There’s A Difference Between The Terms Hispanic, Latino, and Spanish

There’s A Difference Between The Terms Hispanic, Latino, and Spanish

As someone who’s learned some Brazilian Portuguese (and still has a lot to learn), something like this has been on my mind for a while. One of the things that us physicians are supposed to have is cultural competence. I think that before I started learning Portuguese, when I heard the term Latino/a or Hispanic, Spanish speakers typically came to mind. Granted I realized that encompassed people from many places as cultures (a patient of Puerto Rican decent who’s family has been in the U.S. Mainland for a generation or two might not have all of the same concerns as people who came from Columbia, Peru or Mexico).

Even people who come from the same country might be very different, though more similar to each other than they are to the ‘average’ american. In this I think of people from China where there are many languages and dialects spoken. Even in the U.S., someone who grew up in New England might have a much different outlook than someone who grew up in the Mid West or South East of the U.S. They might have different dietary proclivities as well.

Does that mean it’s useless or futile to try to be culturally competent? No. But it does make it more interesting at times. I think it just means keeping an open mind and remembering people from other cultures might have different expectations of time, needs from their physicians, etc. It is also helpful to know who a patient might – or would – rely on for decisions and for help. What might be considered to be “on time” for an appointment for a physician, might not be for someone where the sense of time is more fluid.

Another reason for being culturally aware – and here I am also including having a knowledge of a country’s or ethnic groups history – is risks for certain diseases. For example, if one doesn’t know much about the colonization of Cape Verde, one might not know to test a patient for Cystic Fibrosis mutations in a couple who are concerned about genetic diseases before getting pregnant. In Jewish populations, one might think of Tay Sachs as being a “Jewish Disorder”. However the genetic disorders jewish patients who trace their ancestry to Spain prior to 1492 (Sephardim) or to the near east (E.G., Persia) actually mirrors the countries they come from (For example,they can carry mutations for certain forms of Muscular Dystrophy). Knowing this kind of history helps inform decisions about testing and treatment.

some interesting thoughts

JAMA Network | JAMA Internal Medicine | A 300-Year-Old Solution to the Health Care Crisis.

Of note, I think when you click on the link above, you will have to download  the PDF.

I remember reading this article abut the time it came out. Though I don’t think it necessarily has all of “The Answers”, it does bring up some interesting points. I’ve often why some health insurance plans won’t pay for some preventive care when it would benefit the patient. When I’ve asked colleagues this the answer I  often get is “because the patient will be on different insurance [ie, medicare or  a managed care product from a private insurance].”

However many private insurances also have a managed care product for seniors. people may not ‘graduate’ into a plan from insurance they have while working. However there are people that might go from  Having Harvard Pilgrim Health Care to AARP’s program (through united health care). however, some might go fro United healthcare to HPHC’s product (or an equivalent insurance in a different part of the country). This might even things out a bit.

Anyhow, I sugges you read the article and make your own conclusions.

Should doctors be environmentalists/advocates for the environment?

One thing that sometimes crosses my mind is whether physicians and other health care workers should also be environmentalists. After all the environment does play a role in people’s health. Contaminated water lead to outbreaks of water born diseases (John Snow, a London physician in the mid 1800’s is credited [at least in part] for ending a Cholera outbreak  by convince authorities to block use of a water pump at the center of the outbreak).  The cholera outbreak following the earthquake in Haiti several years ago is another example. Polluted air leads to increased respiratory disease.

Though in the U.S. and other developed nations with functioning governments, the chances of contaminating water with sewage is low. The one exception could be when severe weather overloads the septic systems in an area. However even in the Northeast U.S. where I live, beaches are monitored for coliform bacteria (this is a generic term for bacteria that live in our guts) and closed when the counts are too high.

Air quality effects health of populations – there were reduced hospitalizations in parts of Ireland after there were bans placed on burning coal.  When lead was taken out of gas (well, actually prevented from being put in gasoline…), blood levels of lead dropped. It’s a neurotoxin and high blood levels can affect brain development in children (hence the ban of lead in paint in the U.S.), and function in adults. For water, it’s not just bacterial contamination/pollution that is important. Chemical pollution can also affect health. Toxins can build up in the food chain – this is part of the reason why it’s suggested that pregnant women limit their intake of certain fish, for example. Mercury builds up in fish at the top of the food chain, such as in Tuna, and can adversely affect people neurologically and adversely affect developing brains. Studies continue to show an association between air pollution and respiratory  deaths.

Given the number of of medications that are derived in whole or part from the plant and animal world (aspirin, reserpine, taxol, digoxin, penicillin, streptomycin, are all plant and fungal products), an argument could be made that making sure plant and animal species don’t become extinct because it might affect future drug discovery. Before you say “but wait,….” think of this: heparin is derived from the linings of Pigs. ACE inhibitors were discovered through research on snake venom. There are some newer medications for Type 2 Diabetes which are derived/grew out of research on saliva from a lizard known as the Gila monster.

 

healthcare disparities

A few months ago there was an article in a prominent medical journal about an association with one’s income and place of death (it was looking at hospice patients only). The higher one’s income the more likely someone was to die at home with hospice rather than in a nursing home or hospital.

As a practicing physician,  that there are healthcare disparities bothers me. There are multiple factors that go into this. Some are patient related (limited english skills, little/no social support in cases of people with little mobility), some are patient and societal (I would put literacy here, not just health literacy). As of 2013 I would hope that being a member of a minority would not have an effect on one’s healthcare. There is evidence  – and i don’t recall which journal I saw this in – that minorities that go to hospitals that have good healthcare results do as well as non minorities, and those that go to hospitals with less good results have corrispondingly poorer outcomes. In this case I guess we could argue for putting systems in place for all health care institutions to give health care with good results.

One thing physicians get measured on are things like checking cholesterol levels, glycosylated hemoglobin A1c’s twice a year, etc. However  to just focus on measures like that take time and energy away from measuring and doing other things that ‘count’. Sending someone for a test and usually takes less time than spending 1/2 an hour educating patients as to why those measures count and how to take care of their health. There have been articles that have brought this issue up. There are easy answers. However, I have a feeling that at least as of 2014, having processes in place to be sure that patients are educated about disease prevention and self management would go a lot farther in preventing complications than would checking a glycosylated hemoglobin twice a a year.

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