Physician Interaction and
Counseling of Filipino Patients
Filipino American Cardiovascular Health Conference
National Harbor, MD
July 8, 2011
Potri Ranka Manis Queano Nur, MA, RN
Kalusugan Coalition, Inc.
Objectives
•
To cite situations of Filipino Americans that may help
explain underlying behaviors, attitudes, and perceptions of
health and determine health outcomes and health
disparities.
•
To describe socio-cultural factors impacting Filipino
Americans non-adherence to medication
•
To examine cases of physician interaction and counseling of
Filipino patients
•
To highlight the importance of understanding various
barriers Filipinos encounter when it comes to medication
adherence and the best way to communicate without
labeling a patient as "non-compliant".
The Clinical Encounter
•
Patient’s Barrier: Lack of health insurance/coverage -->
Association of clinical encounters with cultural stigma (i.e.
death, high costs, poor self-care)
•
“Is it hiya, or just fatalism…? ‘God take me’, they say…
They know they’re sick and have high blood, but going
to the doctor is just going to lead to high costs and
things getting worse, not better… and more disruption
with other parts of their life, like work, church, family,
social functions.” - AsPIRE Community Health Worker
Case Study
• Perry is 57/female years old. She was an architect in the
Philippines. Currently working as a manager of a nurse staffing
agency.
• " I was in the ER last week. My blood pressure went up to
200/110. I thought I will die. I am in medication but it
makes me cough. I went to see my doctor, she gave me
cough medication. She was so in a hurry that I was not able
to ask her more questions that is related to what I am
feeling. I stopped taking the medication. I saw her in a party
and I thought I can speak to her about me but when I told
her I have a headache and a backache she said I needed an
MRI. I stopped seeing that Doctor. Right now I am just taking
the medicine when I feel my BP is high.”
Physician-Patient Communication in
the Primary Care Office: systematic
Review Rainer Beck, MD,et al
•
According to Dr. Beck, et al study, Physician-patient
communication has frequently been judged to be
inadequate.
•
According to Dr. Mcbride et al study it was found that
patients considered communication to be one of the top
three competencies a physician should possess, yet they
frequently rated their own physicians' communication skills
to be unsatisfactory.
Qualitative Studies on Filipino
Americans & Medication
Adherence
•
The Role of Sociocultural Factors on Medication Adherence
and Control of Hypertension Among Filipino Americans: A
Qualitative Study - Gregory S. Calip, PharmD, MPH, 2009
•
The Illness beliefs, perceptions, and practices of Filipino
Americans with Hypertension – Felicitas Dela Cruz, 2007
•
Nonadherence due to forgetfulness because of
multiple family responsibilities and time constraints.
Environmental Characteristics
• Patient barriers:
• Immigration status and recent migration
• Lack of time for self care
• Prioritization of employment versus
health status
• Cultural perception of health
Immigration Status and
recent migration
Immigration status. Displacement of status.
•
It can be silent in the written survey that most of the
domestic workers are teachers, accountants, engineers,
lawyers, nurses, even doctors in the Philippines. One of the
recent encounters in a recent health screening, the client
was a Mayor in his town in the Philippines.
Lack of time for self-care
•
Most Filipino immigrants have 2-3 jobs to meet the
economic demands here plus the demands of their
family/extended family back home in the Philippines.
•
“Managing high blood among my clients is only possible if
they knew they had the time/ability to work, send money
home to the Philippines, and then… take time to see the
doctor.” AsPIRE CHW
Prioritization of employment
versus health status
• Filipino immigrants/recent immigrants
who work 2 jobs and 7days a week often
note they have no time to go to health
providers for their health care needs.
Cultural Perceptions of Health
• There are those who stop when they feel
better or their blood pressure becomes
normal and mistakenly believe that they no
longer need the medication or that they
thought they were cured. Some just simply
forget taking their medication.
Cultural Characteristics
• Chronic nature of hypertension management
• Cultural perception of well being
• “Folks in our community can’t FEEL their
high blood pressure they tell me they feel
fine if they have time to work and don’t see
the bigger picture until someone they know
gets sick or dies.” Community Health Worker,
Jersey City, NJ
Lack of understanding and
Information
•
Low awareness of treatment: Risk factors, Characteristics,
Complications
•
Most knowledge acquired from sources other than health
providers
•
Long term use of medication drug-taking contingent to
symptoms
•
“Clients of mine receive medications from family members or
doctors in the Philippines because they’re cheaper. They
share them because they think it worked well for their
relative. They might know they have high blood from a
screening, but never saw a doctor because they couldn’t
pay.” Community Health Worker, Queens, NY
Physician as a Patient
Educator
(Diane Florde McCANN, EdD, et al.)
A
Establish rapport by eliciting patient’s ACTIVE INVOLVEMENT
D
Assess needs by listening carefully as a patient DISCUSSES
CONCERNS
U
Develop a plan by promoting an UNDERSTANDING OF THE
ISSUES
L
Implement the plan by offering patient opportunities to LEARN
NEW BEHAVIORS
T
Evaluate the plan by identifying strategies for TRACKING
PATIENT’S PROGRESS
Art of Communication
Judgmental Feedback
• Language Barriers
• Trigger defensiveness, aggression, or
resistance
Example:
• “You’re 35 years old. You should be
pregnant by now.”
~ spoken by a Filipina OB/GYN doctor to a
Filipina patient.
Art of Communication
Seven Levels of Listening
• Non-listening – too busy
thinking about your own
response or feelings
• Avoiding – tuning out what
we don’t want to hear
• Blaming – ‘The blame game’
• Negating – “You should not
feel that way”
• Top This – “Let me tell
you…”
• Interest – “Tell me more…”
• Reflective – “What I hear you
say is…”
Keys to Active Listening
• Block out obstacles to
listening such as noise
• Full attention – not on the
cellphone; Maintain eye
contact (remember cultural
variations)
• No interruptions – allow the
person to speak, nodding is
acceptable
• Ask the person to repeat in
the event you don’t
understand
• Acceptable to take brief
notes to keep track of details
CHW/Adjunctive Instructions
Egbert and colleagues were among the first investigators to report
the positive effects of adjunctive patient instruction by members of
an interdisciplinary health team.
• Combination of cognitive and motivational and skill-building
education and reinforcement from the community health
worker
• Community health workers can be part of a team approach to
patient education as an adjunct to personal physician
education through regular physician visits
THANK YOU!
For more information please contact:
Potri Ranka Manis Queano Nur, MA, RN
39-04 63rd Street
Woodside, NY 11377
Phone | 718.426.7600
Fax | 718.426-7609
Email | info@kalusugancoalition.org
Website | www.kalusugancoalition.org
Facebook |www.facebook.com/kalusugancoalition
Twitter |www.twitter.com/kalusugan