more (omfortable. 4f (ourse$ it is important to at some point spea# to the patient in private for a little 'hile$ in (ase there is something the patient does not feel (omfortable revealing in front of their famil". )n addition$ some people prefer to hear good or bad ne's from a famil" member rather than a stranger. )t ma" be 'orth'hile to as# a patient 'ho the" 'ould prefer the do(tor dis(uss a diagnosis 'ith first$ *ust in (ase the patient prefers a famil" member hear first. &he final (onsideration har#s ba(# to machismo. &here are husbands 'ho 'ill beat their 'ives and feel that it is their right to do so. )t is ver" important to get a (han(e to spea# 'ith ea(h individual on their o'n$ espe(iall" in (ases 'here there is a possibilit" of abuse$ so that there person is able to spea# freel" about the problem. Again$ if the patient still isn9t (omfortable$ it is important to offer them the resour(es$ so that the" #no' help is available if violen(e or other problems are o((urring in their household. +amilismo As previousl" mentioned$ the famil" is ver" important. )t is stressed over and over again in man" literature sear(hes and almost all intervie's performed$ that the ispani( (ulture is not ver" individualisti($ but rather ver" famil"+oriented. @amilies share all of their resour(es$ and if a famil" member is si(#$ the" 'ill 'or# together to help that person improve. &herefore$ if the patient 'ishes the matter dis(ussed 'ith famil"$ it ma" be 'orth'hile to do so. Dr. )baNez states 7)9ll leave them <the famil"= for the main part of the visit$ be(ause ) feel that9s important to them. Cut at one point or another$ )9ll as# them to leave$ be(ause there is al'a"s that (onfidentialit"

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issue;but "ou have to respe(t the fa(t that the"9ve even brought them. Ce(ause if not$ the" almost see "ou as not a good person$ as not sensitive.: )n man" (ases$ the famil" as a 'hole ma#es important de(isions. &his in(ludes de(isions regarding a person9s illness. &hus$ it is important to have the support of the famil"$ sin(e the" 'ill li#el" be as important a part of that person9s re(over" as an" medi(al interventions. Dr. )z2uierdo points out$ 7)n a stud" of the Latin Ameri(an Can(er Resear(h$ the" sa' that most men got (are be(ause the 'ives insisted on them getting (are. Dot be(ause the" 'ould have spontaneousl" gotten (are. So$ things li#e that are important. )f "ou 'ant male diabeti(s to ta#e (are of their diet$ "ou probabl" need to be inviting the 'ife in.: Almost all health(are providers intervie'ed stressed the importan(e of getting the famil" involved. 1hen (hildren (ome 'ith their parents$ it is often the (ase that the (hild 'ill have a higher level of a((ulturation and a higher level of edu(ation. 4ne do(tor e0plains that as a result$ 7&he" are usuall" more malleable and a little more open.: Another provider states$ 7)9m for the edu(ation. And the more people that are e0posed to it$ the more valuable it is. And the more that ) feel (onfident that the" <the patients= 'ill a(tuall" follo' through 'ith something. So "es$ ) prefer the famil" <being present=.: -spino et al. re(ommend spending about >H minutes 'ith the e0tended famil" e0plaining the illness$ treatment options$ et(. )n some (ases$ this e0tra time ma" 2ualif" as a 7Medi(are e0tended visit.: Case Stud& Re*iew A >A "ear+old female (omes in$ (omplaining of flu+li#e s"mptoms. She has brought her entire famil" 'ith her: her husband$ both her parents$ and an aunt visiting from out+of+to'n. Do "ou allo' the famil" to sta" in 'ith the patient$ or as# them to 'ait in the 'aiting room3 &e$ie' As 'as e0plained$ families are ver" important 'ithin the ispani( (ommunit". )t is signifi(ant that the patient de(ided to bring her famil" along. As a result$ the do(tor should be sensitive to her 'ishes. )t is al'a"s up to the best *udgment of ea(h do(tor to de(ide if and for ho' long the famil" ma" sta" 'ith the patient$ depending on ea(h situation. o'ever$ it is re(ommended that the famil" be present at least at the beginning or the end$ or both$ so that the" (an be involved in the pro(ess. &he famil" doesn9t feel left out$ and (an ta#e a more a(tive role in ma#ing sure the patient gets better. Ce(ause of (on(erns of priva("$ it is ver" important$ for both men and 'omen$ to have some time in private 'ith the do(tor to dis(uss issues that the" ma" not feel (omfortable dis(ussing in front of famil" members. &he purpose$ in the end$ is to find the best balan(e of famil" support and priva(" for ea(h individual patient. !ain Points + @amilies are often ver" (lose+#nit. Consider allo'ing famil" members to remain present 'ith a patient for at least part of the e0am$ to ma#e the patient more (omfortable. + Continue to respe(t patient priva("$ and still give ea(h patient some time alone 'ith the do(tor. + Ce a'are that in some (ultures$ ma(hismo and marianismo are ver" strong. &his is not endorsing nor denoun(ing it$ but it is something that do(tors should be a'are of.

