Doctor: (después del examen de los ojos) Ud. tiene
algo se llama “ojos secos” . Es por eso tiene ojos rojos, que le pican y le
molestan, especialmente cuando está afuera en el viento. No tiene
infección. Parte del problema es que su
glándula lacrimal—la glándula que produce las lágrimas—no está produciendo
bastante lágrimas para mantener la tela de lágrimas en la cornea. Es por eso
está parpadeando a menudo. Pero, la otra parte del problema es que, los
medicamentos que usa para el glaucoma, bueno, algunas de esas gotas tienen
preservativos y es el preservativo que está contribuyendo a su molestía.
Paciente: Recuerdo cuando era niña,
mi mamá tenía, un ungüento que ella se lo pondría en mis ojos cuando yo tenía
ojos rojos. No sé lo que tenía yo, pero el ungüento funcionaba cada vez.
D: Bueno, no puedo
decir lo que tenía durante ese tiempo pero, puedo decirle que en este caso una
crema no va a ayudarle. Necesitamos cambiar sus medicamentos para el glaucoma. Va a necesitar gotas que no tienen
preservativos. Entonces, debes empezar
con una gota artificial—es un lubricante--dos o tres veces al día en cada ojo. Hablando
de su glaucoma, la presión de los ojos es alta hoy. ¿Por qué?
P: Acabé la gota.
D: ¿Acabó que? ¿--su medicamento para glaucoma?
¿Cúando?
P: Sí. Hace tres meses ahora.
D: ¿Por qué no llamó para la recarga?
P: No sabía que—que necesitaba continuarlo. Es muy difícil para mí, tengo sólo una hija,
y ella no vive lejos de mí, pero, nunca me ayuda con nada. Necesito ir de
compras para la comida, pero ella nunca es disponible para ayudarme. Es muy
difícil. Vivo solo, es muy difícil.
Just to quickly summarize this interaction I had one
day with a patient, I was explaining to her that her eyes are red because they
are dry, partially due to age and partially due to the preservatives in the
glaucoma drops she was using. Many patients with red eye think they have an
infection, and this woman was no exception. She recalled a “salve” her mother
used to give her as a child which she remembered as a “cure-all” for any eye
problem she had. The way she spoke about it showed she had real confidence in it
as a treatment.
Later in the conversation, I came to discover that
she was not taking her glaucoma medications as prescribed. She used them until
she finished them, and then did not get refills. When I ask her why, she began talking about
the relationship she has with her daughter and how disappointed she is with
it. Her daughter lives nearby, but
according to my patient, never seems to make the time to go spend with her
mother.
Medicine is never simply about medicine. It’s about
the whole person. It is important to
take into account a patient’s strong beliefs concerning home remedies because
it’s less about the remedy itself and more about the fact that it’s tied into
the patient’s past— in this case, her mother.
I never try to immediately dismiss the use of home or folk remedies,
which may give the patient the sense that I don’t feel her personal experiences
are important. However, that being said,
if the “treatment” is outright dangerous or potentially damaging (case in
point: I had a patient once state that she believed in using diluted Boric acid
to clean her eyes!) I will indicate my concerns to the patient. Many
patients share this common trait: the belief that family-taught treatments have
great value, and the Latino patient is no exception to this.
From my experience working with the Spanish-speaking
Latino community, the family unit
and multiple family units which comprise the community at large, are central to every person’s well-being. In other words, I have
worked with patients who, even though they are medically well and/or stable, do
not perceive their status as “good” if all is not right with the relationships
they have with family and community.
Conversely, a patient who is not
doing well health-wise is still empowered by the love and support of his
family.
The article “Caring for the Latino Patient” from the
January 2013 issue of American Family Physician, reiterates the importance of
recognizing certain aspects of the Latino culture in the clincal health care
setting. These include personalismo (friendliness), respeto (respect) and simpatía (kindness). Personalismo
relates to the importance of family and closeness of society in the Latino culture. Respeto refers to the respect that is given
to people based on their age or status
within the family and/or community.
Simpatía refers to treating one
another kindly and considerately, essentially, treating our neighbor as
we would wish to be treated ourselves.
Understanding and recognizing the importance a patient places on this
qualities is crucial to us as physicians because incorporating them into our
daily practice results in successful treatment of the patient.
Going back to my patient above, if I chose to ignore
my patient’s concerns about her relationship with her daughter because that has
no bearing on glaucoma treatment, I am actually doing a disservice to myself
and the patient. If I instead provide a listening ear, I begin to realize that
to her, ‘wellness’ has more to do with stability and happiness in her family
life, and less to do with an eyedrop schedule.
Sharing a little bit about my own family also goes a long way in relating
my understanding, my own personalismo,
to my patient:
D: Entiendo lo que dice. Mi madre vive cerca de mí,
y estoy preocupada de ella porque ella tiene problemas médicos, pero ella no le
gusta ir a su doctor. Ella tiene—de hecho—siempre
tenía, un temor del “mundo de medicina”,
y por eso, ella elige quedarse en casa y no busca la ayuda de médicos. Tal vez,
no estoy de acuerdo con su elección a continuar sin el consejo de médicos, pero
la amo a ella. Estoy aquí a soportarla y ofrezco ir al médico con ella si un
día ella decide hacer una cita.
P: Sí, es muy difícil cuando se preocupa de un otro.
D: Sí. Comprendo que probablemente está frustrada con
su hija. Usted quiere que ella pueda hacer más tiempo para Ud. en su vida. Y,
pienso que vale la pena a hablar con ella una otra vez en el futuro. Pero, no
importa lo que pasa, no es un pretexto a
no cuidarle a su propia persona—su salud o su visión.
P: Le entiendo.
D: Y, imagino estaría difícil a mantener un
horario de gotas, medicamentos, cuando tiene preocupaciones de otras cosas. Le
prometo que podemos trabajar, juntos, a encontrar una manera en que es un poco
más fácil a recordar el horario de gotas.
Entonces puede continuar con su vida diaria sin problema.
References
Juckett G MD. Caring for Latino patients. Am Fam Physician. 2013;87(1):48-51.
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