Latino Patients: Understanding the Family and Latino Culture
“Why are there so many people in the room?” is a question often asked by our medical Spanish students when talking about treating their Latino patients.
“I go in to talk to a patient and there are 12 people in the room listening to my every word and even leading the conversation.”
Many of these health care workers are overwhelmed or perplexed by the huge attendance at the treatment or diagnosis of a patient – an event that’s generally so private in mainstream U.S. culture that it’s guarded by confidentiality laws, rights, signed agreements and facility policies.
The strong presence of family – even extended family – at the side of a Latino patient is quite normal for a variety of reasons. The most immediately visible role of family members may be as interpreters, since older Latinos often depend on their children’s English skills for communication with doctors and nurses.
However, the aspect that may be less understood is that once the interpreting relative has presented the patient with his or her medical options, the question “What do you think?” may be directed back at the relative. After all, Western medicine is practiced in Latin America just as it is in the U.S., so why would a patient ask a relative – particularly a son or daughter – for his or her opinion on the situation? Sure, immigrants’ U.S.-born children may be more fluent in the language and savvy in the culture, but shouldn’t one make one’s own medical decision?
This is where the concept of Familismo enters the picture. While the predominant cultural values in the U.S. focus mainly on the individual, Latino cultural values are rooted in collectivism. The group (in this case, the family) is more important than the individual, and it’s important to for health care workers to realize that the large Latino families aren’t just there for moral support. They have a great deal of influence, and even responsibility in the decision-making process.
While the idea of surrendering one’s autonomy is unthinkable for many non-Latinos in the U.S., it’s simply a function of the collectivist nature of Latino culture. In fact, many Latinos don’t want to know the full extent of their illness, and leave decisions entirely up to the family. This may present an ethical dilemma for health care workers, particularly for end-of-life treatment. However, as Dr. Nilda Chong points out in her book The Latino Patient: A Cultural Guide for Health Care Providers, “Because family is “sacred” for Latinos, health issues are most effectively dealt with at the family level if possible.”
Dealing with health issues at the “family level” means providing enough time for extended family to gather and make decisions collectively, and including family to the greatest possible extent. They are not spectators, but actors in the treatment of a loved one. As stated by Dr. Glenn Flores, “Failure of the clinician to acknowledge familismo can potentially lead to unnecessary conflicts, dissatisfaction with care, non-adherence, and poor continuity of care.”
So the next time you find yourself in a crowded room, you might consider the importance of the family’s presence to the patient both as a support system and potential decision-makers.