October 2009




Managing cultural and language misunderstandings


Weak health literacy skills may not be the only reason your patients aren’t following their recommended eye care regimen; culture and language may also provoke miscommunication problems.

For example, a patient refuses what you think is necessary eye surgery. If you explore further, you may find the patient is refusing surgery because he or she would like the family involved in making that decision, said Sade Kosoko-Lasaki, M.D., who leads seminars on cultural competency for medical students at her university.

Additionally, patients whose first language is not English may face health challenges even if you use interpreters; for example, sometimes the terms used by native Spanish speakers from a particular country are not understood by native speakers from other countries, said Juan C. Celedón, M.D., Dr.P.H. Educational handouts or translations may lose some meaning if patients don’t inquire further. Here are some suggestions to strengthen your communication with patients from other cultures and language backgrounds.

Learn the lingo

Learn a few words of the native language spoken by your patients, recommended Carlos Buznego, M.D., Miami. Dr. Buznego, a native Spanish speaker, has a friend who trained at Bascom Palmer Eye Institute in Miami and knows only a few words in Spanish. However, his ability to speak these few words has led him to become the “Latin American eye doctor” at his Mid- western location near a poultry plant. “Having that capability encourages word of mouth to spread,” Dr. Buznego said. It’s a way to grow your practice and reach out to those patients who would prefer to speak in their native language for health care purposes.

If you don’t have the chance to learn the native language and English is the only option during the exam, keep in check how you’re speaking to these patients, Dr. Kosoko-Lasaki said. “We tend to raise our voices and talk down to people who don’t speak English. They’re not deaf,” she said.

Note language preferences

Between 70% to 80% of the patients seen by Dr. Buznego are Hispanic. Some patients may have non-Spanish names but speak Spanish; others may have Spanish surnames but don’t speak a word of Spanish. So Dr. Buznego makes a discreet note in the patient file of the patient’s language preference so he can follow that during future visits.

Check translations

Although translating educational handouts into languages spoken by your patients is a good idea, watch out for problematic translations, Dr. Celedón said. One person’s word for an important health care term may mean something completely different to those from another country. If you have access to speakers who know different dialects of the same language, you can make sure that translations you use are universally clear.

Check cultural morés

Occasionally, you may not be connecting with patients because of culture issues—not because they flat out do not want to comply with your recommendations. For example, Dr. Kosoko-Lasaki said that the exam rooms where she works are small, with only space for the physician and patient. Sometimes an accompanying family member needs to sit outside; this isn’t the best arrangement for female patients from Sudan, where the man speaks for the family. In those situations, Dr. Kosoko-Lasaki makes sure the male partner is present during the eye exam.

While it’s hard to make generalizations, Dr. Buznego said that some characteristics are typical of a number of Latin American patients. “Latin Americans are more likely to hold doctors on a pedestal, and many want the doctor to give a direction of therapy,” he said. This contrasts with patients who look up information on the Internet and request certain forms of treatment. Family involvement in decision making is also important for many Latin American patients, Dr. Buznego said. Some patients from certain cultures may even need a family meeting or a visit from their religious leader to help them make a decision regarding surgery, Dr. Kosoko-Lasaki added.

Some compliance relates to a cultural fear of medication-related side effects, Dr. Celedón said. When this is the case, it’s helpful to point out that you or someone in your family has used the medicine before.

Ophthalmologists also should be aware of alternative healing methods that may be used or even preferred by patients from some cultures, Dr. Kosoko-Lasaki added. Harry A. Quigley, M.D., would like to see further scientific research into how to boost medication compliance for patients from specific cultural groups. “Cultural competency has to be improved in such a way that we’re helping people understand what to do with their medicine. Education needs to be tailored to the attitudes of the people we’re trying to change. Maybe we need to change the doctors’ approach and the patients’ attitude,” he said.

Managing cultural and language misunderstandings Managing cultural and language misunderstandings
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