Latino Culture: Communication Style
Comparison of Cultural Values
Anglo Culture: The most highly prized style of communication is assertive, direct, and of low context.
Latino culture: Good communicators use a style that is passive, is indirect, and provides high context.
Assertive vs. Passive
In Anglo Culture the most highly valued communication style in the USA is assertive and direct communication: If the patient needs something they need to speak up and request it. When patients state their opinions and preferences this is expected and welcomed. Replies are given as clear and unequivocal “yes” and “no”s. What you say is more important that how you say it.
In Latino culture passive communication is the most effective style, so the patient will not openly challenge the doctor. By being non-confrontational the patient can preserve his personal relationship with the provider, and this is paramount. Showing respect and maintaining harmony are more important than getting my way. If I can maintain a good personal relation with my doctor, I am sure we can work out the rest. By the way I said “yes” or “no” (with hesitation, in a tentative way, or with enthusiasm) the provider will know where I really stand.
Direct vs. Indirect
Anglo Culture favors direct communication that is transparent and to the point. What we say closely reflects how we feel and we do not ask our listener to read between the lines. We also value our time and that of our interlocutor so, without too much pomp and ceremony, we quickly get to the point we want to make. If we need to say something that is unpleasant, we can be very surgical about it and deliver the critique or request matter-of-factly.
In stark contrast to the English direct approach is the Spanish indirect style. One of the most important Latino cultural priorities is to maintain good relationships, specially with members of a person's support system. Sometimes this means being non-confrontational in speech, for example by using euphemisms, replacing a “no” with a “maybe”, or taking a flexible stand instead of a very firm one. For example, if something is found broken, a Latino speaker may chose to say “se rompió” (“it was broken”), instead of the more direct “Usted lo rompió” (“You broke it”). The problem (a broken object) is verbalized but no blame is assigned. The focus is on fixing the problem, not on embarrassing someone.
English direct communicators are frustrated by all the guesswork that indirect communication requires; it can be hard to know where the other person really stands. While Spanish indirect communicators are taken aback by the uncaring and callous way information can sometimes be delivered by direct communicators. Another way to think about the difference is that for direct communicators it's about what was said, and for indirect it is about how something was said.
Low Context vs. High Context
One of the reasons communication in English is very expeditious is that very little context or backstory is given. Dwelling on the narrative or plot is not as important as getting to the point. If the listener asks for further details, the speaker will surely provide them, however peripheral or supporting information is not typically the starting point of conversations. Furthermore, indulgence in off-topic facts quickly become labeled as T.M.I. (Too Much Information). Communicating quickly and precisely is highly appreciated, in other words, “Just the facts ma'am”.
In Latino culture communication is context-rich. It's not only about the individual elements of a story; it's about how different elements and people are connected to each other. The initial narration is just as important as the insight, request, or punch line that is delivered at the end. An English speaker may simply ask “Can I burrow your car?”. Instead a Spanish speaker may tell you what happened to his own car, the emergency they had, their pressing need for transportation tomorrow, the good deed they could complete if they had a set of wheels, that they do not want to impose on you, and finally(!) they will ask if you could lend them your car. In my opinion, this style of communication comes from a world view where, rather than being a collection of self-reliant individuals, people see themselves as part of deeply interrelated groups, tribes, and families. Hence it becomes important to explain how the action of one member affects the others.
When interviewing Latino patients, Anglo providers feel trapped in conversations characterized by an unending carousel of words and tangential information. Conversely, Latinos feel defrauded by Anglo communicators who, metaphorically speaking, start with the end of the movie. Sure it's faster to jump to the end and skip the middle, but once there, there is not enough information to understand the meaning and the importance of the conclusions and how they relate to other important factors and events. The patient may feel they are being presented with isolated facts floating in space — not that useful.
Examples of Cultural Misunderstandings
Scenario A
Situation: Provider announces “Mr. Garcia, you have a very aggressive form of cancer and only have three months to live”. Patient finds the provider to be a blunt communicator to the point of being uncaring. A new, life-changing, diagnosis was just rendered in a terse and rather unemotional way.
Mitigation: Provider ramps ups slowly to disclose important news and eases into it, creating a rich and complete picture of what is going on. For example, a provider who needs to inform a Latino patient of a terminal diagnosis, can provide a chronological summary recapping all of the studies completed to date (MRIs, biopsies, lab work) and how events and the peristence of symptoms led to the unfortunate news they are about to disclose. Latino patient needs to understand the bigger picture, see things coming, and have an opportunity to brace themselves.
Scenario B
Situation: A doctor asks a Latino patient if she agrees to cut back her hours at work until her back injury resolves. Patient hems and haws and eventually says “yes”. However, the patient is illegally employed and is afraid of losing her job if she cannot be there every day. The provider finds the patient to be shy and a bit cagey but believes they got a straight answer. The patient does not decrease her hours and when she comes back for the one month follow up appointment, her the injury has worsened significantly.
Mitigation: Provider pays attention to how things are said, not only to what is being said. For example, a tentative “yes” in Spanish is equivalent to a “NO (but-I-am-too-polite-to-tell-you)” in English. So it is best to fully explore any hint of hesitations by a Latino patient before moving on to the next topic or question.
Scenario C
Situation: Provider asks the patient how they broke their femur. Patient starts narrating in detail the whole day leading up to the accident. Provider is frustrated that the patient takes sooo long to say things and does not answer direct questions with direct answers. He decides to interrupt the patient and repeat the original question. Patient feels that they are being cut off and are not allowed to express themselves. Provider is seen as rude, a person ahead of themselves who cannot wait for the important information that is coming.
Mitigation: The provider redirects the patient and rephrases his questions from open ended questions (e.g. “How did you hurt your leg?”) that invite longer answers, to close-ended questions that zero in the needed information more expeditiously (e.g. “Did you hurt your leg by falling OR did you hit it with something?”, “Do you want us to care for you at this hospital OR to be transferred to one near your home?”)
This article is part of a series on Latino Culture and Healthcare.
View the main article here.