In this MD Newsline exclusive interview with family medicine physician Dr. Alexis Smith, we discuss how to provide culturally sensitive care and overcome language barriers.
How have you been able to implement culturally sensitive care in your practice?
Dr. Alexis Smith:
“In my well-child visits, I have gone through the Disney princes and princesses [regarding the concepts of gender identity and sexual orientation] with parents of children who are about 4 or 5 years old.
The parents are very receptive, and I don’t know if it’s because I’m in the safety net setting that they’re just very appreciative of all the care they’re getting or if they’re really agreeing with what I’m saying. I’m not sure. But people have not been combative in any way to me talking about these concepts.
Additionally, we always ask about sexual identity and gender identity for patients that are 12 and older in all well-child and adult visits. We say that we’re accepting and supportive of all identities in our clinic. I know not only do I do this [practice], but all of my colleagues do as well. It’s a health metric that we have in my whole healthcare system.
Providers also can wear rainbow pins and pronoun badges. Some waiting rooms have LGBTQ+-inclusive content. Mine doesn’t yet. I need to work on that. But we’re trying our best to let patients know that we are supportive of all identities and that we can encourage the conversations from a young age.”
How do you deal with language barriers so that they don’t impede your ability to deliver quality care?
Dr. Alexis Smith:
“I have a bilingual bonus. I am not fluent in Spanish like a native Spanish speaker, but most of the time, I get through my visits, and everyone understands each other. I think that I have enough of a vocabulary to be sensitive in talking about LGBTQ+ people. Having the education, the life experience of speaking Spanish, I’m able to do that.
There are some times when I will need an interpreter, even with Spanish. [For example,] when there’s a word that’s said that I don’t understand, I get an interpreter because I need to make sure that I understand every bit.
With other languages, it is more challenging. I haven’t really had to have these conversations too often in other languages. Only rarely we’re talking about sexual orientation and gender identity. But we also have interpreters to make sure that we’re getting our message clearly across and that the patient’s message is getting clearly heard, and that we understand each other.
I think it is challenging because then there’s another person listening. So, just explaining that these services are confidential and the interpreters [and providers] are not going to be sharing any of the information that they hear, I think is very important so that the patients feel that their needs are being met.
Most of my pediatric patients speak English, but many of the parents speak Spanish. Separating the child from the parent, which we do anyways during well-child visits when a child’s a teenager, but sometimes if they’re younger and seem like they’re struggling, it’s good to separate the child from the parent. If the child feels like they can better explain themselves in English, that’s also helpful, or, again, if they want to explain things confidentially.”