In last week´s post, I discussed the cultural value respeto and the role it plays in pediatrics, mental health, doctor-patient communication and patient compliance. This week I would like to focus first on how to interact adequately with a Latino patient who values respeto in light of this information. I will then offer a few ideas on how to introduce the topic in class and practice the doctor-patient interaction.
As stated last week, respeto refers to the importance of showing the respect, courtesy or decorum that corresponds to an individual´s place in a hierarchical relationship. It can be broken down into four categories: 1) obedience, 2) deference, 3) decorum, and 4) public behavior. Last week I also highlighted some ways that the patient´s view of respeto can affect the doctor-patient communication. But, what does it look like when a patient is showing respeto? Some signs may include the use of formal language, avoiding eye contact, agreeing with what the doctor is saying either by nodding or vocally stating “yes”, a lack of questions and a lack of presenting concerns. However, the patient does not only exhibit respeto, but he or she also expects to be treated in a similar manner. When a doctor comes in the room, greeting the patient by his or her first name, she addresses the patient using the informal forms, which undermines the status differences that the patient is accustomed to in his or her tradition. As a result, instead of making the patient feel more welcomed, he or she can end up feeling uncomfortable or believe that the doctor is being rude.
To make things short and simple, I will offer some bullet points for suggestions on how medical professionals can interact with Latino patients in such a way that they encourage open, honest communication without undermining their cultural value. (Note: I am intentionally using bullet points rather than numbers in order to stress that there is not one more important than another.)
- Address patients with titles of respect such as Señor or Señora.
- Use the formal form (Usted) when speaking with the patient.
- Use phrases of decorum (good morning, good afternoon).
- If there is more than one family member in the group, greet each one individually before starting the medical interview.
- Do not ask “¿Cómo está usted?” when wanting to know if they are ill or the reason for the visit. It may be considered a question of decorum rather than a medical question. It would be better to use something like: “¿Cómo puedo servirle?”
- Before offering a diagnosis, ask the patient what they believe is causing their symptoms. Also, before offering a treatment, ask the patient what they believe are adequate treatments for the ailment. This encourages discussion regarding their beliefs and allows the doctor to present reasons for the diagnosis and treatment. It also gives an opportunity to possibly incorporate the patient´s remedy in the treatment plan when it will not negatively affect the patient or cause a harmful interaction with any prescribed medication.
- Do not assume that a nod means understanding or agreement but seek confirmation through having the patient give back concrete information. For example, encourage the patient to tell you how to take the medicine to ensure they understand.
- Instead of simply asking if the patient has questions or concerns, first let him or her know that it is OK and appropriate to voice them. Express that having a question does not show a lack of respect and that it is even OK and important to voice disagreement if he or she does not agree.
- Finally, remember this value of respeto when treating children or families. Think about ways to better motivate change or more appropriately offer recommendations based on what you know about raising children in a culture or respeto.
Given these points, how can we present respeto in the Spanish for healthcare professionals classroom? As explained when I wrote about teaching marianismo and machismo, one possibility is to start with a discussion of what the professionals believe about respect both in raising children and in the medical setting. Discuss how they show respect to their patients. Then, present information on respeto: what it is, how it can be seen in their interactions with their patients, and how to communicate with the patient adequately based on this information. Finally, it is important to practice this interaction in class so that it moves from theory (which students often do not remember, or at least do not remember well, when the moment arises) into a skill. There are many possibilities for how to allow the medical professionals to interact with this concept in the classroom. My personal favorite is the use of the task-based approach and role play. That is to say, I like to start by presenting simple tasks that reflect a real-life situation. These tasks then build until the students perform a full role play of what could occur in clinic when working with a patient who holds to the cultural value of respeto. Tasks that lead up to the final role play deal with issues that can come up, and allow the students to focus on each component separately (using the formal, encouraging the patient to ask questions, getting the patient to repeat directions, etc.). However, when there is not enough classroom time to allow for multiple tasks (as is often the case), it is important to have at least one general activity where the students can communicate and practice what they have learned before moving on to a new topic.
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Calzada, Esther J.; Fernández, Yenny y 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.
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