For Latina moms, pediatrician's personality, empathy trump knowledge of Spanish, quick service

February 23, 2012

A small study of Latina women with young children led by researchers at Johns Hopkins Children's Center shows moms value a pediatrician's empathy and warmth far more than their ability to speak Spanish or other conveniences.

A report on the findings is published online Feb. 15 in Journal.

The lead investigator a pediatrics fellow at Johns Hopkins, conducted the research during post-residency training at the University of Michigan as a Robert Wood Johnson Foundation Clinical Scholar.

The study involved interviews with 38 Latina mothers with limited English proficiency whose infants and young received care at 10 primary-care community clinics in Detroit. More than 90 percent of the mothers were of Mexican descent, and most of the children were born in the United States.

Researchers say the study was undertaken in an effort to better understand how to service the needs of Latino children, who make up the largest of children in the United States. These children also have worse access and suboptimal primary care compared with other children. The gaps in care are particularly wide among who live in homes with limited English proficiency, the researchers say.

But the current study suggests that reducing healthcare disparities among these children has little to do with bridging language gaps and more to do with the "good old fundamentals" of physician-patient interaction such as genuine concern, compassion and spending time to do a thorough physical exam, the investigators say.

"As providers, we tend to focus on and sometimes assume that taking care of this in and of itself is enough, but contrary to expectations, language barriers were not the greatest concern," says lead author Lisa DeCamp, M.D., a pediatrician at Hopkins Children's.

About half of the mothers in the study said they were happy with the primary care services their children received. Having a strong and respectful relationship with a pediatrician and a nurse was the moms' overriding concern, trumping other factors like language ability and convenience of hours, the study found.

Because much of childhood illness is unpredictable and with sudden onset, mothers were dissatisfied when walk-ins were not available and they needed to make an appointment. Many reported frustration with clinics that didn't offer evening or weekend hours, which led them to seek care in the emergency room. Expanded hours, same-day sick care, reducing wait and language services were all important. However, mothers were, for the most part, willing to overlook such inconveniences if they liked their pediatricians and nurses. And mothers who liked caregivers were more likely to perceive a diagnosis as accurate and the treatment as appropriate.

"We cannot overemphasize the importance of emotional intelligence and genuine concern for the child and the parent," DeCamp adds. "This back-to-basics approach may be key in reducing any disparities."

The mothers described their ideal provider as warm, caring and friendly, one who didn't rush through the visit, performed a thorough , accurately diagnosed the child, prescribed the appropriate medications and answered all the parent's questions. Mothers seemed to sense when nurses and pediatricians were asking questions out of routine rather than genuine concern.

Moms paid particular attention to whether a doctor or a nurse knew the child's name without consulting the chart, asked mothers and children how they were doing, engaged in a conversation with them during the exam, joked, made the child feel comfortable and asked the child questions directly.

In sum, kind and caring physicians and nurses who took the time to examine and care for the child appear to be as fundamental to Latina as they are to parents of other populations, the researchers note.

"Many medical schools emphasize the importance of sensitivity to ethnic and cultural differences, but this study suggests there may be more similarities than differences across ethnic groups," DeCamp says. "Such commonalities are what we should really focus on."

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