Communication runs deeper than the words that are exchanged between two people. Words are important for sure, but often times when we're working with patients of a different culture than our own, words alone are not sufficient to motivate a patient to make a lifestyle change, or to accept a suggested treatment plan. We must take cultural norms and values into account when working with patients who do not share the same set of assumptions and values.
What cultural factors influence your success with a Latino patient, and how likely is it that your Latino patient does not share the same set of norms and values as you? These are complicated questions to answer for several reasons. First and foremost we assume that it is possible to describe and understand unique individuals through generalizations. For example, the term "Latino" includes anyone who traces their origin to Latin America; lumping together the Mexican immigrant who has been in the country for 1 month and the Mexican American family who has been established here in Colorado for 3 generations (not to mention all of the other nationalities of Spanish-speaking immigrants that we see as patients). Other confounds that complicate our discussion are various levels of acculturation to North American norms and values, religious beliefs, gender roles, levels of education, etc. With this in mind, the general differences discussed below are just that. They are not rigid prescriptions that apply to every Latino patient, rather they are general descriptions that help you understand and help your Latino patients better.
Most authorities on the subject of Latino culture and medicine agree that there are anywhere from 5-10 significant cultural differences that affect the relationship between non-Latino providers and Latino patients. For a concise yet practical description of some of these important cultural factors consider reading "The Latino Patient: A Cultural Guide for Health Care Providers" by Nilda Chong, MD, 2002.
You may have noticed some differences in your Latino patients with respect to their family's involvement in the healthcare choices of an individual. This Latino cultural value termed Familismo often stands in contrast with the typical North American value of Individualism. As Dr. Glenn Flores from the Division of General Pediatrics at the Boston Medical Center observes:
"Familismo can be described as a collective loyalty to the extended family that outranks the needs of the individual. Important decisions are made by the extended family, not the individual alone. The three basic dimensions of familismo are: (1) familial obligations (providing material and emotional support to family members), (2) support from the family (the perception that family members are reliable providers of help and support in solving problems), and (3) family as referents (decisions and behavior should be based on pleasing and consulting with family members). "
In his article "Culture and the patient-physician relationship: Achieving cultural competency in health care" (The Journal of Pediatrics. January 2000), Dr. Flores goes on to describe that if healthcare professionals fail to recognize familismo they run unnecessary risks. Latino patients who have this sense of family ties but who are treated medically based on values of individualism are likely to be dissatisfied with care, not adhere to treatment plans, experience avoidable conflict with their providers and their families, and receive poor continuity of care. Your Spanish language skills could be impeccable, but if you fail to understand the powerful influences of cultural norms and values, you will still face many challenges on the road to effectively treating your Spanish speaking patients.