Patience is key when working with other cultures

Learn something about their values and customs

Don’t get upset if your case management clients from other cultures have trouble understanding Western medicine, Chue Xiong, RN, advises.

Among the case management clients Xiong works with in her role as care coordinator for Minneapolis-based UCare Minnesota Senior Health Options are people from the Hmong culture.

Throughout her health care career, Xiong has worked with Somali, Russian, Cambodian, Bosnian, and Hispanic patients. Her advice to case managers working with clients from diverse backgrounds apply to more than the Hmong population.

First and foremost, Xiong advises, be patient with your clients. Many don’t understand Western medicine, and it may take some education to get them to agree to treatment.

"These clients may not be familiar with technology or with western practices of treatment. When I deal with the Hmong members, I have to take that into consideration and explain it over and over to the family," she adds.

Xiong spends a lot of her time explaining the Hmong culture and traditions to clinicians. For instance, the patient may not be the person in the family who can make health care decisions. It may be an older or a younger member who needs to be called in.

"As a case manager, you have to know the family structure. We have to make sure that the person in the family who is responsible is called in when there is a need to communicate," she says.

Sometimes, a physician may not understand the Hmong traditions and how they affect health care decisions.

For instance, if a patient has cancer and the physician wants to do a biopsy, the patient may decide to wait and involve the family in making a decision about whether an invasive procedure is right for them.

"That is where I walk in. I tell the physician that we need to have a care conference and find out who is the decision maker in the family. The process of making a decision for treatment can take a long time, and sometimes there is an emergency and the doctor needs to know right away. My role is to help improve the communication between the health care provider and the Hmong family," Xiong says.

Xiong acts as a liaison between the physician, who often feels that immediate medical action is necessary, and the family, who may want to think about it and consult among themselves.

"The physician may not understand that the patient needs to go through such a process. I tell them that they have to wait for the patient and family members to make the decision to prevent future problems," Xiong says.

Occasionally, if the patient has a terminal illness, the physician will ask if the family wants to bring in the Hmong shaman, or spiritual leader, for a traditional ritual.

"I tell them that the ritual is very complicated and must be done in the home because it’s very noisy and very intrusive for other patients in the hospital," Xiong says.

Here is some other advice from Xiong for dealing with patients of other cultures:

  • If you don’t know much about the client or the population, be honest with them and ask questions.
  • Learn something about the cultures of the people with whom you work. They won’t expect you to know the language, but you should know about their culture, Xiong says.
  • Make sure you have an interpreter who is familiar with the language and the culture as well. For example, Hmong are very polite and if you ask a question they don’t understand, they may say "yes" so they won’t offend you.
  • Remember that people in some cultures need a lot of time to evaluate information before they make a decision. Be patient with them. Advocate for your clients and be there for them.
  • Remember that building trust is a slow process. It may take a while for them to open up to you, but if you’re patient, you’ll find that they trust you more with each encounter.
  • Respect their culture and particularly the family culture.