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+urther References -spino DG$ 4a#es SL$ Grever )A$ 4livares 4$ Alford CL$ Mouton CP. 7 ealth Care for ispani( -lder Patients.: Caring for Hispanic Patients. 5HHA8%:5H+55. enderson$ George and Martha Primeau0. &rans(ultural ealth Care. Reading$ MA: Addison+ 1esle"$ %IJ%. Lipton RC$ Lose" LM$ Gia(hello A$ Mendez K$ Girotti M . Attitudes and issues in treating latino patients 'ith t"pe 5 diabetes: vie's of health(are providers. The Diabetes Educator. %IIJ85A:FL+L%. Loue$ San. ed. andboo# of )mmigrant ealth. De' /or#$ D/: Plenum Press$ %IIJ. Poon$ A1$ Gra" MG$ @ran(o GC$ Cerruti DM$ S(hre(# MA$ Delgado -D. 7Cultural Competen(e: Serving Latino Patients.: J Pediatric Orthopaedics. 5HH>85>:BAF+BAI. Solo'a" C. 7 uman )mmunodefi(ien(" Girus and the ispani( Communit".: Caring for Hispanic Patients. 5HHA8%:%A+%J. TH ! 9# TH %$N:U$: B$RRI R ;Linguisti(all" and (ulturall" (ompetent (ommuni(ation 'ith patients is a right guaranteed under the &itle G) of the Civil Rights A(t.: ,Correa and Moreno.. O&he follo'ing applies to those patients 'ho either do not spea# -nglish or have a lo' abilit" to spea# -nglish. !ain Points + Avoid using famil" members as translators. + !se bilingual medi(al staff or professional interpreters 'henever possible. + &r" to allo' patients to spea# in their native language 'hen possible. + As# patients to repeat 'hat "ou have said$ to assure (omprehension. Avoid as#ing$ 7Do "ou understand3: Case Stud& A patient 'ho spea#s onl" Spanish (ame in this morning. Dr. Smith onl" #no's a fe' phrases in Spanish$ so he as#ed for an interpreter$ 'ho arrived 2ui(#l". Dr. Smith as#ed the interpreter to introdu(e him to the patient$ and to as# the patient about 'h" the" (ame into the emergen(" room in the morning. &he interpreter does this$ and the patient responds$ des(ribing to the interpreter his (hest pains and shortness of breath that morning. &he do(tor (ontinues to as# the interpreter to as# the patient further 2uestions. o'ever$ the responses the patient gives tend to be rather terse. 1hat 'ould "ou re(ommend Dr. Smith do to help him better (ommuni(ate 'ith the patient$ and help the patient open up a bit more3

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Perception of Hispanic Patients An unfortunate result of the language barrier is that this barrier in+and+of itself ma" lead to an altered per(eption of patients$ and in some (ases a different diagnosis. Resear(h published in literature has sho'n that health(are professionals 'ill often per(eive the t"pe or degree of patholog" differentl" depending on the language in 'hi(h the intera(tion 'ith the patient is done. )n some (ases$ la(# of (ompeten(" in -nglish 'as (onfused for a ps"(hologi(al disorder. Although it should go 'ithout sa"ing$ all patients$ regardless of their native language$ should be treated 'ith respe(t. &he fa(t that a person spea#s -nglish 'ith an a((ent$ or not at all$ does not mean that the" are less intelligent or that the" deserve less respe(t. Goldsmith states in his paper$ 7 ispani( patients 'ho are ill often forgo health(are rather than suffer 'hat the" per(eive as the s(orn of insensitive (lini( personnel.: Patient Response &he response of a patient ma" var" depending on the language in 'hi(h the" must spea#. @or e0ample$ Spanish+spea#ing patients ma" give a long and detailed response in Spanish. o'ever$ 'hen as#ed to respond to the same 2uestion in -nglish$ the" give a ver" terse response. Some resear(h has sho'n that in some (ases$ the ans'er 'ill a(tuall" (hange depending on 'hether the patient is being made to spea# in Spanish or -nglish. Ce(ause of this$ it is of utmost importan(e to spea# to a patient in 'hatever language the" feel most (omfortable in$ espe(iall" if their s#ills in -nglish are ver" limited. Another problem that often arises is that patients ma" not al'a"s understand 'hat the" are being told in a language other than their native language. 