Comparison of Cultural Values

Anglo Culture: Emphasis is on a sense of informed patients that is in part some awarenesss of healthcare system.

Latino culture: For Latino immigrants, their sense of identity is derived in large part by uninformed patients in combination with low awareness of healthcare system.

Identity is a multi-layered concept involving age, gender, name, sexual orientation, nationality, preferences, ethnicity, culture, etc. However among these different dimensions, some are more important than others within different cultures.

Informed vs. Uninformed

The US has compulsory primary and secondary education for its citizens and has a 99% literacy rate. The use of medical terms is pervasive in the news and public health educational campaigns. Some technical medical terms have become mainstream.

The Latino community that immigrates is not a cross-section of society. Educated and wealthy individuals and those with stable socio-economic conditions have no incentive to leave their countries of origin and come to the States. So most of those who come have, at best, some primary education.

High vs. Low awareness

The US healthcare system is a multi-billion dollar industry that is hyper-specialized and has a heavy legalistic focus that requires the signing of numerous forms, releases, and consents, and the documentation of every step of care delivery.

Health care in Latin America relies mostly on public hospital and clinics complemented by some private enterprise. Medicine is for the most part socialized and has many fewer specialties and sub-specialties. Preventive medicine is well developed, but other types of care are much more advanced in the US.

Examples of Cultural Misunderstandings

Scenario A

Situation: Provider explains a necessary procedure and used terms like "endoscopy", "biopsy", and "pathologist". The patient looks confused and the interpreter has to repeat things several times.

Mitigation: Provider adapts their speaking register based on patient's educational level. Use first 2-3 minutes of small talk to gauge patient's educational level and medical literacy. Keep your register high for educated patients and simplify the message for all others. Instead of saying "During the endoscopy we are going to take biopsies of polyps and send them to the pathologist", change it to "We are going to use a small camera to look at the inside of your stomach. We will take samples of any abnormal tissue that we find and will study them".

Scenario B

Situtation: At the Ambulatory Surgery Unit, the anesthesiologist asks the patient whether they would like general, local, or monitored anesthesia. Patient is surprised by question and does not know what to choose.

Mitigation: Anesthesiologist explains the differences and advantages of each type of anesthesia by using layman terms, e.g. ": You will be awake/asleep, you will feel something/nothing, you can talk to us/will have a breathing tube". Only after this explanation does he invite a choice to be made.

Scenario C

Situtation: A patient presents through the Emergency Room and is admitted. During his week-long stay he meets no less than 30-40 different staff and providers each carrying different titles: doctors, surgeons, social workers, admitting clerks, financial counselors, therapists, nurses, and medical assistants. Patient has no clue as to the role of each person and does not know who to speak to for what.

Mitigation: When providers introduce themselves they will constantly repeat what their roles is, rather than just providing their name and title. For example instead of just saying "Hi, I am Jessica, your physical therapist", the therapist adds "I am here to help you to get out of bed, exercise, and get strong again". A neurologist could explain "I am a specialist of the brain and will visit you over the next couple of days to make sure the swelling in the head is going down."

Scenario D

Situation: Patient is repeatedly asked for his name and date of birth, over and over again. Patients start losing confidence in staff and asks himself "Don't they know who I am? Why do they keep loosing track of my information?".

Mitigation: The provider explains the processes used and the reasons for them, for example that patients are purposely identified and re-identified at various stages. This is a safety precaution and is not due to a lapse of memory.

Scenario E

Situation: Patient is offered different services that he seems to need (interpreting services, oxygen delivered to his home, etc.), but inexplicably turns them down. Unbeknownst to the provider, the patient recently received a $3,000 ambulance bill and is reluctant to agree to any more services. A charge like that is tantamount to financial exploitation and would never have occurred in his country.

Mitigation: The cost of any service is explained, specially if there will be out-of-pocket expenses. If a free service is turned down, the patient is reminded that it there is no associated cost.

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This article is part of a series on Latino Culture and Healthcare.
View the main article here.