JOHNS HOPKINS U. (US) — Latina moms value a pediatrician’s empathy and warmth far more than the doctor’s ability to speak Spanish.
Reducing health care disparities for children from Spanish-speaking homes may have less to do with bridging the language gap and more to do with the fundamentals of physician-patient interaction such as concern, compassion and a thorough physical exam, the investigators say.
“As providers, we tend to focus on language barriers and sometimes assume that taking care of this in and of itself is enough,” lead author Lisa DeCamp says, “But contrary to expectations, language barriers were not the greatest concern.”
Latino children make up the largest minority population of children in the United States. Compared with other children, they have generally worse access to health care and less optimal primary care.
The gaps are particularly wide among Latino children who live in homes with limited English proficiency, says DeCamp, a pediatrician at the Johns Hopkins Children’s Center and a pediatrics fellow at the Johns Hopkins University School of Medicine,
As reported in the Maternal and Child Health Journal, the study involved interviews with 38 Latina mothers with limited English whose infants and young children received care at 10 community primary care clinics in Detroit. More than 90 percent of the mothers were of Mexican descent and most of the children were born in the United States.
About half of the mothers said they were happy with the primary care services their children received. Having a strong and respectful relationship with a pediatrician and a nurse was the moms’ overriding concern, trumping other factors like language ability and convenience of hours, the study found.
Because much of childhood illness is unpredictable and comes on suddenly, mothers were dissatisfied when walk-ins were not available and they needed to make an appointment. Many reported frustration with clinics that didn’t offer evening or weekend hours, which led them to seek care in the emergency room. Expanded hours, same-day sick care, reducing wait and language services were all important.
The mothers were, for the most part, however, willing to overlook inconveniences if they liked their pediatricians and nurses. Mothers who liked caregivers were more likely to perceive a diagnosis as accurate and the treatment as appropriate.
“We cannot overemphasize the importance of emotional intelligence and genuine concern for the child and the parent,” DeCamp adds. “This back-to-basics approach may be key in reducing any disparities.”
The mothers described their ideal provider as warm, caring, and friendly, one who didn’t rush through the visit, performed a thorough physical exam, accurately diagnosed the child, prescribed the appropriate medications, and answered all the parent’s questions. Mothers seemed to sense when nurses and pediatricians were asking questions out of routine rather than genuine concern.
Moms paid particular attention to whether a doctor or a nurse knew the child’s name without consulting a chart, asked mothers and children how they were doing, engaged in a conversation with them during the exam, joked, made the child feel comfortable, and asked the child questions directly.
In sum, kind and caring physicians and nurses who took the time to examine and care for the child appear to be as fundamental to Latina mothers as they are to parents of other populations, the researchers say.
“Many medical schools emphasize the importance of sensitivity to ethnic and cultural differences, but this study suggests there may be more similarities than differences across ethnic groups,” DeCamp says. “Such commonalities are what we should really focus on.”
DeCamp conducted her study, funded by The Robert Wood Johnson Foundation, during post-residency training at the University of Michigan as a Robert Wood Johnson Foundation Clinical Scholar. Co-authors were from the University of Michigan and Community Health and Social Services Center in Detroit.
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