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Teaching and Learning Moments: A Different Look

Rapp, David E. MD

Teaching and Learning Moment

Dr. Rapp is a resident in urology, University of Chicago Hospitals, Chicago, Illinois.

An interest in Latin American culture led me to become a Spanish major in college. During college and medical school, my studies took me into the Latin American community as a participant in medical missions to foreign countries and as an emergency technician within a largely Latino community in the suburbs of Washington, DC. These experiences gave me a strong understanding of the language and the culture of Latin America. However even today, as a resident physician in Chicago, I continue to learn about the culture and how it influences medical practice and interaction with Latino patients. Through one experience, I came to realize that a different perspective to the simple stomachache could allow me to better understand Latin American culture.

As an emergency technician, I encountered a young woman who had brought her son in after he suffered an episode of vomiting. No clinical abnormalities were found and she was told that only conservative care was appropriate for what was likely gastritis. The look on her face revealed that despite this reassurance, something continued to worry her.

This experience was my introduction to empacho. Empacho, an illness of folk origin that is common in the Latino community, is most closely defined as gastritis. Patients with empacho may present with abdominal pain, lack of appetite, or nausea, and it is believed by some patients to result from gastrointestinal obstruction or consumption of the wrong type of food. No evidence of mechanical obstruction is generally found using modern imaging modalities. However, abnormalities may be seen on the physical or laboratory examination, which are many times the result of home remedies used to treat these patients. Dehydration, dermatitis, and lead poisoning have all been described as a result of home remedies.

Ninety percent of Latinos interviewed as part of one study knew what empacho was, while 64% stated that a child in their household had been afflicted with the illness.1 Of those who reported having a child with empacho, 33% began treatment with a home remedy, 33% initially took their child for care under a folk therapist, and 33% initially took their child for evaluation by an allopathic physician. The majority of those interviewed who took their child to an allopathic physician at some point during the illness reported feeling that these physicians did not understand empacho. This lack of faith that many Latino patients have in allopathic physicians is common and is what I saw in this young woman's expression. I spent the next ten minutes listening to this woman and, in doing so, attempted to acknowledge and discuss her concerns.

Interactions with Latino patients have given me an appreciation and understanding of cultural differences that exist between Latino patients and myself. More importantly, I have learned the value of acknowledging these differences and the concerns that patients of all ethnicities can have as a result of their cultural identities. Now when I see a confused look on a patient's face, I spend a few extra minutes providing an explanation and reassurance. It is my hope that this simple step allows me to gain the confidence of that patient, which I feel is needed to truly treat their underlying concerns.

David E. Rapp, MD

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1.Pachter L. Culture and clinical care: folk illness beliefs and behaviors and their implications for health care delivery. JAMA. 1994;271:161–3.
© 2004 Association of American Medical Colleges