Frequently asked questions

  1. Where can I find out more about the health of a particular group of people?
  2. How should I talk about death with patients from different cultures?
  3. Where can I find out more about how different diseases affect different groups?
  4. Why should I use a professional interpreter rather than a patients family member or friend?

Stumped by how to deal with end-of-life issues with a Native American patient and family?

Wondering when you really need an interpreter?

Here's the place to look for answers to frequently asked questions in cross-cultural care.

1. Where can I find out more about the health of a particular group of people?

A: Here are some links to information on racial, ethnic and sexually-identified groups.

2. How should I talk about death with patients from different cultures?

A: Here's some advice from Rev. Don Patterson, Regions Hospital Pastoral Care who has years of experience in comforting families and counseling patients as they approach death. The law, and the cultural traditions of Western medicine, hold that patients should be fully informed about their medical condition and participate to the extent they are able in devising a treatment plan.

  • When words can hurt

    Patients from other countries and traditions don't necessarily share those assumptions. In some Native American traditions, for example, discussing the possibility of death frankly is seen as setting in motion cosmic forces that make death more likely, says Patterson.

  • Who decides?

    Western notions of medical decision-making dont necessarily correspond with those from other countries and traditions. People from some Middle Eastern and Asian cultures assume that end-of-life decisions will be made by male elders, not by the patient, nor by a female spouse.

  • Cultural Norms, Individual Differences

    There will always be tremendous variation in the beliefs of individuals within any culture. Patterson is no longer surprised if the priest who blesses a terminally ill Christian Hmong patient is hardly out the door before a shaman appears.

  • Ask questions

    The key is use an "and/also" approach to care rather than "either/or. The best approach is put yourself into the role of student, Patterson advises. The patient and the family are your teachers. Ask them how they make important decisions. Ask what they want and don't want to know. Ask what ceremonies or actions are critical to them.

  • Be Flexible. Be Creative.

    In many cases, even desires that seem initially impossible to honor within a hospital can be met, says Patterson. He ministered to a Native American family that wanted to perform a ceremony with smoldering sweetgrass within an intensive care unit. The obvious risk of fire in proximity to oxygen tanks was just one of many concerns. But Patterson found a compromise that satisfied both the family and medical staff. Smoke from sweetgrass burned outside was captured in a bottle. At the critical moment in the ceremony later held at the patient's bedside, the bottle was opened, releasing a trace of the smoke.

3. Where can I find out more about how different diseases affect different groups?

A: Many conditions and diseases occur at different rates in different populations. For instance, Vietnamese-American women have the country's highest rates of cervical cancer. Africans and Asians are commonly lactose intolerant. You can find an excellent introduction to this subject, with common health problems sorted by race and ethnicity, in the federal government's site, the Provider's Guide to Quality and Culture.

4. Why should I use a professional interpreter rather than a patients family member or friend?

A: You should call an interpreter unless the patient refuses. Here's why:

  • Accuracy: X-Rayed or Microwaved?

    In one study using ad hoc interpreters, between a quarter and half of the words and phrases were incorrectly communicated. A Minneapolis teenager translating for his mother told her she was going to be microwaved instead of x-rayed. Clear communication leads to more accurate diagnosis and treatment.

  • Ethical Care

    Use of family members and friends as interpeters strips patients of confidentiality and privacy and it can reap inaccurate information, if the patient is embarrassed to reveal personal information to a relative or friend.

  • It's the Law

    The federal Office of Civil Rights has consistently ruled that trained and qualified interpreters must be provided in health care settings. Courts have held that a physician's failure to overcome language barriers for non-English speaking patients can establish a lack of informed consent to treatment. Judges have ruled that doctors are responsible for making certain that they fully understand the complaints of patients, whether or not the patient speaks English.

Resources

Bridging the Language Gap: Meeting the Need for Interpreters in Minnesota
Available from the Center for Cross-Cultural Health. Call 612-379-3573, or e-mail ccch@crosshealth.com