Values, World View and Communication
Personal relationships are valued. Asking about the patient’s family and interests before focusing on health issues will generally increase rapport and trust.

Patients may have a fatalistic view of the world, which can interfere with adherence to preventive health care.

Time Orientation
Many have a present time orientation, which may impede use of preventive medicine and follow-up care. Explain the need for preventive medication (such as for hypertension) and to finish antibiotics even after symptoms have disappeared. Tie adherence to something they care about (e.g., dancing at a daughter’s wedding or seeing a grandchild).

Pain
Patients may tend to be expressive (loud) when in pain, although it varies with the audience (males may be more expressive around family members than around health care professionals). However, remember that just because it is acceptable to be expressive, it doesn’t mean there is not a real medical problem. Always investigate.

Family & Gender Issues
Large families are common and all may visit the patient. Allow family members to express their love and concern by spending as much time with the patient as possible. Allow them to assist patient with activities of daily living if the patient is reluctant to do self-care.

Patients may be reluctant to discuss emotional problems outside the family.

Modesty may be important, especially among older women. Try to keep them covered whenever possible.

Older, more traditional wives may defer to husbands in decision-making, both for their own health and that of their children. When patients come in, find out with whom they may want to consult before making decisions. They may want to involve family members.

Pregnancy & Birth
The traditional birth partner may be the mother-in-law or other female relative.

Women are generally stoic while giving birth.

Pregnancy is seen as a normal condition, so prenatal care may not be sought.

The woman’s mother may be the preferred birthing partner.

Laboring women often yell out “aye yie yie” — a loud form of controlled breathing. Others will be stoic.

Traditionally, new mothers avoid cold, bathing & exercise for 6 weeks post partum. Respect post-partum prescriptions for rest. Sponge baths may be preferred.

Since pregnancy is traditionally thought to be a “hot” condition, birth is thought to deplete the body of heat. Restoration of warmth is important. Offer liquids other than ice water, which may be deemed too “cold.”

Pediatric
There are a number of folk diseases that affect children, including mal de ojo (evil eye), caída de la mollera (fallen fontanelle, often cause by dehydration), and empacho (stomach pain).

 “Evil eye” is generally believed to be caused by envy when someone compliments a child. Be sure to touch the child when complimenting him or her to prevent this. The child may be wearing a red string or “deer’s eye” (a large brown seed with red string) to prevent it.

Herbal remedies are often used. Be sure to ask about them. Chamomile tea (manzanilla), used to treat colic, is generally safe and sometimes helpful. However, greta, a yellow to grayish-yellow powder, and azarcón, a bright reddish-orange powder, both used to treat empacho (stomach pain), contain lead and can be dangerous.

A chubby baby is seen as a healthy baby, so additional teaching regarding diet and diabetes may be warranted.

A baby with a fever will often be bundled up, which may run counter to the use of cooling measures that may have been instructed. It is important to include the grandmother in patient teaching since she may have the most say in terms of day-to-day health care issues, especially if she lives with the family.

Belly button binders may be used to prevent an “outie.” Your concerns should be with the cleanliness of the coin and the tightness of the binder. Instead of advising caregivers not to use a binder, teach them to make sure the coin is clean and that the binder is not too tight.

End of Life Issues
Since family members may want to withhold a fatal diagnosis from the patient, ask patient upon admission (or before the need arises, if possible) how much information they want to be given regarding their condition, or to whom the information should be provided.

Family members may resist hospice for fear it will emphasize the fact that their loved one is dying and thus encourage the individual to give up hope and the will to live.

The family of a terminal patient may be reluctant to remove life support lest it be seen as encouraging death. If the illness determined to be “punishment by God,” life support may be considered interfering with the opportunity for the patient to redeem his or her sins through suffering. At the same time, however, traditional respect and courtesy toward physicians may lead the patient or the patient’s family to agree with a doctor who suggests removing life support, even when they are opposed to it.

Health Related Practices
A predominant theory of illness is that it results from an upset in body balance. Patients may refuse certain foods or medications that upset the hot/cold body balance, even if they don’t verbalize it as such. With this in mind, offer alternative foods & liquids. Ask if they prefer water with ice or at room temperature.

Among those following more traditional practices, “fat” is seen as healthy. Many Mexican foods are high in fat and salt. Thus, nutritional counseling may be necessary for diabetics and individuals with high blood pressure.

Ask what remedies, if any, the patient has tried before coming in. Ask in a way that implies that all of your patients attempt self-treatment before coming in, and that you need to know what those attempts were to avoid prescribing something that could result in a bad interaction. Do not let patients believe you are criticizing them for trying home remedies or seeing other healers. Doing so may lessen their trust in you.