P-895: Challenges of providing infertility services to a low-income immigrant Latino population

Abstract

Previous research indicates that infertility is perceived as a devastating life crises in the Latino community. We were interested in couples perceptions of the basic infertility services offered by an urban University-affiliated public teaching hospital. Ethnographic, qualitative interview study. In-depth interviews were conducted with Latino immigrant couples (99 women and 37 men), ages 18-48, who were attending a once/weekly Infertility Clinic at a University-affiliated public teaching hospital. The transcribed interview data were analyzed for thematic content. Most respondents came from rural areas in Mexico and Central America, spoke no English, and had on average a 5th grade education. We identified five areas in which providing care proved problematic: (1) Communication. Resident physicians often attempted to communicate with patients in Spanish because of the paucity of translators, yet their Spanish was often too simplistic or too technical for patients to grasp what was being said. Patients, in turn, often had difficulty making themselves understood, and often did not convey important information because no one had asked for it. The patients’ cultural tradition of telling about their infertility in story form was at odds with the physicians’ need to get a medical history in a short period of time while the patients’ unfamiliarity with the kinds of information physicians needed often led to omitting critical parts of the story. (2) Comprehension. Patients had little comprehension of basic reproductive physiology or anatomy and frequently did not understand physicians’ explanations, and as a result, understood very little about their medical diagnosis or treatment. Patients didn’t ask for clarification because they didn’t know what questions to ask, they were embarrassed to admit they did not understand, and they did not want to be disrespectful to the physician authority figure. (3) Cultural conflicts over bedside manner. Patients were intimidated by the resident physicians and interpreted unsmiling faces as indicating unfriendliness or dislike. As a result, patients often viewed physician demeanor as being emotionally rough. (4) Continuity. Because medical student and resident REI rotations were only 6 weeks long, there was usually a different physician seeing the patient each visit. Patients were frustrated when the new doctor didn’t know the whole story, or the new resident either elicited new information or overlooked old information, thus changing the treatment approach from visit to visit. (5) Hospital bureaucracy. American bio-medical practice is alien to patients and they had a great deal of difficulty dealing with timed laboratory procedures, appointment scheduling, and follow-up visits. This resulted in many patients having to essentially “start over” on multiple occasions. Low income immigrant patients at urban infertility clinics may understand very little about their medical treatment and have difficulty receiving even minimally adequate care. For services to be effective, each new cohort of students and residents rotating through the REI should be made sensitive to the challenges to treatment and the critical role of culture in dealing with this patient population. Compassionate explanations at an appropriate technical level using visual aids through an interpreter are more likely to be effective.