Dios le bendiga

Doctor: “Está bien. Siéntese atrás. Primero, quiero decirle que tenga ojos muy sanos.”

Paciente: “¡Ajj, Gracias a Dios!”

Doctor: “No hay signos de diabetes, y la presión del ojo es estable. Ahora, es importante que continue usted controlar el azúcar, para mantener una retina sana.”

Paciente: “O, sí, gracias a Dios por sus bendiciones, todo esté bien.”

Doctor: “Aquí, lleve este papel a la frente, hacemos una cita  para otro examen en un año.”

Paciente: “Gracias, doctor, pase buen día, Dios le bendiga.”

This conversation at the end of  a visit with my Spanish-speaking patients is quite typical. In this particular case, I am telling a diabetic patient that his eye exam is normal. He shows no signs of diabetic changes in his eyes. The patient expresses happiness and relief by thanking God for this good result. Though I reiterate during the exam that it’s his good blood sugar control that has kept his retina healthy, the patient continues to speak as if it’s not good blood sugar control that equals a healthy retina, but that garnering God’s many blessings equals a healthy retina.

There are many articles that chronicle the topic of “fatalismo”,  a particular concept of Latino culture where a person’s fate determines his outcome in any given situation. In the piece, “Cultural Values of Latino Patients and Families”, author Marcia Carteret, M. Ed. discusses how Latinos “... have a strong belief that uncertainty is inherent in life and each day is taken as it comes.” The term “fatalism” refers to the belief that because we are all assigned a pre-determined fate, there is little that can be done to alter the natural course of things.

When applying the idea of fatalismo to health care, Latino patients are less likely to seek out preventative care or continue a particular treatment. They may not follow up on testing or treatments or even want to know that they have a particular diagnosis like cancer because they believe the disease to be a punishment by God. In the case of my patient above, his good eye health was the direct result of God’s blessings. For others, conversely, diabetic retinopathy is the end result of someone’s fate, not poor blood sugar control.

For people who believe their fate is out of their hands, there is less emphasis on trying to control things in their environment. Time, for example, is flexible in the minds of many Latino immigrants. Being punctual for medical appointments is not necessarily valued and tardiness, in fact, is the societal norm. The author goes on to remark how in US American culture, there is a sense of discomfort that goes along with uncertainty in life. As a result, US born non-Latinos seek control of the natural chaos in life by tightly managing time: setting appointments, keeping them, multi-tasking. Non-Latinos focus on the individual when it comes to decision making, thereby putting “...little faith in fate or karma.”

Through my own experiences with my patients, I was about to conclude that only foreign-born or immigrant Latinos surrender to fatalismo, but an article by Amanda Machado says otherwise. In her piece, “Why Many Latinos Dread Going to the Doctor”, Ms. Machado writes how generations of Latinos in the United States still struggle with relying on Western medicine for their health care needs. They prefer turning to natural remedies used by family members to address any health ailment. She states that, though many of these plant and herbal remedies can be ineffective or even dangerous, Latinos still feel more at ease using them because “..“There’s greater trust for what has worked for your family or what you’ve heard has worked for others in your community.”

I see a large community of Latino patients in my practice. I have to admit that when I first started working there and noted how many of the patients came 15, 20 even 30 minutes late, -and regularly so- I felt frustrated because  1) I took it as a sign of disrespect for me, my time, and my other patients’ time and 2) I had to struggle to rush and squeeze in their exams so I didn’t make the other patients who came on time wait to be seen. However, after reading this information on fatalismo, and understanding the meaning behind it, I now see that the lateness of these patients is not a sign of disrespect. It’s part of a natural belief about life, that there are many things outside our control and that perhaps there’s no point in stressing about every minute, second or microsecond.

This laxity about time does have its benefits. I’ve rarely if ever had a Latino patient complain about waiting to see me. I’ve never had them start screaming at me in the exam room like some of my non-Latino patients, about how time is money and time is everything and I’ve wasted theirs. If time can’t be controlled and fate is out of our hands, then I can breath a little easier. I can give my patients the attention they deserve without rushing. And I can do my doctorly duty and explain a disease and how to prevent it. But if my patient chooses to believe that God and not lifestyle guides his health status, who am I to disagree? I happen to believe in something I’ll call ‘fatalismo plus’: that some of our life is scripted and some of it we write on our own. If we take the extra time to listen to, respect and help one another, then indeed we’ll find ourselves in a world of many blessings.

References

Carteret, Marcia, M. Ed. “Cultural Values of Latino Patients and Families.”http://www.dimensionsofculture.com/2011/03/cultural-values-of-latino-patients-and-families/

Machado, Amanda. “Why Many Latinos Dread Going to the Doctor.” http://www.theatlantic.com/health/archive/2014/05/why-many-latinos-dread-going-to-the-doctor/361547/

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