Latino Culture: Personal Interactions
Comparison of Cultural Values
Anglo Culture: The main tenants that regulate personal interactions in the USA are informality, equality, and personal boundaries.
Latino culture: On the other hand, the main parameters that regulate personal interactions in Latino culture are formality, deference, and connection.
Formality vs. Informality
US doctors are likely to address patients by their first name and be informal. Senior patients are addressed in a similar way as younger patients are. It's ok to forego formalities and prolonged pleasantries and delve right into the topic at hand.
In Latin America most patients, specially those that are either adults, older, or have high social status, are always addressed in a formal manner. This is not considered stodgy or stuffy, but rather, it is a welcomed sign of respect. The only people addressed informally are friends, family members, children, and pets. Formality, and hence respect, is shown in several ways. First, it is shown through ritualized greetings that involve standard phrases such as "Buenos dias" ('Good morning'), eye contact, shaking hands, and small talk. The other common manifestation of formality is the use by Spanish-speakers of a special pronoun ("Usted" instead of the informal "tu" or "vos"). To understand this idea, imagine addressing someone with the old English "Thou" instead of "you" and the dignity that would convey.
The other expression of respect is through honorifics such as "Don" for men and "Doña" for women, think of them as approximately equivalent to "Sir" and "Madam" in English. When the proper level of formality is not used, it is the equivalent in English of a patient referring to the provider as "doc" or the doctor referring to the patient as "dude". It really sound out of place and strikes the wrong chord (lack of decorum and grace).
Equality vs. Deference
In the USA we are aware of our different backgrounds, but hold the belief that at a basic level we are all deserving of the same amount of respect. This entails that, outside of medically relevant information, providers do not need to know too much about a patient's background because they will attempt to treat them fairly, independent of who they are, how much they earn, or what their profession is. Likewise, an Anglo patient does not feel intimidated by and is not in a paralyzing awe of the doctor. Yes, the doctor is highly trained and may even be prestigious, but ultimately he is seen as a professional that was hired to solve a health issue. This sense of equality is the platform from which Anglo patients make their healthcare requests, ask their questions, express pleasure/displeasure with service, and let it be known whether they agree or not to proposals.
In Latin America societies it's a very different story. Here the three most honorable professions are traditionally considered to be that of teacher, priest, and doctor. These professions are not necessarily well paid, but are held in high regard. So doctors are not openly challenged, rebuked, or disagreed with, even when the patient holds a different opinion. Understandably, American doctors tend to misinterpret a Latino patient's lack of questions with understanding, and a tentative "yes" with agreement. In the patient's mind, they and the doctor are not on equal footing or of equal standing, so they will act on the belief that being humble and non-confrontational with generate the best results possible.
Personal Boundaries vs. Closeness
American doctors emerged from a culture that places the individual center stage. Accordingly, a lot of emphasis is placed on being non-judgmental and respectful of patient's individual choices. Furthermore, personal boundaries are respected be they physical, like avoiding any unannounced incursions into "personal space", or informational, by keeping information private and not prying without cause. A lot of care is taken to keep a poker face and not react strongly to whatever the patient reveals, even if the information were to be somewhat shocking.
Latino patients however are not looking for a detached impartial professional, quite on the contrary. It is paramount for them that they have an amiable relation with their medical providers. This priority is captured by the idiomatic expression "caer bien" which literally means "to fall well" and is equivalent to the English expression "to click (with someone)". The degree of closeness the Latino patient seeks from a medical doctor is equivalent to at least what an Anglo patient expects from their psychologist. If the Anglo provider sacrifices warmth and connection in their endeavor to respect individuality and privacy, the patient will likely never feel completely at ease and, as the opportunity arises, will seek out another doctor.
In fast-paced clinics, small talk can easily be seen by American doctors as a questionable use of time, even a waste; however, for Latino patients it's a valuable investment. When a personal connection is established, the patient is much more likely to be honest with answers, compliant with treatment, satisfied with the interaction, and less likely to seek legal recourse or retribution in the event of an adverse outcome.
Examples of Cultural Misunderstandings
Scenario A
Situation: A nurse addresses an older Latino gentleman by their first name and offends them because they are being spoken to as if they were a small child. To his ears it sounded like "How ya doing sport?".
Mitigation: During their first interaction, providers ask Latino patients how they prefer to be addressed (e.g. "Do you prefer that we address you as 'Mr. Gutierrez' or as 'Roberto'?). When in doubt providers should always start interactions using the last name.
Scenario B
Situation: A clinician dashes through the examination room door, logs onto the computer, and immediately starts talking to the patient about the latest lab results. The patient is taken aback by the abruptness of it all and starts wondering if something is wrong. The Latino patient tries in vain to establish a personal connection with his doctor, some signal that they are still on good terms, but cannot find the reassurance he is looking for. Attempts at banter by the patient are quickly steered by the doctor towards the ongoing medical issues affecting the patient. The provider wonders what all the verbal dancing is about and why can't he just get to the data and discuss what it means.
Mitigation: Upon entry into the examination room the clinician makes eye contact with the patient, greets them, and engages the patient in small talk by asking a couple of questions unrelated to medicine (e.g. "Last time you were here you told me your daughter got a new job closer to home. How is that going?" or "Who is accompanying you today?"). This small investment in time actually saves time, because the patient will be more compliant with treatment (he/she will not want to disappoint a provider they like) and will foster more honest disclosures by patient on potentially embarrassing topics, e.g. drug use, number of sexual partners, family mental illness, documented/undocumented status, incontinence, etc.
Scenario C
Situation: The surgeon has laid out all the reasons why she believes that the surgery should be done without delay and asks the patient whether her office can proceed to set a date for the operation. The patient responds with hesitation and utters a tentative "yes" out of deference. Two days later the patient calls saying they have had second thoughts and would like to cancel the surgery.
Mitigation: The surgeon makes her case as to why the surgery should be done very soon. When she notices hesitation in the patient's reply, she explores what the reluctance means instead of moving on to the next topic. She actively encourages the Latino patient to be open and assertive by assuring them that their concerns are valid and that the doctor will not be offended or put off by their questions and requests.
This article is part of a series on Latino Culture and Healthcare.
View the main article here.