In the 1990s, before I started my second year of medical school at University of California, San Diego (just 30 minutes north of the Mexican border) I made a decision that would change my life. The second-year curriculum allowed for a number of elective courses. We were supposed to select from a catalogue of options—radiology, advanced anatomy, medical ethics, and many others. Most students chose two per semester. I chose one that spanned the entire year: Medical Spanish.
How clinicians can address social determinants of health
We have known for decades that income, education, race, gender, and other social factors have a bigger impact than medical care on people’s health and life expectancy. Social determinants of health (SODH) are well documented by respected organizations such as the Centers for Disease Control (CDC) and World Health Organization (WHO).
This content was originally presented as part of our live learning event, "Expanding the Role of Interpreters in a Value-Based System," by Dr. Alexander Green. View the recorded event here.
As a primary care physician, I take care of a large Spanish-speaking population, among other culturally and socioeconomically diverse patients. I’m fluent in medical Spanish and communicate directly with my Spanish-speaking patients. But regardless of whether I’m speaking Spanish or working with a medical interpreter, visits with limited English proficiency (LEP) patients always leave me with a worried feeling in the pit of my stomach. I’m keenly aware that most healthcare takes place outside of the doctor’s office, and this is where LEP patients fall through the cracks. I wonder, “Did Mrs. Ramirez really understand how to prep for her colonoscopy next week?” or “Was Mr. Luan actually convinced that he needs to take the medication I prescribed for his diabetes?”
The most common objection
I've given hundreds of presentations on culturally-competent care to busy clinicians around the world. At the end of my talk, someone always asks the "time question." I know plenty of other clinicians are thinking it, but don’t want to appear insensitive. So I wait for a brave soul to say, “Dr. Green, you’re telling me that if I want to be culturally competent, I have to do all of these things on top of what I already have to cover? I have to ask my patients how they understand their condition? What their religious practices are? Whether they trust me? I’d love to—but I just don’t have time!”
Do your patients really trust you?
Trust in the healthcare system is at an all-time low—only 34% of Americans have “great confidence” in medical leaders, as compared to 73% in 1966. So if you are a health professional, you're wise to assume patient mistrust, rather than the other way around. Depending on your role and the setting, mistrust can present itself in very different ways. But I've learned that you can respond effectively to patient mistrust in any scenario using three simple communication techniques.
Maria Pérez is a 46 year-old woman, originally from the Dominican Republic, who reports to her primary care provider (PCP) because she has been feeling fatigued and dizzy for several months. Exploring this further, Mrs. Pérez acknowledges that she has also had trouble sleeping and has been feeling less "herself" lately. She has lost some weight.
Gary Jenkins is a 71-year-old African American man who has always been able to manage his own affairs, despite being blind since birth. However, when he developed prostate cancer, he realized that he was at a major disadvantage.