“Any questions?” I asked one of my patients, Dona Maria, for the third time.
After her prolonged silence, I asked again, almost in despair, “anything else? Anything that you don’t like about what I have said? Or anything you don’t like about the medications I am recommending?” Dona Maria sees my disappointment and tries to smile at me. Then she shares some stories about her great-grandson, who just turned three.
It is essential to know what my patients think about the medications I am prescribing since their agreement is linked with better outcomes and medication adherence. Despite this, sometimes I feel like all my questions are a form of torture rather than helping my patients. My continuous attempts to know Dona Maria’s opinion about my recommendations, for instance, just resulted in her telling me stories instead about her cooking, family reunions, or her youngest great-grandson.
As a doctor, such experiences are frustrating. But as a patient, I recognize that I also tend to not engage my doctor about the medical information they give me. Instead, I talk about the weather or the traffic. I let them know that I never forget to take the supplement they have recommended, even though I had my doubts about needing it. Still, as soon as I leave the doctor’s office, I regret not asking all the questions I have or disagreeing with how often I need to return for follow-ups or expressing that I do not like the treatment plan they presented to me. “Why didn’t I say anything?” I think to myself over and over.
Research shows that Latino patients tend to agree more with their doctors and question less about the medications or treatment plans offered to them than their non-Latino counterparts do. Over the years, the lack of involvement of Latinos in their health care decisions has been seen by the medical community as “an expected cultural behavior.” Unfortunately, some scholars have even proposed that autonomy – the right of a competent adult to make informed decisions about their own medical care – is not always beneficial to Latino patients. Even more, it has been suggested that a paternalistic approach – when the doctor makes decisions for the patient – may produce better outcomes for Latinos seeking help. These ideas are counterintuitive to the perspective of advocating and empowering our patients to help them build a treatment plan around their decisions.
Is our Latino culture and heritage interfering with medical care?
On the other hand, the Latino culture has some characteristics that might play a role in the patient-doctor relationship. Latino Cultural Values are the core principles and ideals of the Latino community; families practice and teach their children how to behave in society based on these beliefs.
The Latino cultural value of familism speaks of prioritizing one’s family instead of the individual. Other values such as respect, kindness, and modesty reflect on the relationship with peers, authority, and the elders. In the Latino culture, it is expected to be obedient and deferent to authority. In the doctor’s office setting, many Latinos might feel obliged to agree with their doctor’s recommendations since they are also considered an authority. It is essential to point out that these values are not exclusive to Latinos, nor do they apply to all Latinos; however, they are especially common among Latinos.
Therefore, it is crucial that doctors are aware of these dynamics and give their Latino patients the opportunity and trust to express their opinions, no matter what they are. Focusing on their patient’s life, goals, dreams, fears, and learning more about their culture, can help build a safe environment. Latino patients also need to advocate for their rights as patients and their role in health care for their families and communities.
Andrea Mendiola-Iparraguirre is a psychiatrist.
Image credit: Shutterstock.com