Appreciating the richness of cultural, religious, and ethnic backgrounds among older patients and providing interpretation for those with limited English can help to promote good health care.
When you understand how different cultures view health care, you are better able 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.
Using an Interpreter
When working with patients who don't speak English as a first language, be sure to ask which language they prefer to speak and if they can read English (if not, ask which language they read). Approximately 20 percent of the U.S. population speaks a language other than English at home, according to the Census Bureau.
Some older immigrants or non-native English speakers may need a medical interpreter. Federal policies require clinicians and healthcare 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 and 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.
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. Some of the resources listed in the "For more information" section can help you locate State organizations and local services.
Whenever possible, offer patients appropriate translations of written material or refer them to bilingual resources. The National Institute on Aging, for example, provides a number of resources in both English  and Spanish , as well as links to resources in other languages.  If translations are not available, ask the medical interpreter to translate medical documents.
"Tell me about your traditions..."
Mrs. Houssani has been Dr. Smith’s patient for several years and always carefully follows her instructions. So, Dr. Smith is surprised when Mrs. Houssani is not willing to take her morning medication with food, as directed. Dr. Smith gently pursues her reasons. Mrs. Houssani explains that it is Ramadan and she cannot eat or drink from sunrise to sunset. Dr. Smith determines it would be safe to adjust Mrs. Houssani’s medication schedule so that she can take her morning pills before sunrise during the month of fasting.
For more information on working with patients with diverse cultural backgrounds, contact:
This website provides information, tools, and technical assistance to Federal agencies, recipients of Federal funds, users of Federal programs and federally assisted programs, and other stakeholders.
This organization publishes The Provider’s Guide to Quality & Culture. The guide offers materials for healthcare providers who work with diverse populations, including information about common beliefs and practices.
This organization runs a nationally recognized and validated certified program for medical interpreters. Their registry lists more than 1,400 certified medical interpreters.
The Council is a multidisciplinary organization whose mission is to promote and enhance language access in health care in the United States.
MedlinePlus, a website from the National Institutes of Health, features consumer information in English, Spanish, and other languages on a variety of health topics, as well as drugs and treatment options. It also has videos and other tools.
This Federal office works to develop health policies and programs that help to eliminate racial and ethnic disparities in health.