What Latina Patients Don't Tell Their Doctors: A Qualitative Study

Abstract

PURPOSEThe treatment a patient receives is greatly affected by what he or she chooses to disclose to a physician. This qualitative study investigated such factors as culture and background that contribute to Latina patients' nondisclosure of medical information.METHODS Participants were 28 Latina women living in Brooklyn. In-depth interviews in English or Spanish were conducted and documented by extensive notes. We used a grounded theory approach to fi nd emerging themes, which were coded using a continuous iterative process.RESULTS Six primary themes emerged: the physician-patient relationship, language, physician sex and age, time constraints, sensitive health issues, and culture and birthplace. Such qualities as compassion, caring, human interest, and kindness were important to many Latinas, who did not feel safe sharing information if these qualities were absent. Language barriers caused problems with physician-patient interaction, which were complicated by the presence of a translator. Physicians being male or younger could make disclosure diffi cult, especially around issues of sexuality and genital examination. Time constraints and cultural differences sometimes resulted in physicians' lack of awareness of sensitive areas that patients did not wish to discuss, such as sexuality, family planning, domestic abuse, and use of recreational drugs. Birthplace (foreign born vs US born) played a role in how the women perceived barriers to disclosure. CONCLUSIONS Staff training in techniques for building rapport can foster better communication, increase empathy and compassion, and lead to the establishment of trusting relationships in which disclosure is more likely.

Primary Care Utilization and Mental Health Diagnoses Among Adult Patients Requiring Interpreters: a Retrospective Cohort Study

“…For instance, it is possible that the provider appropriately brings the patient back more frequently for visits to address their issues fully and enable patients to feel more comfortable sharing sensitive information. 12,24,25 Our study is not able to determine whether the higher number of visits to PC are patient or provider initiated, nor can a judgment be made regarding appropriateness, although these represent important questions for further study. However, offering integrated mental health and IS in the PC setting where IS patients present frequently for care may facilitate recognition, discussion, and diagnosis of mental health concerns.…”

“…11 However, as a third party, they also inherently bring complexity to clinical encounters and concerns about confidentiality may arise, especially when sensitive issues are discussed. 12 Mental health-related issues present particular challenges as patients requiring interpreters are often from cultures attributing negative connotations to mental health issues with far-reaching personal, familial, and community stigma. [13][14][15][16][17] The purpose of this study was to examine health care utilization patterns of adult outpatients requiring interpreters, with a focus on the PC setting.…”

Is Spanish Language a Barrier to Domestic Violence Assessment?

“…Although numerous studies suggest that domestic violence occurs regardless of the victim's ethnicity and that ethnicity does not protect any group, language appears to have a strong influence on patients' disclosure of sensitive information to healthcare providers. Julliard et al 10 conducted a qualitative study among 28 Latina women, 23 of whom described how language barriers had a negative effect on disclosure in general. Their study described how healthcare providers sometimes appeared frustrated with a patient's accent.…”

In This Issue: Cohort Studies

“…1,2,8 There is some overlap in these categories, which represent strong methods for the types of questions asked. Qualitative methods 9 and an analysis of administrative data 10 showcase other methods well suited to their research question.…”

“…10 A qualitative study identifi es factors related to nondisclosure of health information by Latina patients. 9 The identifi ed factors are a reminder to attend to human and humanist approaches to enable the most important diagnostic test-the medical history-and a vital therapeutic intercession-the clinician-patient relationship.…”