Last week I wrote about how teaching grammar and medical vocabulary in a Spanish course for healthcare professionals is not enough. Belief systems, culture, immigration and even dialect variations play a key role with respect to providing quality attention to Latino patients. Throughout the next few weeks, I would like to present an overview of some of these aspects. This week, I will speak a little on our ideas or beliefs regarding how a healthcare system functions and how this can impact patient care.
Although some belief system differences are more widely recognized (e.g., machismo, marianismo), others, like the one I would like to discuss today, are more subtle. Many people do not realize that we all have certain beliefs regarding how the health system should function. When we go to the doctor, we have an idea of what will happen, what will be said, and how the doctor will respond. However, when we are in a health system that is not our own, we are suddenly confronted with the uncertainty of how to interact within that system and how to make our underlying beliefs, which we may not have realized we had, understood. The Cuaderno Intercultural´s section on Salud Inmigrantes explains:
Los nativos del país solemos conocer cuáles son los pasos a seguir cuando estamos enfermos o tenemos una urgencia. También sabemos qué preguntas nos hará el médico o cómo va a desarrollarse la consulta. Sin embargo, si somos extranjeros puede que no conozcamos la lengua vehicular del país de acogida, que el funcionamiento del servicios sanitario sea diferente o que nuestra concepción cultural de la relación con el médico sea absolutamente distinta. Por tanto, a la angustia inicial puede añadírsele el miedo y el pánico a que no te entiendan, a no saber cómo explicar los síntomas y a no comprender qué está pasando a nuestro alrededor.
Learning how to access and maneuver within the system is difficult and can cause anxiety and frustration. However, this struggle is not always recognized nor attended to. When I worked in the U.S. healthcare system, I found that some doctors would get frustrated with the Latino patients for not following the “norms” (e.g., going to urgent care instead of clinic, coming to night clinic for well-visits, no-showing follow-up appointments, etc). Other times, Latino patients would begin to leave after seeing the nurse because they thought the nurse was the doctor and that they had already been seen. There were also incidents where patients would get frustrated because they felt they did not understand how to access the system and that no one wanted or cared to help them.
I had a similar experience once as a foreigner overseas when I became very ill and had to go to the local clinic. I could not find information online about the schedule, so I did not realize that the clinic was only open in the morning and that the afternoon was reserved for urgent care. The doctor chided me for going during the urgent care hours and reluctantly did the exam. A few days later, I had gotten worse. I returned to the clinic, in the morning this time, and they said they were full and told me to come back in the afternoon. I agreed hesitantly with the memory of the doctor´s frustration fresh in my mind from the first visit. When the same doctor saw me, she rolled her eyes and began to lecture me again on the clinic times, ignoring my explanation that I had been told to come in the afternoon. I left the visit frustrated and belittled.
Similarly, in order to offer culturally competent care to the Latino population, it is important that medical professionals understand this struggle. Spanish for healthcare professionals courses should help them understand that some patients will need extra education on how the system works. Additionally, doctors, nurses and front desk receptionists will need to know that they may have to repeat this information somewhat frequently. This is not because Latino patients are slow to learn, but instead because they have a lot to take in if they are new to the system. Newly arriving immigrants are bombarded with information on how to complete daily tasks, how to find work, how to interact within a new language and culture, etc.
In summary, I have discussed a belief regarding the healthcare system that I think should be addressed in Spanish for healthcare professionals courses. Although it is not a belief that the patients hold, but instead a belief of the professionals, it impacts a patient´s interaction with the healthcare system as well as their trust and satisfaction with the medical provider. For that reason, how to explain the system´s structure and usage to patients, as well as the need to do so, should be addressed in Spanish for medical professionals courses in order to enable students to adequately meet this need of the immigrant population. In the coming weeks, I will continue to address the topic of culture and beliefs systems, but specifically that of the Latino population.