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The
Latino Patient: A Cultural Guide for Health Care Providers
by Nilda Chong, MD, DrPH, MPH |
pdf >>
Review
by Edwin H Cabrera, MD
Yarmouth
(ME): Intercultural Press; 2002. ISBN: 1877864951. Price: $29.95.
227 pages.
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For
200 years, Western-trained physicians have cared for patients by using
an approach consisting of analysis of signs and symptoms and, more
recently, interpretation of an expanding array of laboratory tests
as they relate to disease states. For doctors to update their knowledge
continually as information and technology advance at a furious pace
may be exciting, but this task is also demanding, even daunting. When
confronted with the demands of managed care, clinicians may find time
a severely limited commodity. Consequently, they may find themselves
compromising by de-emphasizing care of the "whole" patient--care
which uses sensitivity and considers the patient's cultural background.
This compromise, of course, decreases the effectiveness of health
care. During the training of family practice physicians (and, we hope,
in their medical practice), emphasis is placed on a central idea:
that both family health and community health are a consequence of
the people that comprise them. Their health is affected by various
other factors in their daily lives that impact their understanding
of their health. Moreover, health is often socially defined into physical,
mental, or spiritual components in a way that affects a patient's
acceptance of recommended treatment.
In her
book, The Latino Patient: A Cultural Guide for Health Care Providers,
Dr Nilda Chong addresses the impact of cultural influences on Latino
patients. Dr Chong shares her personal background: Born in Panama
to a Chinese father and a Latina mother, Dr Chong worked as a medical
intern in the tropical rain forest of Panama; completed her doctoral
studies at the University of California at Berkeley; and finished
her book when she joined Kaiser Permanente. In the Introduction,
she points out that "Latinos are dramatically changing the demographic
profile of the United States. They currently comprise 13.3% of the
total population and will likely grow to roughly 20% in 2030 and 25%
by 2050" (page xvii). Moreover, where I practice, the Latino
population currently represents nearly 27% of the county's 2.9 million
residents.
The
book is divided into two parts, each containing five chapters. Part
one defines the Latino patient and discusses historical progression
of the terms Latino and Hispanic. She presents six social
and demographic factors (language, nationality, religion, race, social
class, age) which help define Latino culture. Dr Chong reviews the
major health problems of Latino populations and discusses an interesting
finding that a number of investigators have termed the epidemiological
paradox, defined as "... the apparent lack of correlation
between the socioeconomic profile of Latinos and their health outcomes"
(page 13). The author states, "Some researchers have posited
that the Healthy Migrant Effect might explain the lower mortality
rates among Latinos. They [researchers] suggest that Latinos who immigrate
to the United States are healthier individuals and therefore have
lower mortality rates than of those Latinos who remain in their homeland"
(page 15). This effect may further be accentuated by the Salmon Bias
Effect, a postulate which holds that many Latinos prefer to return
to their birthplace to die.1 A later chapter discusses
the combined effect of these factors on the health care of Latino
families as well as the way disease management is affected by the
social networking that occurs within and between Latino families.
The
illustrative vignettes presented in the first part of the book depict
clinical encounters that will be enlightening for clinicians who have
had little experience with Latino patients, and the vignettes will
ring true for clinicians with more experience also. To positively
influence health outcomes most effectively, health care practitioners
must understand the definitions and beliefs held by Latinos about
causes of illness. Some of these definitions and beliefs are reviewed
in the chapter titled "Health Attitudes, Beliefs, and Practices,"
which discusses how supernatural causes, emotions, and folk diseases
are perceived by Latinos to affect health. The relation of self-care,
religion, and folk medicine to health care is also discussed. The
use of curanderos, sobadores, santeros, and herbal healers by Latino
patients will be of particular interest to readers.
After
establishing a strong foundation of background information, Dr Chong
explains how understanding cultural values may help clinicians to
communicate health information effectively. The author describes the
importance of incorporating several concepts--family, friends, faith,
and fatalism--into a treatment plan. Part two of Dr Chong's book presents
"A Culturally Competent Care Model for Latinos," a model
that invokes all the previous lessons to develop a practical and useful
approach applicable in a clinical setting. A chapter is devoted to
each portion of the model: greeting, listening, caring, treating,
developing patient loyalty, and an effective farewell. The author
explains the importance of each section of the model.
To guide
development of a patient-clinician relationship that is effective
from the beginning of the patient visit to the farewell, Dr Chong
again uses clinical vignettes to provide clear, practical examples
of critical points. This exercise will prove useful for clinicians.
The
Latino Patient provides a clear, concise review of many health
care factors that are important for this population of patients. Health
care practitioners should find that the information presented can
assist them in caring for their Latino patients. On a personal note,
I hope that after reading this resource, physicians and other health
care practitioners will wish to continue expanding their knowledge
and appreciation of the rich and diverse Latino culture.
Reference
1.
Herrera CR, Stern MP, Goff D, Villagomez E. Mortality among Hispanics.
JAMA 1994 Apr;27(16):1237
