In her latest book, The Latino Patient, Nilda Chong says that "When a non-Latino provider meets a Latino patient in the clinical setting, both face the challenges of a cross-cultural interaction". In this way, not only language can be a barrier, but also body language, and even voice tone. Within a medical appointment it is important to be able to get the patient to trust the provider and relax, so he or she can open up and share symptoms, habits and worries without fear of being misunderstood. Being able to speak the same language certainly helps, but it is not everything. There are things we can take into consideration that will help the interaction, even if it is carried out with the help of an interpreter.
First, any hospital or clinic knows the kind of surrounding local population and be prepared to offer services tailored to the neighborhood. For example, staff training on cultural competence will vary if the building is situated near Asian or near Latino communities, where their beliefs regarding science, doctors, and the help they can expect is culturally specific. Furthermore, the experience Latinos will have in mind about a visit to their doctors sometimes differs greatly from what is considered "common sense" or "customary" in America.
For instance, one of the biggest contrasts will be regarding who is a patient. In other cultures, the extended family is understood as close family, so it will not be rare for an adult patient to go to his or her doctor's appointment with their parents, or even their uncles. If asked to leave, they might consider that rude or inappropriate, and the bond between doctor and patient will never occur. Trust is key in these relationships, and understanding the nature of the family ties and values could be the foundation for better treatment. In these cases, the doctor's attitude should be to remain observant, at least during the first moments. Things are going to be visible if we are ready to see them. If you notice that your patient is a bit uncomfortable - for example, seems in a hurry, does not make eye contact or answers questions with monosyllables - there is definitely something that is unsettling them, and this will could interfere in your capacity to understand symptoms and treat the patient’s underlying illness. On the other hand, if asked, most patients will not disclose what is making them unease, out of fear of being ridiculed or perceived as immature or difficult. It is always better to be alert to the particular dynamics and try not to impose our view unless it is absolutely necessary.
Cultural competence is an ability that builds upon observation and evaluation. Sometimes a minor gesture, or taking two more minutes to talk to the patient will make a huge difference with someone who is on the fence about trusting his health issues to a doctor. Focusing an open and committed perspective towards diverse cultural contexts will not only help practice, but will also be key to building a better relationship among doctors, nurses, and patients.