4ne 'a" of seeing if a patient understood 'hat "ou have e0plained to them is to as# them to repeat ba(# to "ou 'hat "ou had said. )t is best to avoid using the phrase$ 7Do "ou understand3: sin(e patients ma" simpl" respond "es$ even if the" are not sure. As#ing them to repeat 'hat "ou 'ant them to understand is a better 'a" of determining ho' 'ell the" (omprehend "ou. Interpretation )t is vitall" important to have (ompetent interpreters 'henever possible. &he best (ase is one in 'hi(h the health(are professional themselves is profi(ient in Spanish. 1hen this is not possible$ people are en(ouraged to hire bilingual staff andEor use professional interpreters. &he use of nonprofessionals as interpreters should be avoided 'henever possible$ as this (an lead to mis(ommuni(ations. Another option 'hen interpreters are not available is a phone servi(e. &here are phone servi(es that offer interpreters 5A hoursEda". &his (an be useful 'hen a 2ualified person is not available. )f "ou are un(ertain 'hi(h language a person spea#s$ using the follo'ing flash(ard from the !.S. Census ma" help "ou determine 'hose servi(es are needed as an interpreter. )t is espe(iall" important to avoid using (hildren as interpreters 'henever possible 'hen doing translations. @irst$ (hildren ma" translate terminolog" in(orre(tl" due to unfamiliarit" 'ith the 'ords. )n addition$ (hildren often do not 'ant to tell their parents bad ne's$ and therefore might (hange 'hat is being said so that the" don9t have to do so. 4ne resour(e (ites a (ase in 'hi(h a (hild told her father that he had something 'rong 'ith his lung$ but it 'as onl" 'hen an outside interpreter 'as used did the father find out that he had (an(er. &he follo'ing site sho's ho' providing a 2ualified interpreter ma" a(tuall" be more (ost+effe(tive than less desirable methods of (ommuni(ating 'ith patients.

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Girtuall" all sour(es stress the importan(e of remembering that 'hen using an interpreter$ it is important to spea# dire(tl" to the patient$ rather than to the interpreter. &his maintains a feeling that the do(tor is still intera(ting 'ith the patient. 4ne provider re(ommends ma#ing sure the translator sa"s$ 7e0a(tl" 'hat the patient is sa"ing. ?) am having9 rather than ?She said that she is having.9: &he latter method both ta#es longer and ta#es the patient further out of the pi(ture. Dr. )z2uierdo points out that if providers 7have all the (onversation b" loo#ing at the interpreter$ the" miss the fa(t that there are a lot of other non+verbal (ommuni(ation items. So$ 'hen "ou are 'or#ing 'ith an interpreter$ "ou a(#no'ledge the presen(e of the interpreter$ but "ou do all of the bod" language 'ith the patient.: Another re(ommendation is to tr" to avoid metaphors or other hard+to+interpret phrases. &r" to e0plain things in list form$ and 'hen possible$ plan ahead 'hat "ou plan to sa"$ so that "ou don9t have to rephrase things$ 'hi(h ma#es the *ob of an interpreter more diffi(ult. @inall"$ resear(h has sho'n that primaril" Spanish+spea#ing ispani( patients are less pleased 'ith their (are than ispani( patients that spea# -nglish. &his held true even 'hen interpreters 'ere used. Resear(h b" @ernandez et al. sho'ed that do(tors using interpreters 'ere more li#el" to ignore 2uestions posed b" patients$ and that patients 'eren9t as apt to pose 2uestions or share their (on(erns 'hen using an interpreter. &his stresses the importan(e on the behalf of the do(tor to ma#e a (on(erted effort to pa" attention to the patient and intera(t as dire(tl" as possible 'ith them$ espe(iall" 'hen using interpreters$ so as to ma#e the patients feel more 'illing to e0press their (on(erns and 2uestions. 4f (ourse$ the ideal 'ould be to learn Spanish and spea# dire(tl" to the patient. %earnin' Spanish 4f (ourse$ the most ideal situation is for a health(are professional to learn Spanish fluentl" enough that the" (an (ommuni(ate dire(tl" 'ith the patient. All resear(h revie'ed suggests that this offers a signifi(ant improvement in 2ualit" of (are even over 'or#ing 'ith an interpreter. )f be(oming fluent in Spanish is not possible$ man" health(are professionals re(ommend getting at least a basi( understanding of Spanish. Dr. Pierre+Louis e0plains$ 7Mno' a little Spanish$ be(ause a lot of the time 'hen the" are translating$ the" are not sa"ing 'hat "ou9re sa"ing. &he" do not. So definitel"$ definitel"$ "ou need to #no' something. A little bit. Ce(ause a lot of times it does not get translated appropriatel". )t ma" get translated literall". 