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Aidé GomezMedical Spanish and Cultural Competency
UCSD School of MedicineSkaggs School of Pharmacy and Pharmaceutical Sciences
Not all Hispanics/Latinos share the same values
Subculture within a culture
Treat each patient on an individual basis
2Preparing Students to Work with Spanish-Speaking Patients
Role of Religion- Majority of Latinos are Catholic
- Abortion not permitted
- Birth control not permitted but…..
- Discretion with “Day After” pill
4Preparing Students to Work with Spanish-Speaking Patients
Role of Family- Family comes first…”I” am second
- Distorted familism – Women postpone their own healthcare.
- “Your family needs you” “You are important to your family”….for non-compliant patients.
- Adult children participate in the parents’ healthcare
5Preparing Students to Work with Spanish-Speaking Patients
Level of acculturation The degree to which the dominant culture is adopted
Level of assimilation The degree to which individuals integrate into the U.S.
society
Socioeconomic levels Economic status is closely linked to health status and
healthcare access
Level of education
Generation/Age
Rural/Urban upbringingPreparing Students to Work with Spanish-Speaking Patients 6
What is Cultural Competency and Why is it Important? Develop cultural awareness and appreciate and accept these
differences
Develop cultural knowledge by exploring various approaches and explanatory models of disease.
Develop skills by learning how to culturally assess a patient (Kleinman Model)
Understand how cultural beliefs influence medical care and treatment
Personal and professional skills that allow us to increase communication
Improve patient compliance and outcomePreparing Students to Work with Spanish-Speaking Patients 7
Common PracticesHome remedies OTC medications Herbal teas Homeopathic meds Curanderos Borrow medication
9Preparing Students to Work with Spanish-Speaking Patients
Common PracticesWill consult pharmacist before consulting a
physician
Opportunity for:Referral to community resourcesPatient educationPreventive medicine
10Preparing Students to Work with Spanish-Speaking Patients
Community ResourcesPatients may confide in pharmacists about breast
lumps, testicular lumps, STD’s
Patients might be treating with OTC meds only because they think the “problem” will go away or because they don’t have funds to see a physician or to get a mammogram, Pap smear, etc.
Patients unaware of free or low-cost screening
Contact SYHC or other community clinics for free screenings/medical care
11Preparing Students to Work with Spanish-Speaking Patients
Common PracticesPatients will buy medications in Tijuana but may be
reluctant to disclose this information to a pharmacist for fear of reprimand.
Toma otras medicinas?Do you take other medicine?
Toma medicinas que compró en Tijuana?Do you take medication bought in Tijuana?
Es importante saber para ver si no hay interacción con la nueva medicina.
It’s important to know this to see if there isn’t any interaction with the new medicine.
12Preparing Students to Work with Spanish-Speaking Patients
Cortisona - CortisonePatients may discontinue cortisone because of
what friends say about the dangers of cortisone
Possible solutions:
Explain to patients that blood tests will be taken to monitor the prednisone’s effect.
Su doctor ordenará análisis de sangre para monitorear el efecto de la prednisona.
Inform patient about the consequences of not taking cortisone.
14Preparing Students to Work with Spanish-Speaking Patients
Antibióticos - AntibioticsPatients may take antibiotics for colds.
Explain to patient that:
Antibiotics are for bacterial infections and not viral infections.
Los antibióticos son para las infecciones virales…no bacterianas
Patients could develop resistance to antibiotics if stopped early.
Podría desarrolar resistencia al antibiótico si lo deja de tomar antes de tiempo.
15Preparing Students to Work with Spanish-Speaking Patients
Some patients may stop taking their medications when a new medication is introduced. They believe the “old” meds should be stopped when a new one is prescribed because it might be “too much” medication or the new medication might interact with the usual meds.
Solution: Explain to patients that the new medication will not interfere with the usual meds and that stopping the usual medications will …
16Preparing Students to Work with Spanish-Speaking Patients
Communication Between Pharmacist and Spanish-speaking patient
Little emphasis has been placed on the interactions between pharmacists and Spanish-speaking patients. (Res Social Adm Pharm. 2009 Jun;5(2):108-20. Epub 2009 Jan 31.)
Pharmacists' communication with Spanish-speaking patients: a review of the literature to establish an agenda for future research. J Am Pharm Assoc (2003). 2005 Jan-Feb;45(1):48-54. Links
Adherence less in non-English-Speaking patients. Pharmacy-related health disparities experienced by non-English-speaking patients: impact of pharmaceutical care.
Westberg SM, Sorensen TD.
18Preparing Students to Work with Spanish-Speaking Patients
The use of interpretersBilingual does
not equal interpreter
State-certified interpreters are trained in:
- Simultaneous interpreting mode
- Consecutive
- Sight translation
- Medical terminology (Eng/Sp)
- Code of Ethics
- Tested on English/Spanish grammar
19Preparing Students to Work with Spanish-Speaking Patients
Errors made by hospital interpreters vs ad hoc interpretersStudy by Flores, Laws, et al (Pediatrics. 2003 Jan; 111 (1):6-14)
Professional hospital interpreters – training or certification not mentioned.
Ad hoc interpreters - social workers, nurses, 11 yr-old sibling
Thirteen encounters, 6 by professional hospital interpreters
Three-hundred ninety-six errors committed. Mean of 31 errors per encounter
Errors committed by ad hoc interpreters significantly greater (77% vs 53%).
20Preparing Students to Work with Spanish-Speaking Patients
Errors made by hospital interpreters vs ad hoc interpreters
Common errors:
Omissions (52%)
Questions about drug allergies
Instructions on dose, frequency, duration
A child was already swabbed for stool culture
False fluency (16%)
21Preparing Students to Work with Spanish-Speaking Patients
Errors made by hospital interpreters vs ad hoc interpretersSubstitution (13%)
Adding that hydrocortisone cream should be applied to the entire body instead of only facial rash.
Instructing a patient to put amoxicillin in both ears for otitis media
22Preparing Students to Work with Spanish-Speaking Patients
Errors made by hospital interpreters vs ad hoc interpretersEditorialization (10%)
Instructing a mother not to answer personal questions
Addition (8%)
Instructing a mother to place amoxicillin in both ears for treatment of otitis media
23Preparing Students to Work with Spanish-Speaking Patients
The illiterate patientUse simple explanations
Medical terminology must be accompanied by its definition
Ask patient to repeat instructions
Sun and moon stickers/International codes
Write what medication is for on label
24Preparing Students to Work with Spanish-Speaking Patients
What Should I Remind My Patients?RecommendationsHave patients repeat instructions
Do not share medications
Refill medication 3-5 days before it runs out
Inform patients that they are to refill their medication. Some patients think they are only to take what’s in the vial and that’s it….or can stop it if they feel better.
It’s ok to eat pork or seafood with their medication.
Do not stop taking usual meds while taking a new one.
25
Preparing Students to Work with Spanish-Speaking Patients
What Do Patients Want?Someone who speaks Spanish
Respeto - Respect
Confianza - Trust
Write what the medication is for on the label. Is it an anti-inflammatory? Muscle relaxant?
26Preparing Students to Work with Spanish-Speaking Patients
Community ResourcesPatients may confide in pharmacists about
breast lumps, testicular lumps, STD’s
Patients might be treating with OTC meds only because of they think the “problem” will go away or because they don’t have $ to see a physician or to get a mammogram, Pap smear, etc.
Contact SYHC or other community clinics for free screenings/medical care
27Preparing Students to Work with Spanish-Speaking Patients