What are you?

Where are you from? What is your background? What are you? I have been asked variations of these questions for as long as I can remember. For all biological intents and purposes, I am an ambiguous mix of Filipino and Mexican, confusing most people who come my way. Conversations of race and ethnicity have become commonplace to me, and I have learned to be comfortable and not take offense when someone on the street asks me “what I am.”


http://www.downstate.edu/diversity/cultural-competency.html

It was karmic, then, that I fell into a job that requires me to ask similarly invasive questions. These questions relate to who my patients are, at least in terms of their citizenship status, residence, and source of income. More often than not, the answers are very complicated, ranging anywhere from pending citizenship status to multiple jobs with different modes of payment. Knowing how difficult it can be to divulge such intimate details, I try to build my appointments off of a mutual sense of trust, encouraging my patients  to share whatever they are comfortable with.

Unfortunately, by the time patients come to me, they are tired. With the hustle and bustle of a clinic that schedules appointments every ten minutes, cultural and language barriers requiring  an interpreter or longer-than-usual explanations disrupt the routine. The patient not only has to interact with their physician, nurse, or technician via a middleman, but is sometimes forced to deal with the frustration some professionals show when the flow is halted. At times, this makes the patient embarrassed, and their confidence in their ability to communicate drops. Taken together, it’s practically encouraging them to remain silent.

About a month ago, a nurse ushered a new patient into my office. A middle-aged Indonesian man, I asked him what I could help him with, and he apologetically told me that he could not speak English well. When I smiled and responded that it was okay, he seemed relieved and thanked me. He looked at me hesitantly, and I knew what was coming next. “Where are you from?” I told him about my parents, then asked him what part of Indonesia he was from. He launched into an incredible story, describing his journey from Indonesia to rural Iowa to make money so that he could eventually join his family in Philadelphia. As he spoke, I was surprised to hear how clear his English actually was. He became visibly more comfortable speaking and asked me why he needed insurance, as he hadn’t been to a doctor since he moved from Iowa over ten years ago. I couldn’t hide my surprise. I tried to explain the importance of having a primary care physician, but he chuckled and told me that he felt fine. Reminding me of my own stubborn father, I asked him if he had children. He pulled out his wallet, filled with photos of his daughter and her kids. “My dad has photos of me in his wallet, too.” I told him, “I hope that he’ll be healthy for a long time.” The next day, he brought in the documents to apply for insurance and scheduled an appointment with one of our doctors. “I will do it for them,” he said.

After processing his application, I filed his documents away and noted his name in case he ever came back. I am grateful to be one of the few that knows him not for the identity defined by his documents, but for the one he worked so hard to create. I can’t help but wonder, though, how our conversation would have turned out had it taken place through an interpreter, or if he hadn’t felt comfortable enough to speak with me at all. So, what does it take to truly reach patients and form a connection? Perhaps it’s even simpler than we think. Whether it’s acknowledging their differences in a positive way or being open to hearing their stories, it may serve us well to ask in one way or another “what they are.”



This blog post was written by NHC Philadelphia member Jillian Millares.
Jillian serves as an Insurance Specialist at Philadelphia Department of Public Health Ambulatory Health Services - Health Center 2.