4r totall" not 'hat "ou9re as#ing <sa"ing=.: 4ther health(are professionals e(hoed this statement. Patients also appre(iate the effort. 4ne provider pointed out$ 74ne do(tor that ) have translated for;she 'as reall" good be(ause she had an interest in learning the language. And she tries$ she ma#es the attempt 'ith the patients. And the" respond to that. &he" might be laughing under their breath$ be(ause she9s not an effe(tive (ommuni(ator in Spanish. Cut be(ause she ma#es that attempt$ ) thin# the" respe(t that and respond to her.: 4verall$ the effort to learn some Spanish helps the do(tor both b" helping them ma#e sure that the translation is generall" 'hat the" meant to sa"$ and also b" allo'ing them to have a slightl" better (onne(tion 'ith the patients$ even if an interpreter is still needed. Case Stud& Re*iew A patient 'ho spea#s onl" Spanish (ame in this morning. Dr. Smith onl" #no's a fe' phrases in Spanish$ so he as#ed for an interpreter$ 'ho arrived 2ui(#l". Dr. Smith as#ed the interpreter to introdu(e him to the patient$ and to as# the patient about 'h" the" (ame into the

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emergen(" room in the morning. &he interpreter does this$ and the patient responds$ des(ribing to the interpreter his (hest pains and shortness of breath that morning. &he do(tor (ontinues to as# the interpreter to as# the patient further 2uestions. o'ever$ the responses the patient gives tend to be rather terse. 1hat 'ould "ou re(ommend Dr. Smith do to help him better (ommuni(ate 'ith the patient$ and help the patient open up a bit more3 "nal#sis &he patient ma" feel a bit dis(onne(ted from the Dr. Smith. Dr. Smith (ould tr" spea#ing dire(tl" to the patient$ rather than spea#ing to the interpreter. &he interpreter 'ill still translate$ and this 'ill help the patient feel li#e he is more (onne(ted to the do(tor. &he do(tor ma" also 'ant to revie' the 'a" in 'hi(h he introdu(ed himself to the patient. Did he introdu(e himself to the patient dire(tl"$ perhaps even sha#ing hands3 )t ma" be 'orth'hile for Dr. Smith to learn at least a fe' introdu(tor" phrases in Spanish that (an be said 'hile he 'aits for an interpreter to arrive. Also$ did Dr. Smith tr" to (hat a bit 'ith the patient at first$ to get to #no' the patient a little better and ma#e the patient feel more (omfortable3 &he (hatting ma" be 'hat allo's the patient to feel suffi(ientl" (omfortable to open up 'ith the do(tor. Also$ Dr. Smith should revie' 'hi(h #inds of 2uestions he should as# and ho' to phrase them$ so as to tr" to ma#e his patient as (omfortable as possible. @inall"$ Dr. Smith should tr" to determine some of the patient9s beliefs and (on(erns so as to be sensitive to them. !ain Points + Avoid using famil" members as translators. + !se bilingual medi(al staff or professional interpreters 'henever possible. + &r" to allo' patients to spea# in their native language 'hen possible. + As# patients to repeat 'hat "ou have said$ to assure (omprehension. Avoid as#ing$ 7Do "ou understand3: +urther References Correa D$ Moreno CA. 7Demographi(s: ispani(s in a Changing !nited States.: Caring for Hispanic Patients. 5HHA8%:F+L. -spino DG$ 4a#es SL$ Grever )A$ 4livares 4$ Alford CL$ Mouton CP. 7 ealth Care for ispani( -lder Patients.: Caring for Hispanic Patients. 5HHA8%:5H+55. @ernandez A$ S(hillinger D$ Grumba(h M$ Rosenthal A$ Ste'art AL$ 1ang @$ PPrez+Stable -K. Ph"si(ian language abilit" and (ultural (ompeten(e. Journal of (eneral )nternal edicine. 5HAA8%I:%FL+%LA. Goldsmith M. 7 ispani(ELatino health issues e0plored.: J" ". %II>85FI:%FH>. enderson$ George and Martha Primeau0. &rans(ultural ealth Care. Reading$ MA: Addison+ 1esle"$ %IJ%. Loue$ San. ed. andboo# of )mmigrant ealth. De' /or#$ D/: Plenum Press$ %IIJ.

