In the last post, I presented general information on the cultural value of respeto. This week, I will present a closer look at how respeto can impact advice given during pediatric appointments and medical interview with adults in regards to both general communication and compliance. Next week I will wrap up with a few possible recommendations for communicating with Latino patients in light of this information and how these skills can be taught and practiced in the Spanish for healthcare professionals classroom.
Probably the most easily seen effect of respeto on healthcare would be the cultural differences between how children are raised in Latino families versus “westernized American” families. These differences in beliefs on child rearing practices can affect the way parents respond to the pediatrician´s or mental health specialist´s recommendations. Oftentimes, instructions are given in order to better support the child or to correct a behavior and are, unwittingly, culturally based or allude to cultural values for their motivation. Cultural values can be a strong motivator and supporter of behavioral change when they resonate with what the person believes. When they are not congruent with the receiver´s beliefs however, change may be inhibited. For example, spanking is more common in situations of “disrespect” within Latino culture than within westernized cultures. Using less force is often considered “too soft”. Suggesting otherwise may leave the mother feeling disempowered or it may also, as some mothers suggested in the study by Calzada, Fernández and Cortés (2010), disrupt the hierarchy and allow the children to feel that they do not have to respect their elders. The idea of respeto can also be used positively during treatments for both mental health issues as well as physical issues to motivate change or support treatment compliance. Rather than going into more detail here on respeto within the pediatric field, I recommend the article “Incorporating the Value of Respeto into a Framework of Latino Parenting” by Calzada, Fernández and Cortés (2010). As my previous work was neither in the mental health field nor the pediatric field, I myself am continually learning about how culture interplays with care in those settings.
Now for a quick look at how the cultural value of respeto can affect communication and compliance in general. Most Latinos who hold to the value of respeto will place the doctor in a high position in the hierarchy and view him or her as an authority figure. They will treat the medical staff formally and with respect. They are typically never argumentative and may even avoid eye contact. Though avoidance of eye contact among women can also be a sign of domestic violence, be careful in jumping to that conclusion since it is also a sign of respect in the Latino culture.
However, the real problem enters because of the previously mentioned category of obedience. Patients are often “hesitant to ask questions or raise concerns about a doctor´s recommendations, being fearful that doing so might be perceived as disrespectful. They may nod to demonstrate careful listening and respect when a doctor is talking, rather than agreement about treatment [or understanding]” (Carteret 2011). On one hand, this can result in the medical professional falsely believing that the patient understands and agrees with the diagnosis and treatment. On the other, it can result in the patient not asking questions related to his or her doubts or even leaving knowing that he or she will be non-compliant due to disagreement on either the diagnosis or treatment.
This was a recurrent theme in one of the clinics where I previously worked. Being the Latino Wellness Case Manager, I was able to get to know the Latino patients well, build report with them and earn their trust. Sometimes after their appointment with the doctor, they would come to my office to tell me that 1) they did not understand what the doctor told them regarding the , 2) they did not understand the treatment processes, 3) they had questions or concerns regarding their diagnosis or treatment, or 4) they were frustrated because they did not agree with the diagnosis or treatment. I would encourage them that it was OK and important to discuss these aspects with their doctor. Once they were convinced, I would explain the situation to their doctor who truly had no idea that the patient was anything but happy with the outcome and prepared to be compliant.
Truthfully, these situations are just as frustrating for the doctor as for the patient, especially when the patient returns a week later having not followed treatment guidelines or having followed them incorrectly. It is also confusing for the doctor when frustrated patients switch clinics without ever notifying him or her as to why. For these reasons, it is important for us as educators to equip the medical staff to be able to interact with their Latino patients in a way that is respectful but also encourages them to voice their question and concerns. Next week, I will offer a few possible recommendations for communicating with Latino patients in light of this information and also how these skills can be taught and practiced in the Spanish for healthcare professionals classroom.
Calzada, Esther J.; Fernández, Yenny and Cortés, Dharma E. (2010): “Incorporating the Cultural Value of Respeto Into a Framework of Latino Parenting”. Cultural Diversity and Ethnic Minority Psychology. 16(1): 77-86.
Calzada, Esther J.; Huang, Keng-Yen; Anicama, Catherine; Fernandez, Yenny and Miller Brotman, Laurie (2012): “Test of a Cultural Framework of Parenting with Latino Families of Young Children.” Cultural Diversity and Ethnic Minority Psychology (en línea). Recuperado de <http://www.academia.edu/1788855/Test_of_a_Cultural_Framework_of_Parenting_with_Latino_Families_of_Young_Children>.
Carteret, Marcia (2011): “Cultural Values of Latino Patients and Families”. Dimensions of Cultural: Cross-Cultural Communications for Healthcare Professionals. Recuperado de <http://www.dimensionsofculture.com/2011/03/cultural-values-of-latino-patients-and-families/>.
Perez, Magdalena (2009): “Latino Adaptation Guidelines: Cultural Values”. Chadwick Center for Children and Families. Recuperado de <http://www.chadwickcenter.org/Documents/WALS/Adaptation%20Guidelines%20-%20Cultural%20Values%20Priority%20Area.pdf>.
Peterson-Iyer, Karen (2008): “ Culturally Competent Care for Latino Patients: Introduction”. Ethics Articles, Santa Clara University. Recuperado de <http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/hispanic.html>.