Aidé GomezMedical Spanish and Cultural Competency

UCSD School of MedicineSkaggs School of Pharmacy and Pharmaceutical Sciences

a3gomez@ucsd.edu

Not all Hispanics/Latinos share the same values

Subculture within a culture

Treat each patient on an individual basis

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Role of Religion- Majority of Latinos are Catholic

- Abortion not permitted

- Birth control not permitted but…..

- Discretion with “Day After” pill

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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

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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

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Common PracticesWill consult pharmacist before consulting a

physician

Opportunity for:Referral to community resourcesPatient educationPreventive medicine

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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

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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.

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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.

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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.

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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 …

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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.

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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

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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%).

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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%)

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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

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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

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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

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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.

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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?

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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

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Recommended Websiteswww.medlineplus.gov

Manual Merck de información médica para el hogar (Merck Manual in Spanish)

http://www.msd.es/publicaciones/mmerck_hogar/

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