While the ACA has the potential to improve access to care and narrow the chasm between who gets good health care and who does not in this country, access begins with understanding. Hispanic Americans, the fastest growing minority in this country, may be hampered from the start. Stopping the crippling disparities Hispanic Americans face in pain management can only occur once the language barriers and misconceptions are addressed.
The first hindrance is in the language itself, and this occurs in the very naming of the site through which Hispanic Americans should sign up for benefits. Since there is no direct translation for the word “healthcare” in Spanish, the Spanish language counterpart of healthcare.gov is cuidadodesalud.gov. This translates to being “careful” with health. It’s not exactly the same meaning. Not only may access get lost in translation, but pain management could, too.
My residents universally know that dolor means “pain.” As anesthesiologists, our expertise is in removing pain. Yet, in my experience, I have seen that not everyone’s pain goes away.
Pain is one of the most common reasons patients seek medical attention. It can interfere with the ability to do basic activities, and untreated pain can significantly worsen a person’s quality of life. Pain is also incredibly costly; in the United States, pain costs between $560 and $635 billion annually, counting lost days of work and treatment fees.
What many don’t know is that your race and ethnicity can affect whether or not you receive treatment for pain. This is true particularly for Hispanics. Several studies have shown that Hispanic patients are less likely to receive pain medication during acutely painful situations, such as in the management of surgical pain, or after breaking a bone. Disparities have also been found in the treatment of more chronic painful conditions, like cancer.
Duele. It hurts. As a trainee, who grew up in a Spanish-speaking household in Miami, I saw Hispanic women repeatedly refuse treatment for labor pain. In fact, that one word altered my career path, and I chose to focus my research on understanding racial and ethnic disparities in pain management.
What I found was that there was a large disparity in epidural use. My colleagues and I at Northwestern Memorial Hospital initially thought that the desire for a natural childbirth would be the leading reason pregnant women would reject an epidural for labor. After interviewing more than 500 women, we were surprised to learn that almost half of them declined an epidural for labor due to fear and misconceptions about what the procedure is and what it does. Women feared that they or their babies would be harmed. Among Hispanic women, two major concerns emerged: the fear of chronic back pain and the fear of paralysis. Multiple studies have shown that there is no association between the use of an epidural for labor and future back pain.
Similarly, another survey of 50 Hispanic women found that 76 percent were avoiding epidurals because they were afraid of being paralyzed. One woman that we interviewed as part of one of my studies was adamant that any movement during the procedure could cause paralysis, which is simply not true.
Miedo. This means fear. Many would say that pain is subjective, and that it is a patient’s choice whether to treat pain; however, while that is true, patients need to have the right information to manage pain appropriately. As we found with the fear of paralysis and epidurals, patients may be making decisions on pain management due to unfounded fears.
These fears need to be addressed through education, in language that patients can understand. The Hispanic community is diverse, and not all needs are the same, as a recent landmark study of Latinos health needs by the National Heart, Lung and Blood Institute affirmed.
As patients or family members, we should ask questions, and not assume we completely understand how to manage pain. As physicians, we should ensure that patients understand their pain management choices. No one knows if targeted, culturally sensitive education will reduce disparities in pain management in the Hispanic community; but such education has been effective in improving knowledge in other areas where misconceptions exist among Hispanics, such as in organ donation. For instance, some believe that physicians may not try to save a dying patient if they know the patient is an organ donor, or that wealthy patients on the transplant waiting list have priority for available organs. Neither of these are true.
We need to do more to understand the health of the Hispanic community, y tenemos que tener cuidado, we need to be careful, when it comes to our health, so that moving forward, we can eliminate racial and ethnic disparities in healthcare.
Paloma Toledo, M.D., M.P.H. is an Assistant Professor of Anesthesiology at Northwestern University and an OpEd Public Voices Fellow. Dr. Toledo's research is funded by the Robert Wood Johnson foundation and focuses on reducing racial and ethnic disparities in pain control.