Appreciating the richness of cultural and ethnic backgrounds among older patients and providing interpretation for those with limited English can help to promote good health care.
"Cultural differences, not divides."
Azeeza Houssani had been Dr. Smith's patient for several years. She had always carefully followed his instructions. So, Dr. Smith was surprised when Mrs. Houssani was not willing to take her morning medication with food, as directed. He reminded her that these drugs were very hard on the stomach and could cause her pain if taken without food. But Mrs. Houssani just shook her head. Rather than getting frustrated, Dr. Smith gently pursued her reasons. Mrs. Houssani explained that it was Ramadan and she could not eat or drink from sunrise to sunset. Dr. Smith thought a bit and suggested that she find out if it's okay to take medicine with food during Ramadan—there might be an exception for people in her situation who need to take medicine.
Understanding how different cultures view health care helps you to tailor questions and treatment plans to the patient's needs. Although you cannot become an expert in the norms and traditions of every culture, being sensitive to general differences can strengthen your relationship with your patients.
Each culture has its own rules about body language and interpretations of hand gestures. Some cultures point with the entire hand, because pointing with a finger is extremely rude behavior. For some cultures, direct eye contact is considered disrespectful. Until you are sure about a patient's background, you might opt for a conservative approach. And, if you aren't certain about a patient's preferences, ask.
The use of alternative medicines, herbal treatments, and folk remedies is common in many cultures. Be sure to ask your patient if he or she takes vitamins, herbal treatments, dietary supplements, or other alternative or complementary medicines. Also, in order to help build a trusting relationship, be respectful of native healers on whom your patient may also rely.
Older immigrants or non-native English speakers may need a medical interpreter. Almost 18 percent of the U.S. population speaks a language other than English at home, according to the Census Bureau. Among older people, 2.3 million report not speaking English or not speaking it very well. Federal policies require clinicians and health care providers who receive Federal funds, such as Medicare payments, to make interpretive services available to people with limited English.
Many clinicians rely on patients' family members or on the ad hoc services of bilingual staff members, but experts strongly discourage this practice and recommend the use of trained medical interpreters. Family members or office staff may be unable to interpret medical terminology, may inadvertently misinterpret information, or may find it difficult to relay bad news. Although a patient may choose to have a family member translate, the patient should be offered access to a professional interpreter.
When working with non-native English-speaking patients, be sure to ask which language they prefer to speak and whether or not they read and write English (and, if not, which language they do read). Whenever possible, offer patients appropriate translations of written material or refer them to bilingual resources. If translations are not available, ask the medical interpreter to translate medical documents.
For more information on working with patients with diverse cultural backgrounds, contact:
Management Sciences for Health
National Institute on Aging (NIA)
National Institutes of Health (NIH)
National Library of Medicine
Office of Minority Health
A number of States have associations and foundations that can help with locating, and in some cases provide funding for, medical interpreters. Some State Medicaid offices offer reimbursement for medical interpretation services. A web search can locate State organizations and local services. Or you can contact:
National Council on Interpreting in Health Care
5505 Connecticut Avenue, NW, #119
Washington, DC 20015-2601