Culturally competent patient encounter tips
Enhance communications with your Hispanic and Latino patients
By Ramon Jimenez, MD
"What the scalpel is to the surgeon, words are to the clinician the conversation between doctor and patient is the heart of the practice of medicine."
This outline was prepared based on my 30 years of patient encounters (over 100,000) while in practice in Northern California, where Latinos make up one-third of the population. I also have done research and presented several papers on culturally competent care. Bayer Institutes "Clinician-Patient Communication Course" was also at the basis of this work.
The Hispanic/Latino population is significant and growing in the United States. It now represents 12 percent or 34 million peopleit is the largest minority and in a few decades, 25 percent of the US population will be Latino. Presently, only 2.4% of orthopaedists are Latino. Consequently, the non-Latino orthopaedist has to be prepared to effectively evaluate and treat the Latino patients he or she will increasingly encounter.
Culturally competent care is defined as a complex integration of knowledge, skills and attitudes that allow health care providers to understand and take care of people who are from cultures that are not their own. In this document you will find several patient encounter tips to help you improve your communication with Latino patients. Compassion and communication are essential ingredients for success.
At a typical patient encounter, you are likely to find one to three family members with the patient in the examining room, especially if the patient is a woman. Dont walk into the room looking at the patients chart, even if you are trying to figure out how to pronounce the name. Practice name pronunciation and review the patient information before you enter the room.
Latino patients hold physicians in great respectthe doctors in their home country practice paternalistic medicine.
Although not entirely necessary, "Buenos días" (Good morning) or "Buenas tardes" (good afternoon) is simple enough and effective.
Greet the patient with "Senor" or "Senora" Rodriguez; "Yo soy, Doctor Watson." (Senorita for single females. However, if you are not sure, it is better to say "Buenos dias, yo soy el doctor .)
Make sure to greet and acknowledge everyone in the room, even the children. They will immediately accept you as warm and compassionate. Do not act rushed during the appointment.
Try to establish who is going to be the interpreter before you enter the room (sometimes this is not possible) or immediately after introductions. If it is one of your staff, introduce him or her to the patient and/or family. In all of your communication with the patient, do not relate with the interpreter, relate to the patientthe interpreter is purely an instrument or communication tool. It is preferable not to use a family member, but sometimes there may be no choice.
Speak to your patient as if he/she understands your message. The interpreter should translate your messages in the first person. Make sure the patient responds to your questions through the interpreter. Do not allow the interpreter to respond to your questions without the patient answering your questions or replying to your comments.
Any efforts you make to speak Spanish is admired and appreciated by your Spanish-speaking patients.
Latinos/Hispanics prefer to be addressed by their country of origin: they are "Cubans," "Salvadorans," "Mexicans," and so forth. It is culturally courteous to address your patients by their country of origin. Therefore a good introductory statement is to ask them their country of origin.
Take some interest in their culture and after a few repeat patients from the same country, you will have a common point of familiarity. Do some light research on that countryyou may be surprised and, maybe, discover a new world. In any case, your patients will admire and appreciate your sincere efforts. Latinos and Hispanics are happy when called "Americanos" since their country of origin is, in fact, in the "Americas."
Pitfalls and practical tips
Awareness is key
Imagine yourself in a foreign country surrounded by people speaking a foreign language that you do not understand. Imagine further that you need medical services. Sounds like a pretty scary thought. For you, your Latino/Hispanic patient, or any patient for that matter, a warm smile and an attitude of compassion and concern will go a long way toward creating a sense of trust.
Try to be aware of the fears and attitudes your Latino patients may have in regard to:
All of these can be alleviated by communication with the patient, utilizing the technique of education.
Use simple drawings or anatomical pictures, or better yet, models to explain your diagnosis and/or proposed treatment. Most of the information you impart will not be retained, so enhance it with "take home" information, such as a Spanish written patient education brochure or fact sheet.
For your Internet savvy patients, provide information on what is available through the AAOS patient education Web siteYour Orthopaedic Connection. The address is http://orthoinfo. aaos.org. There are approximately 20 topics en español and more are being developed. If your patient does not have Internet access, print out a copy from your office computer.
I have tried to give you some background and practical tips to lead you to a more successful and satisfying encounter with your Hispanic/Latino patients. If you would like to learn more about this topic, visit the Communications Skills Mentoring Program section of the Academys Web site at: http://www.aaos.org. Just click on "Medical Education" then "Communications Skills Mentoring Program."
There you will also learn about a unique educational effort being offered by the Academy in partnership with the Bayer Institute for Health Care Communications. The Institutes mission is to enhance the dialogue between clinicians and patients through education, research and advocacy. The Institute and the Academy have co-developed a number of educational workshops that focus on increasing skills in doctor-patient communication.
These interactive, experiential and skill-based workshops are based on scientific evidence regarding the efficacy of educational interventions. They are taught by orthopaedic surgeons, for orthopaedic surgeons. The program is organized under the Council on Education under the direction of chair John R. Tongue, MD. I encourage you to consider attending one of the workshops.
Ramon Jimenez, MD, is chair of the AAOS Patient Education Committee and a faculty member of the Bayer Institute. He practices in San Jose, Calif. He can be reached at firstname.lastname@example.org