Latino Culture and Healthcare: Authority and Power Differences between Providers and Patients
The fact that many Latino patients view healthcare providers as an authority figure affects the relationship you have with your patients. This conversation is intended to help you understand this perspective, lower barriers between you and your patients, and give you some language tools to help you involve your patients in care decisions.
While I was on Medical Spanish Immersion with a group of healthcare workers and students, I had the chance to interview doña Sandra about how doctors are perceived in Central America. Talking about cultural norms is tricky because we tend to generalize when we discuss trends. Please keep in mind that adhering to patient centered care practices and approaching differences in perspectives with cultural humility are the best way to achieve an authentic understanding of your patients.This post is really more about linguistic ways you can put your patient at ease than it is about cultural values.
Here is our conversation with subtitles in Spanish (no English in this one). This is a great medical Spanish listening comprehension activity!
Three of the challenges that many of my healthcare clients talk about are:
- A sense that their Spanish speaking patients aren’t being very forthcoming when they are nodding heads and saying “yes”. The sense is that they maybe don’t understand completely, but it’s difficult to get them to ask questions, express their doubts, etc.
- Successfully involving patients in the care process, getting their ideas about what might be causing the issues that they’re experiencing
- Getting patient preferences on treatment choices and helping to make medical decisions with you
Some of Sandra’s insights into Latino culture are:
- Sandra tells us that doctors are unquestionable authority figures for most Latinos. She says “I perceive him or her on a pedestal”.
- Some tactics that providers can use to reduce that inherent power distance and build trust are:
- Give a friendly greeting
- Call the patient by his/her first name
- Look at your patient in the eyes
- Be conscious of your facial expressions and make sure you have your “kind face” on
- Have a conversation with your patient about the reason for their visit vs a quick and and mechanical (direct and to the point) interview
- There are probably 2 reasons for this power distance percpetion: 1. the provider is from another culture (dominant culture), and 2. the provider is the professional with very specific knowledge about health – and the patient isn’t. She says: “as a patient I might know my symptoms, but the provider is the one who knows what my problem is”. There is a real perceived power distance.
- Regarding titles, using “don” or “doña” with your patient’s first names (as long as they are adults) might build a little more trust than using “señor” and “señora” with the patient’s last name.
Sandra suggests that one of your goals could be that the patient sees you as the person that is here to help, not necessarily the person with all the answers and the special knowledge. A few phrases that Sandra suggests you consider implementing during your conversations with patients are:
- Estoy aquí para ayudarle (I’m here to help you)
- Necesito que me diga… y que converse conmigo y me de mucha información sobre…(I need you to tell me… and for you to converse with me and give me lots of information about…)
Sandra suggests you consider asking some easy side topics as you get to know your patient. Having some conversation unrelated to the reason for today’s visit should help lower the natural tension between you and your Spanish speaking patients. These are questions that help your patient feel like they are important to you. Those topics might start with… don/doña _____ dígame algo de usted…
- Work: Me interesa que hace usted… ¿Dónde trabaja? ¿Hace mucho tiempo que trabaja allí? ¿En qué trabaja?
- Family: ¿Tiene familia (hijos, nietos)? ¿Cuántos años tienen? ¿Dónde viven?
The next topic I asked doña Sandra about was involving patients in the healthcare process. Successfully getting the patient to express what they think might be causing the problems or even discussing what treatments they’ve tried in the past. She suggests some specific questions and phrasing to be successful getting the patient’s perspective on their problem:
- Para mí es muy importante saber qué piensa usted (it’s very important for me to know what you think)
- Me gustaría saber qué piensa usted (I’d like to know what you think)
- Me gustaría saber, ¿Qué piensa usted? ¿Usted cree, don ____, que pueda ser _(insert whatever you might like to suggest)_ que le está causando el problema?
- ¿Cuáles serían las causas…?
By using the conditional form of the verbs above (vs the present tense), Sandra suggests that we put the patient at ease and give them space to share their feelings on a topic. If we just use the present tense (¿Qué piensa usted que pueda ser el problema?) it sounds very direct and maybe could make the patient feel like they need to have the correct answer (vs just share their opinions). The conditional tense of verbs sounds more hypothetical and takes pressure off the patient to give a correct response.
The last topic we discussed was how to get the patient involved in choosing a treatment when there are options. Sandra suggests the following:
- Explain that there are various options for treatments
- Explain the pros and cons, the ins and outs of each option
- Finish with the question: ¿Cuál piensa usted que podría funcionarle mejor?
Sandra finishes reiterating that using hypothetical language really puts your patients at ease because it gives them space to doubt, to not know the right answer, etc. So, work on your conditional verb conjugations in Spanish so that you can use this hypothetical tone!