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Poon$ A1$ Gra" MG$ @ran(o GC$ Cerruti DM$ S(hre(# MA$ Delgado -D. 7Cultural Competen(e: Serving Latino Patients.: J Pediatric Orthopaedics. 5HH>85>:BAF+BAI. TH ! <# OTH R CONSID R$TIONS Case Stud& A >>+"ear+old male patient has been having ba(# problems. /ou gave him a pres(ription for a medi(ine to ta#e$ and told him to (ome in again in a 'ee#. o'ever$ the patient does not (ome in the ne0t 'ee#. After several (alls$ the patient finall" (omes in$ and "ou find that he has not been ta#ing the medi(ation. 1hat are some possibilities for 'h" this patient has not been ta#ing the medi(ation or (oming in for follo'+ups3 Bloc)s to Healthcare &o re(eive health(are$ there are often man"$ man" papers that must be filled out. )t (an be a big impediment for man" patients. )t is strongl" en(ouraged that paper'or# be redu(ed to a minimum$ and that patients be assisted in filling out paper'or# ne(essar" to re(eive treatment. &here are man" other impediments to re(eiving health (are. Some of the most (ommon in(lude trouble getting transportation to and from a health(are (enter. La(# of insuran(e is a ver" (ommon problem among those of lo' S-S. Man" patients 'ho are illegal immigrants are also afraid that getting insuran(e ma" lead to deportation. 4ne health(are professional states that there is 7a fear of being found if the" are do(umented. Dot appl"ing for insuran(e for one (hild$ even through the"9re 'ithin the la'$ for fear of someho' *eopardizing their o'n re2uest for (itizenship.: Tan'i0le !edicine Some patients prefer a tangible response to (are$ as this feels more effe(tive in improving the illness. @or e0ample$ in some (ases$ a patient ma" prefer a shot to a medi(ation ta#en orall". )t ma" be 'orth the time to as# a patient 'hi(h method the" prefer 'hen there are t'o options available. )n one (ase$ a do(tor intervie'ed b" Marsigli mentioned a (ase of a patient 'ho 'as disappointed 'hen their (hild did not re(eive a va((ine. &here 'as a per(eption that the (hild 'as not getting the (are needed. 4ne do(tor points out that ea(h (ulture and ea(h person is different. Some e0pe(t in*e(tions$ others a series of herbs$ or a suppositor"$ or more nutritional information than an Ameri(an patient usuall" e0pe(ts. So giving patients options and e0plaining 'h" "ou re(ommend a parti(ular option is important. Again$ this ta#es e0tra time$ but is 'orth it if it gains the trust of the patient. Cost of !edicine and Care )n the (ase of patients of lo' S-S$ health(are providers intervie'ed b" both Marsigli and the author re(ommend using the most ine0pensive drug that 'ill still help the patient. &his is preferable over offering free samples of more e0pensive drugs and having the patients (ontinue 'ith that e0pensive drug later on 'hen the samples run out. Do(tors are urged to remember that even 'hen the drug is ine0pensive$ patients ma" still not bu" it due to (ost. 4nl" use more e0pensive drugs if the (heaper ones do not 'or# initiall". 4ne of the biggest (on(erns brought up b" health(are providers has to do 'ith patients bu"ing medi(ine from their (ountr" of origin. &he" either bu" it 'hen the" go home to visit$ or

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on the bla(#+mar#et in the !.S. Man" providers e0pressed a great degree of (on(ern about this. Man" of the patients from Latin Ameri(an (ountries 'ere able to get a great deal of medi(ines 'ithout a pres(ription in their home (ountr". &he" are not a((ustomed to needing to get a pres(ription here. 1hen Dr. Pierre+Louis (omes a(ross this self+pres(ribing she usuall" tells the patients 7ho' 'e don9t #no' 'hat e0a(tl" is in the medi(ation. )f something goes 'rong$ 'e 'on9t #no' e0a(tl" 'hat 'e9re treating be(ause 'e didn9t pres(ribe it. And so it9s al'a"s more dangerous to do that$ to bu" it from another (ountr". And even though the" ma" trust the sour(e$ 'e *ust$ if something goes 'rong$ 'e (an9t help them. So again$ that9s the fear. 4ther'ise$ the" 'ould do it$ be(ause it9s (heaper$ and the" 'ant to #eep it in the (abinet.: $cceptance of Disease 1ithin man" (ultures in Latin Ameri(a$ there is often a belief that things happen for a reason$ and that ever"thing is in Gods hands. &his e0tends to diseases and health issues$ 'hi(h patients ma" feel happen for a reason. &he" ma" believe that if God means to (ure a disease$ e 'ill do so. Man" health(are providers have had great diffi(ult" 'or#ing around this some'hat fatalisti( vie'. 