Are there specific cities or states that should focus more on multicultural education? Which ones?
Gutierrez: Yes. There is a more pressing need to conduct targeted multicultural education in those areas that have large numbers of
ethnic or minority groups. For example, the Southeastern United States has earned the designation of "Stroke Belt," which
is a direct reflection of the high prevalence of hypertension and cardiovascular disease in that part of the country. Multicultural
education focusing on African Americans and Hispanics is a major need in the Southeast. Similarly, the West and the Southwest
show a high incidence of metabolic syndrome and diabetes, which disproportionately affect the Mexican-American population.
Healthcare practitioners in inner cities are constantly caring for multiple cultures, so they face the biggest challenges
in providing proper care. These challenges present unique educational opportunities.
How can multicultural education improve the overall healthcare of patients?
Gutierrez: Multicultural education will improve the overall healthcare of patients in several ways. First, physicians will be acutely
aware of barriers that impede communication, and also knowledgeable of ways to penetrate those barriers. This will enable
them to address their patients appropriately, so that they can gain their trust, better understand their needs, and prescribe
the appropriate treatments—in short, they can provide better care.
Secondly, patients will be better educated about their illnesses and how they may be at particular risk because of their race
or culture. They will be better able to adhere to their doctor's prescribed treatments. And finally, patients will be better
equipped to understand and thereby access the complex US healthcare system. They will benefit from earlier appropriate care,
including preventive care, instead of thinking that their only access is the emergency room.
Are there any ethnic groups that doctors need to concentrate on the most? For example, which ethnicity has the highest rate
of heart disease, diabetes or osteoporosis?
Armani: Doctors need to concentrate on those populations that are currently at high risk and those that receive the worst care, which
unfortunately represents a very large segment of the US population—African Americans and Hispanics. In these groups, certain
diseases have become endemic, such as diabetes, cardiovascular disease, HIV, and certain cancers. African Americans experience
the highest risk of mortality from heart disease, Hispanic Americans face double the risk of dying of diabetes compared to
all others, and Native Americans die disproportionately from diabetes as well. Additionally, HIV has become a major epidemic,
primarily affecting African Americans and Hispanics, especially Hispanic women. Minority groups are at especially high risk
of cancer death, in part due to delayed diagnosis of what can be a treatable disease.
What are some strategies doctors need to know about in order to approach a patient who might be resistant to diet or lifestyle
Gutierrez: Often, Hispanic patients involve family members in their medical decisions, so it's crucial to let the doctor know the people
they need to approach. It's the family member the medical provider should talk to and teach how the patient should follow
medication and follow lifestyle changes. Doctors have to control the decision maker in order to control the patient. In African-American
and other cultures, physicians have to be able to understand that culture and know how influence works. They have to influence
the patient with something or someone that is of value to them. For example, if a patient is resistant to change, it's vital
to tell the patient it's not about him, but how he will affect the other individuals in his life.
CME programs have to be designed to provide doctors with these tips and tools to help patients dispel myths about certain
conditions. When dealing with diabetes or heart disease, some patients don't know it's a silent disease with long-term effects.
A Hispanic person with diabetes might be resistant to taking insulin because she's heard it will make her go blind, when in
reality it's the progression of the disease that is causing her to lose her eyesight. There are a lot of mistakes and misconceptions,
so it's up to the doctor to educate them about their illness and health.