Discussing reproductive health with a Latine/x patient.
Discussing reproductive health with a Latine/x patient.
Magdalena waits in the sterile waiting room. When the receptionist called her name, she almost did not recognize it, as it was pronounced incorrectly, delaying her response time. The receptionist appeared annoyed to Magdalena, and Magdalena profusely apologized.
Once in the exam room, Magdalena already feels uncomfortable. The provider picks up on this discomfort when they enter the room.
The provider introduces themselves and apologizes for the wait. The provider noted that Magdalena’s language preference was Spanish, and they requested a promotora de salud (community health worker) to be available during the visit, who was also a certified medical Spanish interpreter.
While introducing themselves, the provider asked if it would be okay to have the promotora de salud in the room during the visit. Magdalena immediately feels at ease when she sees the promotora de salud, and agrees to have her in the room. The provider asks Magdalena about her day, giving her space to respond before asking Magdalena about her medical history, inclusive of sexual and reproductive health questions. Once a bit of rapport is built, the provider asks Magdalena:
“What are your goals for care today?”
Magdalena gestures to her groin and displays a look of pain on her face. Magdalena lets the provider know that she has been experiencing vaginal discomfort and odor for a month, and that she needs antibiotics to resolve the issue.
The provider listens to Magdalena concerns and requests for treatment, and asks how she has been self-managing her discomfort. Magdalena reports that she has been taking two showers a day, wearing loose clothes at home, and drinking homemade therapeutic juices.
The provider asks Magdalena what she normally bathes with and she reveals the name of the feminine wash. The promotora de salud states that the feminine wash is a commonplace bath item in Mexico.
The provider, knowing that feminine washes can cause vaginal infections, uses this moment to provide neutral health education on proper care and maintenance of the vagina. The provider asks Magdalena if they would like to rule out the presence of a UTI with a urine sample, and Magdalena says yes.
Things to consider.
Latine/x patients can be overly deferential to providers because of the apparent power imbalance between provider and patient. By taking the time to build rapport, patients can begin to trust providers and to see them as members of the community over time.
Collaboration with specialized community workers can help to tailor care to the patient and uncover health behaviors that otherwise will go unnoticed.
How would you counsel a patient who has cultural ties to a potentially harmful health behavior?
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