Hispanics shift hospitals' resources

11:26 PM CDT on Friday, September 14, 2007
By JASON ROBERSON / The Dallas Morning News
jroberson@dallasnews.com

Last year, for the first time, fully half of Parkland Hospital's patients were Hispanic.

Over at Methodist Dallas Medical Center in Oak Cliff and Methodist Charlton Medical Center in southwest Dallas, 22 percent of patients last year were Hispanic – up from 14 percent just 10 years ago.

Meanwhile, doctors and clinics across the area say they are seeing growing numbers of Hispanic patients, many of whom don't speak English and have their own cultural attitudes toward treatment and ethnic vulnerabilities to disease.

This shift has meant changes in the way health care professionals interact with those in their care, and in the kinds of problems doctors must look out for.

At Dallas hospitals, there are now signs in Spanish as well as "translation phones." Texas medical schools are teaching Spanish to the state's future doctors. And physicians and insurers are focusing more on diabetes, a particular problem among Hispanics.

Such accommodations are not without controversy.

Some argue not enough is being done to tailor care to a group expected to account for nearly 60 percent of the state's population in 30 years. They say doctors working in Texas should be required to speak Spanish, or at least have a better understanding of the Hispanic culture.

But others bristle at the notion doctors should spend time in medical school learning a foreign language rather than honing their craft. "I think the reasonable thing is for doctors to learn how to practice medicine well," said Dr. Jerry Frankel, a Plano urologist who recently retired after 33 years. "If you make the doctor speak Spanish, then what about Chinese? ...Where do you draw the line?"

And the accommodations go well beyond language.

At Parkland, for example, all medical forms are now available in Spanish and the hospital is installing Spanish signs. More than 300 special telephones with two phone handsets serve as electronic translators throughout the hospital. Patients talk into one receiver in their native tongue to a distant translator about their ailment; their doctor listens at the second handset as the translator explains the problem in English.

Texas Health Resources, the largest hospital system in North Texas, has made its entire Web site – www.texashealth.org – available in Spanish as well as English. The system, which includes Harris and Presbyterian hospitals, says it is the first, and so far only, local hospital system to do so. Many of Texas Health's 13 hospitals hold health fairs with names like "Fiesta Diabetes" and "Hispanic Wellness Fair."

In San Antonio, the country's largest Hispanic-majority city, Methodist Healthcare System last month became the first and only U.S. hospital to be designated a "Hispanic Healthcare Hospital" by the Diversity Health Care Program of Mexico, a Mexico-based advocacy group for better Hispanic health.

Methodist Healthcare impressed the judges with Spanish used in everything from legal documents to the magazines on waiting room coffee tables.

Diabetes, cancers

Compared with whites, Hispanic Americans have higher mortality rates for stomach and liver cancer. They are twice as likely to have diabetes – and are twice as likely to die from it than white diabetes patients once they get it, according to the Texas Medical Association.

Dr. John Menchaca, a pediatrician at Cook Children's Medical Center in Fort Worth, has spent the last decade fighting diabetes in his Hispanic patients, who represent 85 percent of his practice.

Obesity is one of the major risk factors behind the surge in diabetes cases in the U.S., and Hispanics are more likely to be obese, according to the Texas Medical Association.

Dr. Menchaca developed a 36-week program with the help of an exercise physiologist, a nutritionist and a psychologist to treat overweight kids on the path to diabetes.

He said his program does what insurance companies have failed to do: prevent obesity, rather than treat the complications of it. Insurers push wellness programs to companies, but they are not doing enough to prevent obesity in individuals, Dr. Menchaca said.

"If I'm fighting obesity and I need some help, I'm [as a patient] only allowed two visits to a nutritionist," he said.

And, despite their risk, Hispanic diabetes patients often get even less treatment than their white counterparts. Among people over age 40 with diabetes, 51 percent of whites had the recommended hemoglobin A1c test, retinal eye examination and foot examination in the past year, compared with only 41 percent of Hispanics, according to the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services.

Insurance normally covers such tests, but Hispanics are increasingly likely to be uninsured. Earlier this month, the U.S. Census Bureau reported that the percentage of uninsured Hispanics jumped to 34.1 percent – for a total of 15.3 million people – in 2006.

Insurers Humana Inc. and UnitedHealthcare counter Dr. Menchaca's criticisms with examples of health education initiatives that target Hispanics.

Humana came up with the campaign "Su consejero cuando mas lo necesita" ("Your counselor when you need it most") to appeal to Hispanic patients.

