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.

Talking with your doctor.

As this is my first blog post I’d like to start of by saying a few of things. One is thank you for visiting my blog. The other is that I won’t be responding to specific questions on this blog, except perhaps in a relatively generic way. In other words, talk with your primary care physician before you act on anything you read in this blog. For that matter, it’s probably a good idea no matter where you get your medical information from. Lastly, I have yet to decide on a schedule for posting. I don’t know whether it will be once a week, once a month, something in between or even less frequently.

And now to the subject of today: suggestions for talking with your doctor and getting the most out of your visits.

As a practicing physician there are times when I think my patients and I speak different languages even when English the first (and sometimes only) language either of us knows. For example there are times when I’ll be seeing a patient for the first time and I’ll ask what medications he or she is on and the response I get is along the lines of “a heart pill” or “a blue pill, for my heart”.  Other times the patient will know the medication name but not doses so I’ll get the response, for example “metoprolol twice a day”.  This is somewhat better but as medications often comes in multiple doses, knowing the dose is important especially if there is a need to change doses or when a patient calls in for a refill.  This leads me to my first suggestion: make a list of all your medications and include the dose of the medication and frequency. As some medications have more than one use, adding the condition can be useful. For example, some anti seizure medications and a class of blood pressure pills called beta blockers are sometimes used to prevent migraine headaches in people who have them frequently. It also can clue your physician into medications that other physicians you see are prescribing.

A list might look something like this:

Metformin     500 mg twice daily      diabetes

lisinopril    10 mg once daily  high blood pressure, to protect renal function

gabapentin    300 mg three times daily for neuropathic pain

Well, you get the idea. It is also helpful if, heaven forbid, you get sick and need to visit an emergency room on a weekend (your regular doctor might not be covering) or out of state. You might not even be in a position to talk and give information. This last possibility brings up the idea that having a “file of life” – a small document that also lists your name, doctor’s name, health problems, etc – on you in case you can’t speak for yourself.

Another thing that can help you communicate with your doctor is to actually bring a list of written questions/concerns you have to your visit. This is especially important for a few reasons when you have a number of medical problems. One is that even if you’re at a routine office visit, a symptom that you bring up might alert the physician something new is going on, a known condition could be getting worse (or better so now you’re over medicated), or medications might be interacting. Realize however, that if the list is long, your physician might choose to focus on what he or she feels is the most one or two important items on your list (or the one or two that you both agree are the most important). Yes, the knee pain may be making life miserable for you, but if you’re also getting chest discomfort or winded just walking down a hallway or up a flight of stairs, your doctor might feel that focusing more on your heart and lungs might be more important this visit as this could indicate problems with those two organ systems. It also avoids making your visit longer than it needs to be. Often if someone has a lot of issues, a physician will have a patient come back to go over the other issues at a future visit. There are cynics out there that might say we do this to make more money. To counter this I would say that I would not want to miss diagnosing severe heart disease or a potential cancer because someone was coming in for something unrelated. Though I like to believe that all doctors give each patient the time they need to address every issue at each, we also need to keep in mind that there are usually other patients waiting as well!

Having a family member with you can help if you feel overwhelmed by the number of health issues you have, or if you have memory problems. The family member might remember something you forget, for example. I think in general physicians don’t mind when a family member accompanies their patients. There may be some circumstances/questions a patient doesn’t want a family member to know about, this is one of the reasons we shy away from having family (especially young family members) act as translators when a patient has limited – or even no – proficiency in English. For this reason, don’t be surprised if the doctor asks the family member to leave the room for a few moments or chooses/requires the services of a professional translator.

Try not to make a diagnosis yourself. There is a reason that the maxim “doctors who treat themselves have a fool for a patient”. It’s commonly taught that if we listen to our patients, they’ll tell us what they have. However, I know I’d prefer someone saying “I think I have _fill in the blank_ because I have the following symptoms….” than to say “I have _fill in the diagnosis_”. Many disorders have similar symptoms and might be easy to confuse, though many times a patient will be correct, at least with more common or well known disorders. Often I’ll ask a patient why they think they have a particular disorder, as on occasion they will dismiss a symptom that might indicate a different disorder, or be so focused on the diagnosis and the need for particular treatment that it can be a challenge to convince them that something else is wrong or they don’t need treatment. A good example is someone coming in saying that they have “strep throat” and “need an antibiotic” when only a minority of people with a sore throat will have strep throat and a minority of those (I believe it’s only about 1-5%) of adults get complications and all antibiotics are doing is shortening the course of symptoms.

On the other hand there is nothing wrong with looking things up before you go into see your doctor and asking questions.

Anyhow, I hope some of this is helpful to people. Some of the recommendations have been written about elsewhere. If I could recall where I’d be glad to attribute them. If there are other things that come to mind that fit the description of this post, I’ll put them in a part II.