Do You Speak the Other Guy’s Language: Culture, Diversity and the Bottom Line Dr. Paul Mendis,M.D., Chief Medical Officer Neighborhood Health Plan Boston, MA Shani A. Dowd, B.A., L.C.S.W. Dir., Clinical Cultural Competency Training Harvard Pilgrim Health Care Boston, MA
68
Embed
Do You Speak the Other Guys Language: Culture, Diversity and the Bottom Line Dr. Paul Mendis,M.D., Chief Medical Officer Neighborhood Health Plan Boston,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Do You Speak the Other Guy’s Language: Culture, Diversity and
Health Care Disparities: Treatment for Cardiac Care
Among Medicare Beneficiaries:
African Americans are 60% LESS likely than whites to received heart bypass surgery, even when controlled for income, insurance status and place of treatment
Patient satisfaction increases when clinician uses psychosocially-oriented interview
Psychosocially oriented interview was LEAST frequently used
Perception among physician that takes more time
BUT: Study found that psychosocial interview did not significantly increase time of the clinical encounter
Roter,DL, Stewart, M., Putnam, SM, Lipkin, M, Stile, W. & Inui, T (1997) Communication patterns of primary care physicians. Journal of the Amer. Med. Assoc., 277(4):350-56.
Specific communication problems were identified in a sample of malpractice claims. Physicians with no claims against them were more likely to:
orient patients to the process of the visit
use facilitative statements more, e.g. “Go on, tell me more”
ask patients’ opinions about their medical problems
use humor, indicated warmth and friendliness
Levinson, WL, Roter, DL, Mullooly, JP, et al. (1997) Physician -patient communication: The relationship with malpractice claims among primary care physicians and surgeons. JAMA, 277:553-559.
Four problematic themes emerged when plaintiffs depositions were reviewed:
Deserting the patient 32%
Devaluing the patient or family views 29%
Delivering information poorly 26%
Failing to understand the patient
and/or family perspective 13%
Beckman, HB, Markakis, KM, Suchman, AL and Frankel, RM. (1994) The Doctor Patient Relationship and malpractice: Lessons from Plaintiff Depositions. Arch. Internal Med., 154: 1365-1370.
While 1% of hospitalized patients suffer a significant injury due to negligence, fewer than 2% of these patients initiate a malpractice claim.
Patient dissatisfaction is the key element in the decision to initiate a malpractice claim.
Levinson, WL, Roter, DL, Mullooly, JP, et al. (1997) Physician -patient communication: The relationship with malpractice claims among primary care physicians and surgeons. JAMA, 277:553-559.
Physicians and hospitals who wish to participate in federally funded medical programs, specific requirements are articulated in the language of the contract relating to cultural issues, such as linguistic access:
It is the ability to deliver effective medical care to people from different cultures.
By understanding, valuing and incorporating the cultural differences of America’s diverse population and examining one’s own health-related values and beliefs, health providers deliver more effective and cost-efficient care.
Patient Cultural FactorsThese factors are shown to facilitate immigrants positive adjustment to medical care in the US: A relatively high level of formal education
Greater generational removal from immigrant status
Low degree of encapsulation within an ethnic and family social network
Experiences with medical services that incorporate patient
Translation of Clinical Condition: Rheumatoid Arthritis
English:
Rheumatoid arthritis can be acute or chronic. Acute rheumatoid arthritis is more common during adolescence. The cause is believed to be due to an over-sensitive reaction of the joints to the Beta Hemolytic Streptococcus. The most common sites of infection are the throat and tonsil.
English to Chinese to English:
Wet Wind Style Joint inflammation has fast and slow type. The fast type sees more at small year time. The reason for its up believes to be the joint’s over-sensitive reaction to the blood-dissolving chain-ball bacteria. And the affecting path is most frequently the swallow tube and the flat-peach gland.
Majority of elderly speak Toisenese; most of them also understand Cantonese.
Mandarin speakers are likely to be students or professionals who probably also speak English (except for the elderly). They tend not to speak Cantonese.
Cantonese-speaking Chinese also speak Mandarin if they are educated.
A fifty-nine year old bilingual Vietnamese immigrant who had been a farmer in Vietnam and was poorly educated prior to immigration, interpreted the direction, “Take with meals,” to mean he should carry the medication in his lunch pail. He did not actually take the medication at the time he ate, as he did not want anyone to know he was ill.
Alternative Medicine More than 4 out of 10 people in the United States visited alternative
medicine practitioners in 1997.
Sharp increase in the number of Americans using it, from 61 million in 1990 to 83 million in 1997, even though many alternative therapies aren’t covered by insurance.
Patients’ spending on alternative therapies nearly doubled from 9.4 billion dollars in 1990 to 17 billion dollars in 1997.
(1998)Trends in Alternative Medicine Use in the United States, 1990-1997, JAMA , 280: 1569-1575.
Lack of Trust•Many ethnic minority patients find it easy to believe that a provider is experimenting on them
•Many believe that medications used to treat whites are “too strong for the system” of ethnic people.
•Patients who are being treated for diseases with no apparent symptoms, find it hard to be compliant with treatment regimens, especially in the context of abuses in the medical care system.
•Be persuasive as opposed to commanding•Describe use•Inform about side effects:
Research shows: This does NOT increase
side effects•Tell when and how medication will help•Avoid being too complicated or detailed•Use “plain” English, avoid technical terms•Avoid anxious mannerisms (e.g. touching self, shuffling papers, looking at watch). These may be interpreted as a lack of truthfulness or honesty.
Source: Cohn, E. R. (2000) Communication to Promote Therapeutic Adherence. (www.pitt.edu)
Patient Satisfaction Patient satisfaction increases when clinician uses
psychosocially-oriented interview
Psychosocially oriented interview was LEAST frequently used
Perception among physician that takes more time
BUT: Study found that psychosocial interview did not significantly increase time of the clinical encounter
Roter,DL, Stewart, M., Putnam, SM, Lipkin, M, Stile, W. & Inui, T (1997) Communication patterns of primary care physicians. Journal of the Amer. Med. Assoc., 277(4):350-56.
Many languages lack terms equivalent to our medical terminology:
When interviewed in English, patients sometimes responded positively to questions, even when they were confused by the terminology used in the interview.
When interviewed in their language of origin, lack of understanding was more readily identified.
Pasick, RJ.,Stewart, SL, Bird, JA & D’Onofrio, CN (2001) Quality of Data in Multiethnic Health Surveys, Public Health Reports, Supplement 1, Vol. 116:223-243
Chinese women wondered why one would go to a doctor if one was healthy. They felt that Chinese respondents might associate regular check-ups with a presumption of illness, may not answer truthfully, even if they did indeed have a check-up.
Vietnamese women had trouble understanding the concepts of “routine” and “check-up” though most answered the question in the affirmative when interviewed in English.
Pasick, RJ.,Stewart, SL, Bird, JA & D’Onofrio, CN (2001) Quality of Data in Multiethnic Health Surveys,
Public Health Reports, Supplement 1, Vol. 116:223-243
When patients were allowed to complete their initial statement of concerns, there were fewer spontaneous statements of concerns which occurred after the history taking portion of the interview (14.9% vs. 34.9%)
Marvel, MK, Epstein, RM, Flowers, K & Beckman, HB (1999) Soliciting the patient’s agenda: have we improved? JAMA, 281(3):283-287