Communicating with Diverse Patient Groups

language diversity

21% of the U.S. population (67 million people) speaks a language other than English at home

Both law (Title VI of the Civil Rights Act of 1964) and good medicine require that providers make the best attempt at communicating with ESL patients

use in-person Certified Medical Interpreters when possible, ideally same country of origin, gender, similar age

video interpreters, telephone interpreters

In the healthcare setting, why do you think a human Certified Medical Interpreter is the preferred option over a translation app, despite some of the logistical difficulties that may come up when using these services?

building rapport with a human is much better

translation apps don't have translations for some medical terms

tips for working with interpreters

face the patient and the interpreter

use normal tone

keep the exchange simple

ask one question at a time (avoid grouping symptoms together in a question)

speak in first person

avoid slang

learn several common phrases

say thank you to the interpreter

strategies for working through a language barrier

- become bilingual, especially if you plan to work in an environment with a large population of non-English speaking patients

- speak in shorter sentences with clear annunciation

- avoid sequential questioning

- be creative

culture

the set of acceptable behaviors, beliefs, and material traits of a racial, religious or social group

what does culture influence

- views of health and illness

- how to make decisions about treatment/care

- what types of treatments are considered acceptable

- how someone relates to/manages pain, injuries

-whether someone feels they have control over their health

- likelihood of someone following treatment directives

cultural imposition

when a person or group believes others should adhere to its values and patterns of behavior

cultural sensitivity

awareness that cultural differences and similarities between people exist - without assigning them a value, positive or negative, better or worse, right or wrong

awareness that culture has an effect on values, learning and behavior

a set of skills that allows you to understand and learn about people whose cultural background is not the same as your own

aspects of cultural sensitivity

denial

defense

minimization

acceptance

adaptation

integration

tips for improving cultural sensitivity in healthcare

- encourage patients to discuss their beliefs

- show genuine curiosity about learning about other cultural practices

- look for confusion/resistance

- treat all patients with compassion

- seek out opportunities to interact with others with backgrounds and life experiences different than your own

stage theory of cognitive development

sensorimotor: birth - 2 years, primitive reflexes

preoperational: 2-7 years, self-centered

concrete operational: 7-11 years, greater reasoning skills

formal operational: 11-15 years, understand abstract concepts

when children are ill, their developmental stage can sometimes

regress

considerations for children

- get on eye level with them, sit, kneel, or squat

- avoid standing over the child

- tell them before touching

- be honest about whether a procedure will hurt

- involve them, ask questions if developmentally appropriate, let them handle equipment, as appropriate

- speak to child whenever feasible

- do not scold/shame for crying

- reward with stickers/toys, not food

- avoid idioms - children are very literal

- explain procedures in clear terms

sex

a medical term designating a certain combination of primary and secondary sex characteristics, hormones, and chromosomes. the categories included intersex, female, and male

gender identity

a person's internal sense of gender, for lack thereof. this is information that each person can identify for themselves, and it is likely to be based on gender in their society

sexual orientation

the desire or lack of desire for intimate emotional and/or sexual relationships with people of the same gender/sex, another gender/sex or multiple genders/sexes

Why is SOGI information important in health care?

significant health disparities exist in the LGBTQIA+ community, including higher rates of smoking, alcohol, and other drug use, and depression and anxiety

certain disease are more common in this community - HIV-PrEP

impact of sex vs GI on appropriate health screenings

impact of sexual orientation on safer sex education

communication tips for SOGI

- ask "what pronouns do you use?"

- introduce yourself with your own pronouns

- do not assume someone's pronouns based on their appearance

- if someone doesn't share their pronouns with you, or doesn't want to share their pronouns, you can use their name

- it is not always possible to avoid mistakes - apologize for errors