With Hispanic Patients: Reflections From a Service Learning Project
By Danielle Granieri
What struck me the most about Oaxaca was the noise; music
filled every street and bus, cars honked incessantly, planes
flew low over the city with announcements blaring over loud
speakers, and gas trucks made their rounds, their horns sounding
just like mooing cows.
I was in Oaxaca with a non-profit international health organization
to be part of a service-learning project. My desire to take
part in such a project stemmed from being a regular volunteer
at a free medical clinic that serves a predominantly Hispanic
population. After a few short months of interacting with the
staff and patients at RotaCare, I developed a strong interest
in the Hispanic culture and a desire to learn Spanish. Although
the clinic has a regular staff of Spanish interpreters, it bothered
me that I was unable to speak directly to the patients I was
working with. Additionally, because of cultural differences,
I felt that I was not identifying with Spanish-speaking patients
as well as I would have liked.
Traveling to Oaxaca, Mexico was the perfect solution. Not only
did I have the opportunity to live in a city rich in culture
and traditions, I was able to see firsthand how the medical
system in Mexico was run. By shadowing and learning from Mexican
doctors, I gained a deeper understanding of how best to communicate
and relate to Mexican and other Hispanic patients. Additionally,
being in a city where the majority of citizens did not speak
English, I was thrown into an environment that facilitated a
rapid and immense improvement in my Spanish language skills
in a mere four weeks.
My time in Oaxaca was divided into four, one week, sections
that enabled me to observe four different aspects of the health
care system - low income health care, hospital care, rural health
care, and private practice. Throughout the course of my stay
I learned much of value. Aside from the medical knowledge, what
was most important to me was how to translate what I was learning
in Mexico into how to better serve the Hispanic community back
home - the essence of service-learning. Throughout the duration
of my stay I actively observed my surroundings and paid special
attention to the manner in which doctors, or other medical professionals,
and patients interacted.
The Hispanic culture places high value on medical providers.
Doctors are well respected and trusted, to a much higher degree
than in the US. In the Hispanic culture, it is commonly believed
that doctors are infallible and that they do not make mistakes.
I witnessed this phenomenon first hand while in Mexico. Patient
after patient would enter the doctor's office without asking
a single question. They simply came in, explained their symptoms,
listened to the doctor's diagnosis and treatment plan, and were
ready to leave. And they would have left, had it not been for
the doctors' insistence on making sure each person understood
what they had been told. Many of the people with whom I interacted
felt that going to the doctor was the solution to their
problems without realizing that they had the ability to play
a role in their own health.
While in Oaxaca, one of my favorite doctors worked in one of
the city's Centro de Salud, literally translated as Center of
Health, which is a primary care clinic for unemployed or self-employed
individuals. This particular provider spent up to an hour with
each patient, regardless of how simple the case might have been.
What struck me most about this provider was that he empowered
his patients to take an active role in their own health care.
By being a doctor, therapist, dietician, and friend, he was
able to instill a sense of comfort in his patients that allowed
them to speak openly about their problems and be receptive to
suggestions that could affect their overall health and wellbeing.
This ability is extremely important because it is common for
Hispanics to place doctors on a pedestal and to be unwilling
or afraid to engage in a dialogue with them.
Providers, however, have the ability to help change this cycle.
One way to achieve this goal is to initiate a conversation with
the patient. If questions are not brought to the table by the
patient, the provider should be proactive and ask if they have
any. He or she should probe a little to ensure that they understand
the diagnosis and treatment. And if a medical provider suspects
that a patient is still unclear, he or she should ask them to
explain what they understood in their own words. To the average
American this may seem insulting or rude, but this type of questioning
does not seem inappropriate in the Hispanic community, for I
witnessed it to be commonly used in Mexico. In fact, the patients
that I spoke with always felt that doctors who used this tactic
were the ones who were the most caring and most highly regarded.
The other trend I noticed while in Mexico was that many people
visited the doctor with several unrelated complaints. Whether
this practice is due to a lack of continuous access to health
care or to the faulty idea that doctors have the ability to
cure everything in one visit, providers should help these patients
narrow down their list of symptoms. Like many of my counterparts,
I used to believe that documenting four to five complaints per
patient was normal; each ailment deserved the full attention
of the doctor. The problem with this tactic, in addition to
being inefficient for the doctor, is that it is detrimental
to the patient. Despite any clinic's best efforts, resources,
including time, are always limited. When dealing with time constraints,
a patient benefits more from discussing one problem in depth
than touching on many complaints superficially.
A simple way for providers to broach this issue with patients
is to ask them which symptom, or group of related symptoms,
led them to make the appointment that day. Regardless of the
number of complaints an individual may have, he or she will
rarely deny that one problem outweighed the others. If, after
the provider has discerned the chief complaint, the patient
continues to discuss other issues, it is well to let them. These
patients simply need to feel that they are being listened to.
From my experience in the Oaxacan clinics, the patients with
the most complaints typically wanted to talk more than they
needed medical attention.
Again, listening and showing genuine concern builds trust and
establishes a positive working relationship with the patient.
After actively listening, providers find that most patients
are more receptive to discerning a chief complaint and focusing
on treating that one issue. They also are less likely to delay
seeking medical advice the next time they have a problem. In
the end, not only does this benefit the patient, it benefits
the providers by saving valuable time during future visits.
Danielle Granieri is an SCU alumna on the staff of the Leavey School of Business at Santa Clara University.