4ne health(are e0plains ho' patients have told her$ 7) thin# that )9m in the hands of God$ and if God 'ants$ e9ll ta#e m" diabetes a'a".: She responds b" sa"ing$ 7/ou #no'$ God gave us a brain for something. )f e 'anted to ta#e (are of ever" single detail$ he 'ould have made us dumb. e 'ants us to do things$ be smart$ and ta#e (are of ourselves. 1hen does the Cible sa"$ be laz"$ do nothing$ and let Me ta#e (are of ever"thing3 )t doesn9t sa" that$ does it3: 4ther do(tors have e0pressed using similar language. o'ever$ Dr. )z2uierdo points out that 7not all Latinos have this idea. M" point is that if "ou tr" to figure out 'hat triggers the non(omplian(e$ its easier <to 'or# 'ith it=;"ou need to understand 'here people are (oming from.: !i'rant Issues &here are man" illegal immigrants 'ho onl" sta" 'ithin a region of the !.S. for a short period of time. Ce(ause the" (onstantl" move from one area to another$ medi(al (are is often in(onsistent and provided b" man" different people. As a result$ it (an be ver" diffi(ult to #eep tra(# of their health. )t might be helpful to provide them 'ith a (op" of their medi(al re(ords under "our (are$ or 'ith "our (onta(t info$ to be presented to 'hoever (ontinues their treatment do'n the road. )f possible$ determine if "ou (an get the (onta(t information of those 'ho previousl" treated the patient$ to see if perhaps "ou (an gain a((ess to that information to better treat the patient. Ser*ices for Hispanic patients of low socio-economic status @inall"$ tr" to find out 'hat (ommunit" servi(es are available in the area for "our patients. &r" to #eep a list of these servi(es hand"$ so that "ou (an help "our patients in as man" 'a"s as possible. &he final se(tion in this 7theme: (ontains some possible sour(es of information in Spanish$ both on the 'eb and in the form of boo#lets or pamphlets. Other Considerations &here are other$ small things that (an be done to improve the 2ualit" of (are for patients. @irst$ man" patients of lo' S-S find it ver" diffi(ult to ta#e off from 'or# to go to visit a do(tor. Remember to as# all patients if the" need a note of some sort as verifi(ation that the" 'ere

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indeed seen b" a do(tor. )f possible$ minimize the 'aiting time for patients$ and (onsider offering o((asional (lini(s in the evening$ or opening earlier or later$ so that patients 'ho 'or# during the da" (an (ome during these hours. &here is no ideal time of da" for ispani( patients of lo' S-S$ be(ause so man" of them are 'or#ing at all hours of the da" and night. -0tending hours ma#es it more li#el" that more patients 'ill be able to (ome. &r" to provide boo#lets and pamphlets in Spanish 'hen possible. o'ever$ never rel" on these pamphlets entirel". Man" ispani( patients 'ho are ne' immigrants of lo' so(io+ e(onomi( status 'ill often have a lo'+litera(" level$ both in -nglish and Spanish. &herefore$ it is better to e0plain things personall" to a patient$ rather than *ust hand them a pamphlet. 