Todo está bien

Doctor: Veo que usted está aquí por un examen completo de los ojos...se dice en su historia médica que usted ha tenido problemas con ver cosas cercanas...”

Paciente: Sí, cuando trato leer cosas, particularmente letras pequeñas, tengo que poner el papel aquí- lejos de la cara y todavía no lo puedo ver bien.

Doctor: (mira al paciente, observa ojos bien rojos). Otro que la visión,¿ hay otras síntomas quiere decirme antes de empiezo el examen?

Paciente: No, todo está bien- sólo necesito lentes.

Doctor:(continua..) Síntomas como, por ejemplo, ¿picazón de los ojos, o la sensación rasposa, ardor, u enrojecimiento de los ojos?

Paciente: Pues, no.

Doctor: Bueno, entonces, vamos a ver... (empieza el examen)

I have noticed that when some of my male Latino patients come into the office for an eye exam , they are not always willing to fully elaborate on all of their symptoms. Many times, they come because they have to:  they are of presbyopic age and need readers, or they need their DMV form filled out. But they will sit in my exam chair with eyes that reveal more issues than a mild refractive error . Eyes that I can tell are uncomfortable, irritated, dry, burning or scratchy. Their eyes may be red, or teary. Their eyelashes have collarettes or sheathing at the base. They have inflamed pterygia. Yet when I push them on symptoms, they act as if nothing is wrong:

Doctor: Entiendo que necesite lentes para leer, pero la agudeza visual hoy es 20/60 en cada ojo. ¿No tiene problemas cuando maneja, particularmente por la noche?

Paciente: ¡No! Veo la distancia perfectamente bien, y puedo leer la mayoría de las cosas sin lentes. Sólo de vez en cuando...es muy raro...que necesito algo para leer.

At some point I began to wonder, is this behavior just a reflection of this particular individual?  Or, is this what is referred to as the Latin machismo?

Allow me to preface the remainder of this article with the following:  Note that I say the word “some” male Latino patients, I didn’t say “all”. I had an anatomy professor in medical school who was well-known around campus for this statement: “The ‘all’ word creates a situation.” What he meant by that is that neither he, nor I nor anyone can make sweeping generalizations about people. Even if it seems a majority falls into a category, not everyone does. Hence, I have noticed some of my male Latino patients exhibiting this behavior, but not all.

Blogger Ashley Bennink, author of Ayuda,Doctor-- a blog about Spanish language in medicine-- explains the Mexican definition of machismo in her entry ‘Teaching Culture – Machismo’. She talks about how at its most positive, machismo describes an honorable and respectable man who is loyal and polite, trustworthy, and a strong leader and caretaker of family. At its most negative, machismo is, in her words, “exaggerated manliness”, a great need to “..differentiate himself from what is feminine and define himself as a man.” This results in various behaviors, namely, the need not to show weakness, traditionally viewed as a feminine quality i.e. ‘the weaker sex’(although any modern-day woman would argue most vigorously that this can’t be farther from the truth!).  As a result of these ingrained beliefs, Ms. Bennink continues in her entry, “The Effect of Machismo on Health & Well-Being” that such a man would avoid routine health care check-ups, or refuse to submit to the authority of a doctor or, in general, would find the experience of seeking help for some malady to be emasculating.

I think about these issues when I come across a patient as described in my conversation above. Perhaps he does fall into this category, and does practice machismo. Maybe he’s just stubborn. Maybe he’s as my grandfather was, someone who became so nervous about health-related issues, he’d bury his head in the sand. Regardless of where this behavior comes from, I handle it the same way with all my patients. I tell them what I see on exam, and the symptoms that these findings often cause, and what to do to treat it:

Doctor: (después del examen). Bueno, primero, quiero decirle que tiene ojos muy sanos, no tiene signos de diabetes y los nervios no son sospechosos por glaucoma. Sin embargo, estoy de acuerdo que usted necesite lentes para manejar – especialmente por la noche – y lentes para leer. Por eso, escribo una receta ahora para usted.

Paciente: Está bien.

Doctor: También, veo que tiene párpados hinchados y inflamados, y eso significa algo se llama “blefaritis”. Con blefaritis, es posible tener síntomas como: ojos rojos, picazón, ardor, lagrimeo reflexiva o la sensación del polvo dentro del ojo. A veces, no hay síntomas. Pero cuando una persona tiene signos de blefaritis en el examen, es importante tratarlo, porque lo que puede suceder si no la se trata es: el orzuelo, sequedad de los ojos u infecciones como celulitis.

Paciente: No tengo los síntomas que dice.

Doctor: Pero tiene blefaritis. En mi opinión, debe empezar un régimen de limpieza de los párpados diariamente. Aquí ( le da al paciente un atomizador de líquido)...utilice este limpiador por la mañana y por la noche cuando se lava la cara. Rocíe el líquido en una almohadilla de algodón y frote los párpados y las pestañas bien fuerte. (le demuestra la acción al paciente). También, le doy muestras de gotas artificiales a poner dos a tres veces al día dentro de los ojos.

Paciente: Gracias.(se pone de pie, listo para irse)

Doctor: Aquí, lleve este papel a la frente – las gotas y el atomizador le esperan ahí.

And then, of course I always give an appointment in a few weeks to check progress. It’s my opinion that  patients should and deserve to know all the findings of their exams as well as possible treatments, whether or not their cultural beliefs dictate otherwise. People are people, and in a manner of speaking, informing and educating someone plants a seed of thought in the mind. Whether or not that thought takes root is up to the individual, but I’ll continue to sew and to tend, as is every doctor’s job to do.

...

References

Bennink, Ashley. “Teaching Culture: the Effect of Machismo on Health and Well-Being”. https://ayudadoctor.wordpress.com/2013/08/01/teaching-culture-the-effect-of-machismo-on-health-and-well-being/

Bennink, Ashley. “Teaching Culture: Machismo Part 2”.   https://ayudadoctor.wordpress.com/2013/07/24/teaching-culture-machismo-part-2/

 

Ponderosa Pine, lone survivor in the desert, Utah