by Lori Madden, Ph.D.
Studies reveal that 70% or more of recent immigrants from Latin America use herbal or other alternative remedies, but many of them do not self-disclose this information to their physicians. You can imagine the potential risks of contraindications in treating these patients. Why might Latin American immigrant patients interacting with the U.S. healthcare system not share this information with their doctors?
With a little introspection, it’s not difficult to understand. For healthcare providers, these are some questions you may ask yourselves.
- Does the physician, nurse or technician ask about alternative treatments?
Don’t assume patients will volunteer information without being asked. Latin American immigrants coming from socialized systems of medicine are not culturally trained to be their own advocates. Some patients simply won’t disclose any information, pertinent or extraneous, if the doctor doesn’t ask.
Some Hispanic patients may be used to having doctors engage them in casual conversation, possibly disguised as a diagnostic tool to uncover medical information. In Latin American cultures, good professional relationships are formed by getting to know patients before treating them. Some social engagement will also help U.S. healthcare professionals earn the trust of their patients. Establishing a social relationship of trust will help convince the patient to follow physician’s recommendations, even if only to avoid disappointing the doctor.
- Does the physician, nurse or technician define what they mean by “alternative” remedies?
Healthcare providers need to be specific when questioning patients about the use of alternative remedies. Asking “What else are you taking?” is not sufficient. This could be interpreted as “What other conventional medicines are you taking?” But what about teas and herbs, massages, sweating, aroma therapy, spiritual cleansings? Find a better way to open up this conversation with your patient. Also, it would help enormously to truly understand the background of your Latino population. Has anyone in your facility canvassed the local community to discover the most common alternative practices? It could save a patient from unnecessary risk. If the locals like to treat their babies’ colic with chamomile tea or teething pains with clover oil, are they aware of the risks of conjunctivitis or toxicity if swallowed? Be specific, with examples, when gauging your patient’s involvement with alternative remedies.
- Does the medical professional feel comfortable inquiring about treatments with which he or she is unfamiliar?
The obvious solution to this situation is for doctors and nurses to inform themselves about potential harmful interactions from the typical herbal remedies practiced by the local community. But even without this expertise, inquiring is better for patient care than not inquiring. No one knows all of the answers. That’s why there are specialists! A referral to a pharmacist or other related professional can help inform the patient and his or her physician.
- Is the patient afraid to disclose this information because of past negative interactions with judgmental healthcare providers?
There are effective and ineffective ways of discussing this topic. Disapproving looks and stern warnings intimidate patients into non-disclosure. A bad experience makes it more difficult for the next encounter with healthcare providers and could sabotage compliance in follow-up care. Casual curiosity combined with a neutral tone is a better tactic. If the patient does disclose the use of alternative or complementary treatments which are NOT contraindicated for their conditions, then encouraging the patient to continue practicing harmless practices may enhance their compliance. Patients with long-term ailments become doubtful of the efficacy of their physician’s advice when improvement is not swift and significant. But now the patients who are simultaneously following harmless alternatives are ‘inoculated’ against reverting to natural remedies as their cure and abandoning doctor’s orders!
- In which language is the diagnostic interview being conducted?
Many recent immigrant patients are not proficient in English. There will be language barriers to overcome. Immigrant patients unassimilated into the U.S. healthcare system may be shy about volunteering information, especially to healthcare professionals they perceive to be authority figures. Having a Spanish-language interpreter who is knowledgeable about U.S. diagnostic procedures and about healthcare practices in Latin America can be your and your patient’s best ally. U.S. born “legacy” speakers of Spanish will help bridge the linguistic gap. However, interpreters recruited from among the immigrant community will be even better suited for this job!
For more information about this and other topics related to immigrant healthcare, see Care for the Hispanic Patient: A Cross-Cultural Approach at www.SLSPublications.com and earn healthcare CE units while you educate yourselves! See http://www.jabfm.org/content/19/6/566.full and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2203387/
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