1hen using pamphlets$ man" do(tors intervie'ed re(ommended going through the pamphlets 'ith the patients$ and using pamphlets 'ith man" images 'henever possible. &here are an in(reasing number of reputable resour(es and government agen(ies offering information both in Spanish and at lo'+litera("$ espe(iall" online. *ources on the 'eb for patients Dational Diabetes )nformation Clearinghouse Dational Diabetes )nformation Clearinghouse in Spanish )nformation about the government$ in Spanish M-Dline &utorials in Spanish More M-Dline health information in Spanish More M-Dline information in Spanish ,eas" to read. *ources of Posters and Pamphlets Listing of Multi(ultural and Multilingual Cro(hures on the 1eb+man" lin#s found here Dational Diabetes )nformation Clearinghouse Dational Diabetes -du(ation Program: @ree Cro(hures on Diabetes Diabetes -0hibit from the Dational ispani(ELatino Diabetes )nitiative for A(tion Pamphlets on Garious ealth )ssues$ 'ith do'nloadable audio versions @DA Publi(ations in Spanish$ and -asier to Read *ources for Healthcare Professionals Coo#lets for ealth (are professionals from the !S Dept of ealth and uman Servi(es 71orld -du(ation: )nformation and Lin#s on Culture and Litera(" G1 !niversit": Lo(al Resour(es in the 1ashington Metropolitan Area Case Stud& Re*iew A >>+"ear+old male patient has been having ba(# problems. /ou gave him a pres(ription for a medi(ine to ta#e$ and told him to (ome in again in a 'ee#. o'ever$ the patient does not (ome in the ne0t 'ee#. After several (alls$ the patient finall" (omes in$ and "ou find that he has not been ta#ing the medi(ation. 1hat are some possibilities for 'h" this patient has not been ta#ing the medi(ation or (oming in for follo'+ups3 "nal#sis &here are man" possibilities for 'h" the patient hasn9t been follo'ing up. 1hen he does (ome in$ as# the patient 'h" he didn9t (ome in earlier. )s it simpl" that he forgot$ or is it famil"

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related$ or 'or# related3 /ou ma" 'ant to (onsider sta"ing open late or starting earl" on(e a 'ee#$ so patients 'ith ver" stri(t 'or# s(hedules (an (ome in. Also$ as# the patient 'h" he hasn9t been ta#ing his medi(ation. &here is an" number of possible reasons. )t (ould be that he doesn9t believe that it 'ill help him. )n this (ase$ it ma" be 'orth'hile to e0plain again 'hat e0a(tl" the medi(ation does$ at a level appropriate to the understanding of the patient. Sho'ing the patient that "ou reall" ta#e an interest in his 'ell being as a person$ not as a disease$ 'ill probabl" also help. Reall" prod him$ and tr" to find the underl"ing (ause or problem. Another possibilit" is that this patient ma" not be able to afford the medi(ation. )n this (ase$ re(ommending the patient to a program that offers free or lo'+(ost medi(ations should be (onsidered. )f possible$ helping the patient fill out the ne(essar" paper'or# 'ould e0pedite the pro(ess tremendousl"$ sin(e man" patients are not as familiar 'ith 'or#ing around the s"stem as health(are professionals 'ho deal 'ith it ever" da". Also$ some patients ma" be hesitant to give information to these programs due to fears of being deported$ and ma" need to be assured that utilizing these programs 'ill not lead to deportation. Do matter 'hat the reason$ tr" to find a 'a" to 'or# around the problem$ so that the patient (an get the help that he needs. +urther References Caban A$ 1al#er -A$ Sonszein K. 7Management of &"pe 5 Diabetes in the ispani( Communit": 4ver(oming Carriers.: Caring for Hispanic Patients. 5HHA8%:5>+5F. Correa D$ Moreno CA. 7Demographi(s: ispani(s in a Changing !nited States.: Caring for Hispanic Patients. 5HHA8%:F+L. Goldsmith M. 7 ispani(ELatino health issues e0plored.: J" ". %II>85FI:%FH>. enderson$ George and Martha Primeau0. &rans(ultural ealth Care. Reading$ MA: Addison+ 1esle"$ %IJ%. Lipton RC$ Lose" LM$ Gia(hello A$ Mendez K$ Girotti M . Attitudes and issues in treating latino patients 'ith t"pe 5 diabetes: vie's of health(are providers. The Diabetes Educator. %IIJ85A:FL+L%. Loue$ San. ed. andboo# of )mmigrant ealth. De' /or#$ D/: Plenum Press$ %IIJ. Poon$ A1$ Gra" MG$ @ran(o GC$ Cerruti DM$ S(hre(# MA$ Delgado -D. 7Cultural Competen(e: Serving Latino Patients.: J Pediatric Orthopaedics. 5HH>85>:BAF+BAI. S#olni(# A. 7Clini( e0plores novel approa(hes to improving health in the ispani( (ommunit". J" ". %IIB85L>:%ALB+%ALF. CONC%USION )t is hoped that this 'ebsite provided useful information that 'ill help "ou in "our o'n intera(tions 'ith ispani( patients$ espe(iall" those of lo' a((ulturation$ lo' S-S$ andEor lo'

