The following post was contributed by a pediatric content author for Rosh Review.<\/em><\/p>\n\n\n\n Ask any primary care pediatrician what keeps them happy at work and you\u2019ll likely get some variation of the same answer: building relationships with our patients and their families. It is, without a doubt, the most rewarding aspect for me.<\/p>\n\n\n\n By following patients over time, we as pediatricians have the privilege of becoming familiar with family dynamics and culture. A variety of cultural and socioeconomic factors affect how each family interacts with the healthcare system, and working to understand these has proven invaluable in optimizing care for my patients. <\/p>\n\n\n\n As a primary care pediatrician working at a federally qualified health center (FQHC) in a large city, my practice is composed mainly of recent immigrants. I have the pleasure of treating patients and meeting families from all over the world, including Central and South America, East Asia, Africa, the Caribbean, and the Middle East. Prior to this position, I worked in private practice in an affluent suburb of the city, where there was little cultural or socioeconomic diversity. <\/p>\n\n\n\n In transitioning to the FQHC, I became acutely aware of how important it is to consider cultural and socioeconomic factors in order to provide optimal and equitable health care.<\/strong> These factors, unique to each family, drive patients\u2019 perspectives, values, and behaviors toward healthcare.\u00a0<\/p>\n\n\n\n Treating a more diverse population has been incredibly fulfilling and I couldn\u2019t be happier in my role at the FQHC. However, no transition is easy and there have been some bumps in the road related to cultural and socioeconomic differences. As a result, a few salient concepts have become important in my day-to-day practice. <\/p>\n\n\n\n Based on my experience, here\u2019s some things I think pediatricians working with children from diverse backgrounds should know.<\/p>\n\n\n\n If using an interpreter, keep sentences short and ideas very simple.<\/strong> Once, I provided detailed counseling on reducing triglycerides by \u201cincreasing fruit and vegetable intake, increasing exercise, and switching to whole wheat bread and brown rice,\u201d and the translation to the patient was, \u201cDon\u2019t eat white rice.\u201d <\/p>\n\n\n\n I was lucky to understand enough of the Spanish translation to notice the abbreviated message so that I could ask the interpreter to elaborate. I\u2019m sure there have been many other situations in which I didn\u2019t catch a misinterpretation, but keeping the message short and simple can help minimize errors.<\/p>\n\n\n\n Just because you give a patient a document written in their native language doesn\u2019t mean they\u2019ll be able to read it.<\/strong> <\/p>\n\n\n\n We routinely give developmental questionnaires to parents of toddler patients, and when forms are returned incomplete I usually assume the form is needed in another language. However, there have been instances when the parent was not able to complete the form due to low literacy, not a language difference.<\/p>\n\n\n\n If you have food or housing insecurity, this takes priority over other needs, including healthcare. I\u2019ve had to reframe my perspective on patients who routinely miss appointments, as what may seem like noncompliance may actually be related to poverty.<\/strong> <\/p>\n\n\n\n It turns out that many missed appointments in my practice are not because the parent forgot, but because the parent cannot miss work, either because they\u2019re concerned about job security or they can\u2019t afford to lose any wages. The same goes for patients who don\u2019t follow through with subspecialist referrals. <\/p>\n\n\n\n Likewise, patients who are not taking their medication may not have the funds to obtain the drug. Patients who are not changing their diet or lifestyle may not have access to healthy food or a safe neighborhood in which to exercise or play outside. <\/p>\n\n\n\n Although poverty may affect many aspects of healthcare, not all patients will readily offer this as an explanation.<\/strong> It\u2019s up to us to identify barriers affecting care.\u00a0<\/p>\n\n\n\n This is a big one that can be applied in almost every situation.\u00a0Here are a few examples:<\/p>\n\n\n\n I have learned over time not to assume the adult accompanying the patient in my exam room is a parent.<\/strong> A child may present for medical care with an aunt, cousin, or grandparent. Many cultures have extended family members living in the same home helping to care for the children. Additionally, some children immigrate to the US without their parents and are living with extended family or \u201csponsors.\u201d\u00a0<\/p>\n\n\n\n In my previous private practice, sleep training was one of the main topics of discussion\u00a0at well baby visits and we routinely recommended letting an infant cry overnight for short\u00a0periods of time. This method assumes that only the parents will be disturbed by the baby<\/strong> crying, a living situation that requires a certain socioeconomic status. <\/strong><\/p>\n\n\n\n The first time I\u00a0recommended \u201ccrying it out\u201d to a family in my free clinic, the parents were appalled as\u00a0they were living in an apartment with neighbors on all sides. Many of my other patients live in homes with multiple family members sharing a bedroom, making this strategy less than ideal.<\/p>\n\n\n\n Caring for the LGBTQ+ community also requires putting preconceived notions aside, as you cannot assume gender identity or sexual orientation.<\/strong> Clarifying these attributes during a patient visit is essential for building a relationship and trust, particularly with a teen who may be struggling with acceptance. It also helps tailor anticipatory guidance regarding safe sexual practices. <\/p>\n\n\n\n I have seen, over and over again, that addressing a medical problem in a vacuum will not offer the best outcome. You have to consider all circumstances affecting each patient. A relative lack of diversity among pediatricians when compared to the US population further complicates the task of bringing equitable medical care to all patient populations.<\/strong> <\/p>\n\n\n\n This highlights the importance of the AAP equity agenda<\/a>, which (among other goals) aims to develop increased diversity among those selecting pediatrics as a career. In the meantime, those of us already in the workforce must do what we can to recognize and address barriers to health.\u00a0<\/p>\n\n\n\n Fortunately, awareness and research in the area of social determinants of health (SDOH) is on the rise. These determinants are often divided into five domains, all of which must be considered in order to help minimize health disparities:<\/p>\n\n\n\n My FQHC is lucky to have several SDOH counselors who meet with families, identify barriers to healthcare, and recommend resources to navigate any needs they may have. <\/p>\n\n\n\n If you\u2019d like more information on the SDOH, they\u2019re discussed in greater detail in this article<\/a>.\u00a0<\/p>\n\n\n\n Interacting with such a diverse patient population has been humbling. For me, it has been a source of personal growth. I am optimistic that, with continued work, the field of pediatrics will progress toward the goal of achieving equitable health care for all children. Follow these tips when it comes to working with diverse patient populations, and you\u2019ll help us reach that goal. Every child deserves the best when it comes to healthcare. <\/p>\n\n\n\n Looking for more ways to give back to your patients? Check out these other (free!) resources on the Rosh Review blog:<\/em><\/p>\n\n\n\n
\n\n\n\n4 Tips for Pediatricians Working With Diverse Patient Populations <\/strong><\/h4>\n\n\n\n
1.<\/strong> <\/strong>Much is lost in translation.<\/strong><\/h5>\n\n\n\n
2. Consider educational attainment.<\/strong><\/h5>\n\n\n\n
3. <\/strong>Poverty plays a role in everything.<\/strong><\/h5>\n\n\n\n
4.<\/strong> <\/strong>Don\u2019t make assumptions.<\/strong><\/h5>\n\n\n\n
Parental Figures<\/strong><\/h6>\n\n\n\n
Living Circumstances<\/strong><\/h6>\n\n\n\n
Gender Identity & Sexual Orientation<\/strong><\/h6>\n\n\n\n
\n\n\n\nAddressing the Need for More Diversity Among Pediatricians <\/strong><\/h4>\n\n\n\n
Barriers to Healthcare for Children<\/strong><\/h4>\n\n\n\n
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\n\n\n\nFurther Reading<\/strong><\/h4>\n\n\n\n
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