Saturday, October 20, 2007

Normative Values in Health Care for Latinos

After finishing my first three weeks of a pediatrics clerkship at Children's Hospital in Seattle, I will spend the next three weeks at the Odessa Brown outpatient pediatrics clinic in Seattle's Central District. Whether your classification is by economic status, race and ethnicity, or language group, this clinic serves a wide diversity of patients. It will be fun to learn there.

I was reading a little about ways that different cultures interface with health care and thought I would share some of my findings about cultural values and medicine in the Latino population.

As with any cultural group, assuming that Latinos are all alike is problematic. Some studies suggest that differences among Latino subgroups (e.g. Guatemalans, Puerto Ricans, and Mexicans) do exist in terms in sociodemographics, health status, and use of health services and may be greater than differences among other major ethnic groups. Despite the differences, normative cultural values seem to exist within this large umbrella of cultural groups. Normative cultural values are beliefs, ideas, and behaviors that a particular cultural group values and expects in interpersonal interactions. Described below are five Latino normative cultural values and their potential clinical consequences.

1) Simpatía - kindness in Spanish; politeness and pleasantness in the face of stress; avoidance of hostile confrontation. Simpatía includes the assumption that physicians have a positive regard for them. The relatively neutral attitude of many US physicians may be viewed as negative, leading to decreased satisfaction with care, an inaccurate history, nonadherence to therapy, and poor follow-up.

2) Personalismo - formal friendliness; the expectation of developing a warm, personal relationship with a clinician. To promote personalismo, consider decreasing the physical distance during interactions with patients, providing contact information such as a beeper number, and showing an interest in patients' lives at each visit.

3) Respeto - respect; deferential behavior based on a position of authority, age, gender, social position, and economic status. Health care providers are viewed as authority figures deserving of respeto. Patients expect reciprocal respeto from the provider, especially if the provider is younger than the patient.

4) Familismo - collective loyalty to the extended family that outweighs the needs of the individual. Extended families, not individuals, make decisions on important issues such as healthcare. When possible, provide ample time and opportunities for the extended family to gather to discuss important medical decisions.

5) Fatalismo - fatalism, belief that an individual can do little to alter fate. Can lead to less preventive screening and avoidance of effective therapies.

It seems to me like the suggestions to address simpatía, respeto and familismo are good for the majority of patient encounters. Fatalismo seems like a more subtle aspect of a care encounter, and would be harder to address; personalismo is something that I've been working on with colleagues and friends - a pat on the shoulder or elbow and a warm smile seem to draw friends closer. I am a little tentative to try this with strangers, but will consider it.

Flores G. Culture and the patient-physician relationship: achieving cultural competency in health care. Journal of Pediatrics. 2000;136(1):14-23. Link (may need institutional access)

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