Paloma Hernandez, 26 year-old, Spanish speaking patient who presents to the clinic for the last 2 days in a row complaining of abdominal pain
Paloma Hernandez, 26 year-old, Spanish speaking patient who presents to the clinic for the last 2 days in a row complaining of abdominal pain
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Main Post ( AMY )
Scenario:
Paloma Hernandez, 26 year-old, Spanish speaking patient who presents to the clinic for the last 2 days in a row complaining of abdominal pain that is getting worse. The first visit the staff relied on her younger bilingual daughter to translate. She was treated with Omeprazole and encouraged to take OTC medication. Today she presents with the same problem. Her daughter states it is the same problem but worse today.
A language barrier is unfortunately one way that makes receiving adequate healthcare harder. With this patient still being fairly young herself, her daughter could not be older than maybe 10, however, could be even younger. Although she is bilingual she may be too young to understand exactly what is going on, and we are healthcare providers should not put that weight on her shoulders. A professional interpreter is the gold standard, however, there are many mobile phone/ipad translators (Panayiotou et al., 2019). Healthcare providers should always have a professional translator/ translator line when gathering patient history so they can hear it from the patient with the least amount possible getting lost in translation. Unfortunately, as Spanish is not our primary language, these patient are more likely to not receive equitable care (Panayiotou et al. 2019).
Depending on socioeconomically and lifestyle stability of Paloma we need to be sensitive but still approach if she is able to afford her medications, if she has health insurance, if she lives close to the doctor/pharmacy showing access to healthcare, and her lifestyle (Ohlson, 2020). Research has shown that patients of Hispanic ethnicity, whether born in the United States of have come here show to be most neglected when it comes to sufficient and regular healthcare (Ohlson, 2020). Healthcare is always evolving and as providers we are always trying to do right/better by our patients. Research has still shown however that Hispanics are expected to have greater health complications related to stress such as economic, education, resources, language, and discrimination (Ruiz, 2018).
With Paloma, we cannot assume just because she is at the clinic that she has adequate access to healthcare, or can afford to go get medications that are being prescribed. Culturally Hispanic patients are less likely to get adequate healthcare based on their lifestyle and jobs. We however need to be sensitive to these types of issues, as well as her speaking another language. We need to be sensitive so that Paloma does not feel judged by us and we can achieve a trusting and helpful relationship in order to give her the best care possible. If we are sensitive and respectful and can get her to open up we could help her if things such as no health insurance, bad diet, poor living conditions etc. are in play in her home.
In order to build a good health history for Paloma, we need to get a professional interpreter and not rely on her younger daughter to translate not only our questions but Paloma’s answers. There is a reason she is back, and worse. That reason may be noncompliance or it could be something was missed in translation. Five questions that I would ask to build her health history and health risks would be:
- Can you explain your symptoms and what has worsened since you were in last?
- Can you explain your home life to me or anything new in your life that could have caused this?
- Do you drink, use any tobacco product, or any illicit drugs?
- Do you have any past medical history?
- Would you able to afford your medications that you are prescribed?
Health risk factors are more than just a patient’s actual health. It is a picture of their life. Again, Hispanics are much more likely to have inadequate healthcare based on socioeconomically instability, lack of insurance, and communication barrier (Panayiotou et al., 2019). Knowing about their home life and any changes in it (knowing if they have access to nutritional foods, medications, heat etc) could be key in helping their care.
References
Ohlson, M. (2020). Effects of Socioeconomic Status and Race on Access to Healthcare in the United
States. Perspectives, 12(1). https://scholars.unh.edu/perspectives/vol12/iss1/2…
Panayiotou, A., Gardner, A., Williams, S., Zucchi, E., Mascitti-Meuter, M., Goh, A. M., You, E., Chong, T.
W., Logiudice, D., Lin, X., Haralambous, B., & Batchelor, F. (2019). Language Translation Apps in
Health Care Settings: Expert Opinion. JMIR MHealth and UHealth, 7(4), e11316.
( VIRA )Case: “Shawn Billings, a 28 year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.”
As a patient, it can be difficult to have to constantly go to a medical facility for medical help, especially when pain is present. The patient is dubbed a “frequent flyer” and his pain is still not resolved as he is returned more agitated, this time with his father. It is important to approach the patient in a calm manner. Patients who seek medical attention repeatedly often lose lack of trust in medical care due to minimal to no improvement in symptoms (Huang et al., 2020). When viewing socioeconomic factors with the young man, it’s important to understand their quality of life from assessing the environment they are in. Asking patients and their family members what their lifestyle practices in terms of religion, culture, and daily habits are accurate indicators of their ability to maintain a healthy lifestyle (Gohar et al., 2021). It’s important to not assume patients are pain medication seekers, as patients who may recently seek medication for acute pain may have had pain for longer than reported (Rash et al., 2018). With the father there, I would also ask him his side of witnessing his son’s headache. The 5 questions I would ask this patient:
- Is there any family history of migraines?
- Do you take any other medications or recreational drugs?
- How often do you rest?
- What current stressors are present in your life?
- Is there anything you do on a daily that helps relieve the headache?
References:
Gohar, B., Larivière, M., Lightfoot, N., Larivière, C., Wenghofer, E. F., & Nowrouzi, B. (2021). Demographic, Lifestyle, and Physical Health Predictors of Sickness Absenteeism in Nursing: A Meta-Analysis. Safety and Health at Work, 12(4), 536–543. https://doi.org/10.1016/j.shaw.2021.07.006
Huang, M., Van Der Borght, C., Leithaus, M., Flamaing, J., & Goderis, G. (2020). Patients’ perceptions of frequent hospital admissions: a qualitative interview study with older people above 65 years of age. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-01748-9
Rash, J. A., Poulin, P. A., Shergill, Y., Romanow, H., Freeman, J. S., Taljaard, M., Hebert, G., Stiell, I. G., & Smyth, C. (2018). Chronic Pain in the Emergency Department: A Pilot Interdisciplinary Program Demonstrates Improvements in Disability, Psychosocial Function, and Healthcare Utilization. Pain Research & Management, 2018, 1–10. https://doi.org/10.1155/2018/1875967
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