Clinical Communication With Minority Elders

• For effective clinical encounters with elderly patients from minority groups, the basic clinical process has to be expanded to include specific questions addressing the patient’s perceptions of the cause of the condition and the most appropriate or acceptable ways to manage it.

  EXPLANATION
  Direct question to be asked:
  “Why do you think you have this . . . (use the patient’s phrase for their) symptom/illness/condition?”  
  Probe questions to be asked:
  What do friends, family, and others say about these symptoms? Do you know anyone else who has had or who has this kind of problem? Have you heard about/read/seen it on television/radio/newspaper/Internet? (If the patient cannot offer an explanation, ask what concerns them about their problems).
  
  TREATMENT
  Direct question to be asked:
  “What have you tried for this . . . (use the patient’s phrase for their) symptom/illness/
  condition?”  
  Probe questions to be asked:
  What kind of medicines, home remedies, or other treatments have you tried for this illness? Is there anything you eat, drink, or do (or avoid) on a regular basis to stay healthy? Tell me about it. What kind of treatments are you seeking from me?
  
  HEALERS
  Direct question to be asked:
  “Who else have you sought help from for this . . . (use the patient’s phrase for their) symptom/illness/condition?”  
  Probe questions to be asked:
  Have you sought help from alternative or folk healers, friends, or other people who are not doctors for help with your problems?
  
  NEGOTIATE
  Direct question to be asked:
  “How best do you think I can
  help you?”  
  Try to find options that will be mutually acceptable to you and your patient and that incorporate your patient’s beliefs rather than contradicting them.
  
  INTERVENTION
  Direct question to be asked:
  “This is what I think needs to be done now.”  
  Determine an intervention (e.g., diagnostic, pharmacological, psychosocial, educational) with your patient that may also incorporate alternative treatments, spirituality, healers, and other cultural practices (e.g., foods eaten or avoided in general and when sick).
  
  COLLABORATE
  Direct question to be asked:
  “How can we work together on this and with whom else?”  
  Collaborate with the patient, family members, healers, and community resources.
  
  SPIRITUALITY SENIORS
  Direct question to be asked:
  “What role does faith/religion/ spirituality play in helping you with this . . . (use the patient’s phrase for their) symptom/illness/condition?”  
  Tell me about your spiritual life. How can your spiritual beliefs help you with this?
  
  

  This ensures a more complete differential diagnosis, builds patient confidence in the physician and the proposed treatment strategy, enhances adherence and follow-up, and has a positive placebo effect for the patient – plus an increased sense of professional achievement for the physician!

   

• The ETHNICS framework was developed to help you integrate culturally-appropriate components into the routine clinical questioning.

  The ETHNICS questions do not have to be asked as a block, they can be inserted as appropriate into your usual flow of clinical questions. For example, the Explanation question can come at the end of presenting compliant or after elucidation of other problems through review of systems; the Spirituality question can come as part of history, during treatment negotiation or towards the end of the interview. How you use the mnemonic depends on how you are managing each individual interview but try to ensure you include all of the questions in each interview with a minority elder.

Try to maintain a calm, thoughtful, professional demeanor
even if you are very surprised or even shocked by what the patient tells
you! Don’t be afraid to ask for further explanations. Above all, enjoy
learning about the enormous diversity of life experiences, health beliefs,
hopes and fears of our elderly patients and their families.