Keep Culture in Mind When Caring for Minority Patients With Chronic Conditions

Research shows that minority patients suffer more than other Americans from chronic diseases. But giving these patients the care they need can be challenging because of prevailing cultural realities. Cultural sensitivity on the family physician's part is key.

Sherri Lynn Morgan, M.D., M.P.H., an assistant director at the Mount Carmel Family Medicine residency program in Columbus, Ohio, is well aware of the chronic conditions to watch for and the cultural sensitivity needed for work with minority populations.

"All of my patients receive a very thorough background screening," says Morgan. "But because the prevalence of certain diseases is higher in certain populations, my radar is extra sensitive when I walk into a room and see a (minority patient)."

In the African-American community, for example, diabetes and hypertension are prevalent, says Morgan. "So when I have a new African-American patient, I am very keen about screening for diabetes and hypertension."

But even before physicians can start treating patients on an ongoing basis, they must develop trusting relationships with their patients. And this type of relationship building can be difficult with some minority patients. For example, African-Americans may be suspicious of health care systems, making them reluctant to volunteer information or even answer questions. Many of them may remember the Tuskegee Syphilis Study, a 40-year experiment in which government researchers deliberately withheld treatment from nearly 400 black Alabama sharecroppers to document the long-term effects of syphilis.

"There is a trust issue that you have to build with minority populations because of past issues, comments Morgan. "Some of that is still there, underlying."

Morgan says she approaches each patient as an individual, telling each patient that managing his or her care requires a "team effort" and saying that she will do everything in her power to make the team work.

"All of my patients are individuals, but in the back of my mind, I know everyone has variations," Morgan says. "I will approach them based on how I think I am going to be most effective."

For example, Morgan currently is treating a woman from Puerto Rico. The patient has high blood pressure and uses a lot of salt to cook her meals, a practice that exacerbates her diabetes. The generous use of salt is part of the woman's culinary culture, prompting Morgan to recommend a reduction, not an elimination, of the salt.

Amber Isley, M.D., a family physician on staff in the department of family medicine at the Mayo Clinic in Jacksonville, Fla., reports similar experiences with patients in Florida. Isley previously worked in a community health center in central Florida, taking care of a large Hispanic population that eats a diet largely consisting of rice and beans. Although the diet worsened the condition of her patients with diabetes, Isley realized that rice and beans are part of these patients' culture; she made allowances for the rice and beans while also recommending some modifications and food substitutions.

In addition, Isley says that in Hispanic cultures, patients expect the physician to talk to them first about their general health before they are ready to answer specific health-related questions, "My Latino patients are not just going to come in, answer your questions and get a diagnosis," says Isley.

The economic status of patients also plays an important role in terms of health care and health care access. Minorities tend to be poorer than whites, and as a result, they are more likely to be Medicaid patients or have inadequate insurance, precluding certain screenings and even treatments that may not be covered by these suboptimal plans.

"You can tell someone to get screened all day, but if they don't have the funds … to do screening, preventative care is not foremost in their minds," says Isley.

Family physicians, she says, should know the specific health care needs of their patient populations and what types of diseases to screen for. "You need to do your background research," she stresses.

In addition, if insurance companies and payers don't want to cover appropriate screenings, present evidence about the prevalence of a disease in a minority patient group and lobby for coverage, Isley says.