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Physician Interaction and Counseling of Filipino Patients

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Title: Physician Interaction and Counseling of Filipino Patients


1
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.

2
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".

3
The Clinical Encounter
  • Patients Barrier Lack of health
    insurance/coverage --gt 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 theyre 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

4
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.

5
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.

6
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.

7
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

8
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.

9
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

10
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.

11
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.

12
Cultural Characteristics
  • Chronic nature of hypertension management
  • Cultural perception of well being
  • Folks in our community cant FEEL their high
    blood pressure they tell me they feel fine if
    they have time to work and dont see the bigger
    picture until someone they know gets sick or
    dies. Community Health Worker, Jersey City, NJ

13
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
    theyre 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 couldnt
    pay. Community Health Worker, Queens, NY

14
Physician as a Patient Educator
(Diane Florde McCANN, EdD, et al.) A Establish
rapport by eliciting patients 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 PATIENTS
PROGRESS
15
Art of Communication
  • Judgmental Feedback
  • Language Barriers
  • Trigger defensiveness, aggression, or resistance
  • Example
  • Youre 35 years old. You should be pregnant by
    now.
  • spoken by a Filipina OB/GYN doctor to a
    Filipina patient.

16
Art of Communication
Keys to Active Listening
Seven Levels of 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 dont
    understand
  • Acceptable to take brief notes to keep track of
    details
  • Non-listening too busy thinking about your own
    response or feelings
  • Avoiding tuning out what we dont 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

17
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

18
  • 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_at_kalusugancoalition.org
  • Website www.kalusugancoalition.org
  • Facebook www.facebook.com/kalusugancoalition
  • Twitter www.twitter.com/kalusugan
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