One of the challenges of providing quality health care in 21st-century America concerns the increased diversity of citizens across the country, especially in urban areas. The United States’ distinction as a cultural melting pot may be an economic benefit and a source of civic pride for many Americans, but the mix of different languages, customs, and traditions found among our immigrant population can pose difficulties for physicians who want to communicate effectively with patients in order to best treat them.
In this episode of Kentucky Health, Dr. Wayne Tuckson speaks with two Louisville physicians about their experiences working in practices that serve largely immigrant populations to learn about their best practices for bridging language and cultural barriers and providing good medical care.
Drs. Svetlana Nakatis and Ricardo D. Ferreira-Lopez both specialize in family medicine and practice with KentuckyOne Health Primary Care Associates in Louisville. Nakatis, a native of St. Petersburg, Russia, practices in a clinic that services a clientele comprised largely of immigrants from Russia and the former Soviet republics. Ferreira-Lopez practices in another Louisville clinic that treats a predominantly Latino patient roster.
Ferreira-Lopez speaks both Spanish and Portuguese, and his wife, Dr. Nakatis, is fluent in Russian. Both arrived at their current career points in similar fashion; after serving their residency in Louisville, they began practicing and soon, through word of mouth, built reputations as physicians who were welcoming and helpful to particular immigrant populations.
“As soon as I started in private practice, lots and lots of people started calling and asking if I’m taking new patients, and showing up, and bringing the whole family,” Nakatis says. “The Russian-speaking community in Louisville is vast. The immigration to Louisville started in the late 1980s and early 1990s, and is still growing.”
Common Language Leads to Better Treatment
For both Nakatis and Ferreira-Lopez, communicating with their immigrant patients in their native languages is crucial to the success of their practices. Nakatis says that while most of the younger immigrants to Louisville from Russia or republics such as Ukraine or Georgia are fluent in English, many of the older ones are not. The immigrant community from Russia in Louisville is tight-knit, she says, and includes many large and extended families. Those who initially came to the U.S. often eventually bring their families to these shores, and a lot of the older parents and/or grandparents had never left their home country before.
“Just because they came here at the older age, they never really picked up the language, so they’re really grateful that a doctor could speak their language,” she says. “The terminology is different to your native tongue, so they’re very glad and appreciative that we speak the same language.”
Likewise, Ferreira-Lopez treats extended families from Spanish-speaking countries such as Mexico or Cuba, or Portuguese-speaking countries such as Brazil, in his practice. “We have a lot of people actually that only speak Spanish or Portuguese, and actually have been living here a long time,” he says. “And they’re still not able to speak English, so they feel more comfortable with somebody speaking the same language.”
Erasing the language difference is the first step to providing comprehensive care, both guests say. Doing so allows them to fully communicate with their patients, and give instructions that are more attuned to their patients’ cultural backgrounds and practices.
For example, Ferreira-Lopez says that his typical patient examination for a Latino patient goes beyond a routine physical exam. Many of his patients bring family members into the examination room for the entire appointment, and the family members will ask questions. Ferreira-Lopez points out that the Latino community is not monolithic in Louisville as it represents a variety of countries and cultures, but says that his own experience as a doctor allows him to make a connection with patients and put them at ease.
“Medical care is the same pretty much for everybody,” he says. “So sometimes, especially because I’ve been traveling quite a lot since I was little, I know most of those countries, so I know a little about what they like, about what they don’t like, and I think that’s the easier part when patients come to see me, because they feel at home.”
Overcoming Cultural Barriers to Quality Care
Establishing good communication with patients is the first step, but both Nakatis and Ferreira-Lopez say that their patients bring a lot of cultural habits from their native countries to the U.S. that are unhealthy and need to be changed. Staples of both South American and Eastern European diets lean toward fried foods, contributing to higher obesity and diabetes rates among the Latino immigrant population and high heart disease and cholesterol rates among Russian immigrants.
Furthermore, each culture has its own social customs that require tactfulness when giving medical advice. For example, Nakatis says that many Russian immigrants coming to the U.S. are reluctant to try new medications or procedures that they are unfamiliar with, which can pose major problems if a patient develops a serious medical problem.
“You prescribe certain medications, and they say, ‘No, I’d rather take this one that I brought from Russia,’ and they don’t even know the generic name of it, so I can’t really match that, and obviously if they end up in the hospital, none of the hospital staff will know what they are taking,” she says. “So I do my best to switch them to the current, American accepted medications. I try not to let them take the medication that their relatives may still be sending them from Russia.
“Same with immunizations, they’re very reluctant to take flu shots or pneumonia shots,” she adds. “It’s practically impossible to convince them; they’ve never done that in Russia. So it takes a lot of work with them, and sometimes you succeed and sometimes you just let them make their own choices.”
Ferreira-Lopez says that many of his Latino patients are also used to natural medicines and remedies from their home countries, and that older Latino men in particular refrain from getting preventive screenings such as colonoscopies or prostate exams. Still, he says that progress is being made in educating the immigrant population and making them aware of all of the benefits the U.S. medical care system provides.
Nakatis says that no one in her office besides her speaks Russian, while Ferreira-Lopez says that most of his medical team does speak Spanish. They say that there is a legal requirement to provide an interpreter for a patient who does not speak English during a medical consultation, and this can be done either in person or over the telephone.
In general, Nakatis and Ferreira-Lopez prefer having an actual human in the room that speaks the patient’s language and is familiar with his or her cultural background. Personal interaction becomes even more important if a follow-up visit with a specialist, or a surgical procedure, is required.
For Ferreira-Lopez, common language and cultural affinity leads to establishing a level of trust between patient and doctor. “In my culture, we like it when people look you in the eye and try to explain everything to you, and to go into details about why you need to take this medicine, or why you don’t need to take this. They like it better when somebody is speaking face-to-face.”