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edu(ation levels. Please remember that this 'ebsite is not (omprehensive. )t is strongl" en(ouraged that health(are professionals use this onl" as a starting point$ and ta#e as man" (ourses and 'or#shops to in(rease (ultural (ompeten(" as possible$ not *ust for ispani( patients$ but for all patients of different ba(#grounds. %IN-S TO R SOURC S ON TH = B ! NTION D IN $RTIC% %. http:EE'''.ri(e.eduEpro*e(tsE ispani( ealthECoursesEmodLEmodL.html 5. https:EE'''.amsa.orgEprogramsEgpitE(ultural.(fm >. http:EEdiabetes.nidd#.nih.govEdmEpubsEhispani(ameri(anE A. http:EE'''.r'hp.orgEtrainEod(sense.html B. http:EE'''.s(u.eduEethi(sEpubli(ationsEethi(alperspe(tivesEminorit"patients.html F. http:EE'''.lep.govE)Spea#Cards5HHA.pdf L. http:EE'''.hispani(health.orgElep>b.lasso J. http:EEdiabetes.nidd#.nih.govEspanishEinde0.asp I. http:EEdiabetes.nidd#.nih.govEspanishEinde0sp.asp %H. http:EE'''.firstgov.govE-spanolEinde0.shtml %%. http:EE'''.nlm.nih.govEmedlineplusEspanishEtutorial.html %5. http:EE'''.nlm.nih.govEmedlineplusEspanishEhealthtopi(s.html %>. http:EE'''.nlm.nih.govEmedlineplusEspanishEeas"toreadEeas"toreadQa.html %A. http:EEmedlib.overla#ehospital.orgElibrar"Emulti.htm %B. http:EE'''.ndep.nih.govEdiabetesEpubsE(atalog.htmRPubs ispLatino %F. http:EE'''.(d(.govEdiabetesEpro*e(tsElatino.htmRe0hibit %L. http:EE'''.fda.govEopa(omElo'litEspanlo'.html %J. http:EE'''.'orlded.orgEusEhealthEdo(sE(ultureEindi(esQsub*e(t.htmlRlatinQameri(ans %I. http:EE'''.g'um(.eduEpartnersE R SOURC S Corra"o -$ Ken#ins SR. 7@eeling frugal: so(ioe(onomi( status$ a((ulturation$ and (ultural health beliefs among 'omen of Me0i(an des(ent. Cultural Di$ersit# and Ethnic inorit# Ps#cholog#. 5HH>8I:%IL+5HF. Caban A$ 1al#er -A$ Sonszein K. 7Management of &"pe 5 Diabetes in the ispani( Communit": 4ver(oming Carriers.: Caring for Hispanic Patients. 5HHA8%:5>+5F. Correa D$ Moreno CA. 7Demographi(s: ispani(s in a Changing !nited States.: Caring for Hispanic Patients. 5HHA8%:F+L. -spino DG$ 4a#es SL$ Grever )A$ 4livares 4$ Alford CL$ Mouton CP. 7 ealth Care for ispani( -lder Patients.: Caring for Hispanic Patients. 5HHA8%:5H+55. @ernandez A$ S(hillinger D$ Grumba(h M$ Rosenthal A$ Ste'art AL$ 1ang @$ PPrez+Stable -K. Ph"si(ian language abilit" and (ultural (ompeten(e. Journal of (eneral )nternal edicine. 5HAA8%I:%FL+%LA.

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Goldsmith M. 7 ispani(ELatino health issues e0plored.: J" ". %II>85FI:%FH>. enderson$ George and Martha Primeau0. &rans(ultural ealth Care. Reading$ MA: Addison+ 1esle"$ %IJ%. Lipton RC$ Lose" LM$ Gia(hello A$ Mendez K$ Girotti M . Attitudes and issues in treating latino patients 'ith t"pe 5 diabetes: vie's of health(are providers. The Diabetes Educator. %IIJ85A:FL+L%. Lopez$ Giselle. )ntervie's 'ith various health(are providers and ispani( patients. )n person. April 5I$ 5HHB through Ma" %B$ 5HHB. Loue$ San. ed. andboo# of )mmigrant ealth. De' /or#$ D/: Plenum Press$ %IIJ. Marsigli C$ Cerard -$ &ures#i M. @o(us Group )ntervie' 'ith ispani( patients. Mar(h 5I$ 5HHB. Poon$ A1$ Gra" MG$ @ran(o GC$ Cerruti DM$ S(hre(# MA$ Delgado -D. 7Cultural Competen(e: Serving Latino Patients.: J Pediatric Orthopaedics. 5HH>85>:BAF+BAI. Risser AL$ Mazur LK. 7!se of @ol# Remedies in a ispani( Population.: "rchi$es of Pediatrics and "dolescent edicine. %IIB8%AI:ILJ+IJ%. S#olni(# A. 7Clini( e0plores novel approa(hes to improving health in the ispani( (ommunit". J" ". %IIB85L>:%ALB+%ALF. Solo'a" C. 7 uman )mmunodefi(ien(" Girus and the ispani( Communit".: Caring for Hispanic Patients. 5HHA8%:%A+%J.

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