Maria walks in my office looking distressed. “I had an appointment with the endocrinologist, and he barely allowed me to talk.” She was under a lot of stress trying to balance work, her husband and children, and family visiting from the Dominican Republic. She shared many details about how happy she was having her relatives visit and all the places they had visited. She also noted that her exercise and meal-prepping routine were disrupted, and she was having problems managing her blood glucose.
At doctor’s visits, do you find the need to set the stage and tell the backstory before you focus on signs and symptoms? Do you embed the symptoms in your story? If others have told you that you are long-winded, you may simply be a circular or high-context communicator. Circular or high-context communicators are storytellers. They address many points related to the topic and may embed the symptoms in the story. Linear or low-context communicators are the opposite. They get to the point. The conversation is conducted in a straight line, and the key points are stated explicitly.
In the United States, most people choose a linear style of communication. Those from circular or high-context cultures, such as Mediterraneans, Slavs, Central Europeans, Latin Americans, Africans, Arabs, Asians, and American Indians, may experience challenges when communicating with low-context linear communicators. Maria’s concern was her high blood glucose levels. She felt it was important to share the story about her relatives visiting and bringing special treats, her lack of sleep, and her high levels of stress.
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As Maria’s story illustrates, important details can be lost at times between patient and provider in medical appointments. Although the reasons are varied, contributing factors are often these different styles of communication or differences in cultural background. Here are some strategies that can help you spot and overcome these barriers and work together to ensure the best care.
Tips for getting the best care at your doctor’s visit
1. Tell an abridged version of the story and mention your concerns in order of importance.
Make sure you note the most important item first. For example, “My blood glucose is above target. I am not sleeping well, and I am exhausted. I am under a lot of stress because my routine has changed. I am eating different foods and eating out more often than usual and I have not had time to exercise.”
2. Have a list of questions ready.
In Maria’s case, for example, some of the following questions would have helped address her concerns:
- Can stress affect my glucose?
- Can lack of sleep affect my glucose?
- I am going to be eating out more often. Do you have tips for me when eating out?
3. Share any alternative or complementary approaches you are considering or using to treat your diabetes or other health conditions with your team.
Complementary or alternative medicine are therapies that are not used in mainstream medicine. Here are some examples of commonly used complementary medicine:
- Eating prunes to keep the digestive system on track
- Soothing a cold with chicken soup
- Eating saltine crackers or drinking ginger tea for nausea or an upset stomach
Many cultures have a plethora of medications, teas, vitamins, herbs, and other treatments used for managing and preventing disease. If you are considering or using treatments not prescribed by your health care team, here are some good reasons you should discuss them at your next visit.
They could enhance the effect of diabetes medications
For example, certain plant parts are used in a variety of cultures for possible blood-glucose-lowering effects. Using these along with diabetes medication can potentially cause hypoglycemia (low blood glucose).
They could block the effect of medications
Alternative and complementary approaches can sometimes interfere or interact with prescription medicines, reducing or otherwise altering their effects.
They may not have the right ingredients or method of delivery
For instance, taking a supplement in tablet form that has only been shown to yield positive results when administered intravenously may not have the hoped-for effects.
They may not work and they could cause adverse effects
Dietary supplements are not regulated by the Food and Drug Administration (FDA), meaning that the amount of active ingredient in these products can vary greatly. Additionally, although they may be promoted as “natural,” they can still cause side effects.
If you are taking nonprescription supplements or herbal medicines, share the following information with your health care team:
- A list of the supplements or medicines
- Your reason for using them
- Dose and frequency
- If you use food to manage your condition, indicate what part you eat (e.g., fruit, leaves, stem, pit), how much you eat (e.g., 1/2 cup, 1 cup), and how often
Also ask the doctor the following questions:
- Does this interfere with my current medications/treatment regimen?
- Am I taking the right form and dose?
- What are the potential side effects?
- How effective is this approach?
Your provider can provide feedback on whether the approach is safe and effective.
4. Discuss your cultural food preferences.
You may have received a diabetes exchange meal handout and found that it did not list a favorite food that is popular in your culture. Here are some strategies to make sure your cultural foods are always part of your diabetes meal plan.
- Break the food down into its basic ingredients: For example, in the case of papadum, a seasoned flatbread from India, the main ingredients are typically black gram (urad or chickpea flour), water, and cumin seeds. For this item, you would want to determine if chickpea flour is listed on the food exchange list.
- Visit the USDA’s FoodData Central at fdc.nal.usda.gov. This website has an extensive food database that includes the nutrient composition of many foods.
- Share how often you eat your cultural foods, how you prepare them, and what else you have them with. Your registered dietitian nutritionist will provide you with the information you need to eat these foods and manage your blood glucose levels.
- Bring a list of ingredients and food labels for your favorite foods to medical appointments. Many cultural foods hide nutritional treasures. For example, one of my Mexican patients dislikes kale even though she knows it is very nutritious. However, she likes quelites, assorted dark green leafy vegetables, and she discovered she could eat quelites instead of kale because they have a similar nutrition profile.
- Don’t be afraid to ask for substitutions. For example, if you don’t like the taste of brown rice, ask what you can eat instead.
- Ask your health care team to help you find healthier options for traditional favorites. You don’t have to change an entire dish, but you can often tweak it without compromising taste and tradition.
5. Plan for holidays and cultural celebrations.
What do Christmas, Thanksgiving, New Year’s Eve, and other holidays have in common? Food! Besides turkey, ham, fish, and mashed potatoes, you may also prepare your traditional cultural dishes for these celebrations. Your cultural holidays and observances may also include fasting, such as during Yom Kippur and Ramadan.
Whether you feast or fast, your health care team can help you do it safely. Here are some must-ask questions:
If you are feasting:
- How can I adjust my favorite cultural holiday dishes to make them more healthful?
- What can I do to minimize out-of-range blood glucose values during the feast?
If you are fasting:
- Can I fast safely?
- How often should I check my blood glucose?
- Do I have to adjust my medications?
6. Understand your medications.
Understanding your medications is the first step to taking them as prescribed. While many people are hesitant about taking medicines, a study showed that Latinos and African-Americans have more concerns about diabetes medications than whites. While some concerns may be valid, stopping your medicines can result in poor diabetes outcomes. If you have concerns about any of the medicines you have been prescribed, arm yourself with knowledge by contacting your doctor or diabetes care and education specialist. Here are some important questions to ask.
If you don’t like taking multiple medications:
- Can I have a combined pill instead? There are some medications that combine two medications into one.
If you have a limited budget:
- Where can I find medications at low cost? Can you provide me with a list of patient assistance programs?
If you are concerned about side effects:
- What side effects might I expect with this medication?
- How likely am I to experience side effects?
- How long will they last?
If you are taking a medication and can’t tolerate the side effects, before suspending the medication, call your doctor and ask:
- What other medication do you recommend?
- Can I suspend this medication safely? If so, what steps do I need to take?
If the medication dose concerns you:
- What is the starting dose?
- Am I going to stay on this dose or is it going to change?
- How does this dose compare with other medications I am taking?
- What is the highest dose I should take?
If your doctor adds a new medication:
- Why do I need an additional medication?
- Is my condition progressing?
- Should I expect any side effects or different results in my condition?
When you visit your doctor or other members of your diabetes health care team, you bring your culture with you. Your communication style, favorite foods, and health beliefs and practices affect your patient experience. Enhancing cross-cultural communication will make your visit more productive and help you achieve your diabetes management goals.