When UnitedHealthcare and West Coast insurer PacifiCare merged in December 2005, UnitedHealthcare executives kept PacifiCare's Latino Health Solutions division to fill a void in its relationship with the Hispanic community, said Jaime Gonzalez, national business development manager for UnitedHealthcare's Latino Health Solutions.

In his business pitch for insuring more Hispanics, Mr. Gonzalez uses simple mathematics.

"One-third of the population in Texas is Hispanic – right? If you take whatever business you're in and cut the pie into three pieces and say, 'I don't need one-third of the pie,' is that good for business?" Mr. Gonzalez asks rhetorically.

Hispanic health course

At schools like the University of North Texas Health Science Center in Fort Worth, Hispanic health is becoming a bigger part of the coursework.

UNT began a class this year that teaches students how to use community-based resources to help Hispanic patients.

"If a 15-year-old kid just had a baby and she's undocumented, where do I go? Who do I see? Where can I access resources?" said Dr. Bruce Dubin, associate dean of medical education at the Health Science Center, citing some questions students might face.

UNT's is the first such curriculum at a U.S. medical school, Dr. Dubin said.

At UT Southwestern Medical Center's Allied Health Sciences School in Dallas, Cristina GonzÃ*lez, an assistant professor of physician assistant studies, developed the school's medical Spanish language class five years ago.

It is currently an elective for students studying to become doctors, but Ms. GonzÃ*lez wants her course to become a requirement for new physicians. Relying on translators is not efficient, she says.

"I kind of have mixed emotions, because I kind of feel if you're going to be in this country, you've got to learn English," Ms. GonzÃ*lez said. "But at the same time, I recognize the fact that we have people from all over and it eventually ends up saving money because you're helping these people before their health gets out of control."

Language isn't the only thing that can separate a Hispanic patient and his doctor. There are cultural divides as well.

American doctors often refer their patients to other doctors, not realizing it's harder for most Hispanics, who generally work lower-wage jobs, to repeatedly take off from work, Ms. GonzÃ*lez said.

Hispanics are also more likely to use herbal remedies and nontraditional healers.

Dr. Dubin said he has come across Hispanic patients who believe taking hot chili peppers will cure them. He teaches students to negotiate treatment rather than insult the patient. For instance, an antibiotic can be used along with the chili peppers.

Dr. Rajiv Pandit, an ear, nose and throat specialist in Oak Cliff, said he was struck by the dearth of questions from his Spanish-speaking patients. He first thought there was a translation problem, or that the patients were afraid of him. Now, he realizes they often are just very trusting of doctors.

"You can let them know you're going to put them to sleep and open up their sinuses. They'll look at you and say, 'OK. When do you want to do it?' " Dr. Pandit said. "And what that means is I have to be a little more aggressive about informed consent, a little more aggressive to make sure I've explained the pros and cons."

Bilingual staffing

Dr. Pandit, 38, moved to Oak Cliff from Chicago seven years ago. Though nine employees on his 10-member staff are bilingual, Dr. Pandit is not fluent in Spanish.

Still, he is an example of the effort by non-Hispanic doctors to make their increasing number of Spanish-speaking patients feel comfortable. For instance, his staff took it upon themselves to translate an electronic patient questionnaire template into Spanish, a process Dr. Pandit said was very time consuming but worth it.

But Dr. Menchaca, who is Hispanic himself, says not enough of his peers are trained to understand the special needs of their growing Hispanic caseload.

One solution would be to recruit more Hispanic doctors, a measure the League of United Latin American Citizens supports.

While Latinos now make up 12.5 percent of the U.S. population, "They represent only 3.3 percent of the nation's physicians and only 2 percent of the nation's registered nurses," said Jaime Martinez, co-chairman for LULAC's health commission.

One day earlier this month, Galina Chavez, a bilingual registered nurse at Presbyterian Hospital of Dallas, talked with 86-year-old Paula Alcocer, who had come to the hospital after four days of nagging abdominal pain.

"A lot of times they'll have pain but can't specify where it is," said Ms. Chavez, who is from Peru. "When they know you speak Spanish, they give you more information."

Doctors like Dr. Frankel chose to deal with the problem another way: He said he told his Spanish-speaking patients to bring someone fluent in English to their appointments.

Dr. Frankel retired from practice Aug. 31. The young doctors who replace him may have to be more accommodating.


http://www.dallasnews.com/sharedcontent ... 186bf.html