Transcript Preparing your Students to Work with the Spanish

Aidé Gomez
Medical Spanish and Cultural Competency
UCSD School of Medicine
Skaggs School of Pharmacy and Pharmaceutical Sciences
[email protected]
 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 upbringing
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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 outcome
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Common Practices
 Home remedies
 OTC medications
 Herbal teas
 Homeopathic meds
 Curanderos
 Borrow medication
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Common Practices
 Will consult pharmacist before consulting a physician
 Opportunity for:
 Referral to community resources
 Patient education
 Preventive medicine
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Community Resources
 Patients 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 Practices
 Patients 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 - Cortisone
 Patients 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 - Antibiotics
 Patients 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 nonEnglish-speaking patients: impact of pharmaceutical care.
 Westberg SM, Sorensen TD.
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The use of interpreters
 Bilingual 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
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Speaking Patients
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Errors made by hospital interpreters
vs ad hoc interpreters
 Study 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 interpreters
 Substitution (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 interpreters
 Editorialization (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 patient
 Use 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?
Recommendations
 Have 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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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 Resources
 Patients 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 Websites
 www.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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