Maria, a thirty-five year old Latina patient, presents for services at your practice. This is the first time at your practice, and she is seeking an annual physical exam. Maria brings her nine-year old son with her to the appointment. You note that her admission health record was completed in full and she had no significant health problems. She is married and has 3 children aged 9, 7, and 3 years of age. Maria was born in Mexico and has lived in the United States for 10 years. Upon reviewing the nurse’s records, you find that Maria has a blood pressure of 170/95 and a BMI of 30.
During your interview you note that Maria is pleasant but appears somewhat apprehensive. While you attempt to gather a more extensive health history, the patient provides you with little additional details. She answers you with a nod or shake of the head, and smiles often. When you ask if she understands, she says yes. Maria looks at her son quite often during the interview, and they will occasionally whisper Spanish to one another.
After her son leaves the room, you conduct a physical examination that is normal. You then discuss with Maria your diagnosis of hypertension and options for treatment that include reducing salt intake, weight loss, and medications. You provide her with options to assist her in dietary changes and encourage her to be physically active. You also provide her with some Web sites to visit for additional information. At the end of this conversation, you again ask the patient if she understands, and she again says yes.
Finally, you talk with Maria about blood pressure medication, which she seems agreeable to. You tell her that you will telephone the prescription to the local pharmacy, and she will need to take one pill two times daily. You ask the patient if she has any questions, and she says no.
Three months later, Maria returns for a follow-up visit. An older sister accompanies her to the clinic for this visit. Maria’s BMI and blood pressure remain at the same levels. When you ask Maria to tell you about how well she adhered to the management plan, she gets anxious and turns to her sister. The sister explains that Maria lacks confidence in her English and communicates primarily in Spanish.
She says that Maria ‘s mother lives with the family and encourages her daughter to take folk remedies instead of the medication that was prescribed. The mother also does most of the cooking for the family. Lastly, she says that although there is a computer in her home, Maria gets most of her health information from friends and family and does not trust what she reads on the internet, even if it is in Spanish.
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