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2 fhea.com Fitzgerald Health Education Associates, Inc., April 2015 patients. 2 Language Barriers Limited proficiency in English is a significant obstacle to care for many Asian-born persons living in the United States. Being unable to communicate clearly with their clinician can cause Asian patients to avoid seeking health care altogether, as well as lead to re- duced compliance with recommended diagnostic testing and treatment regimens. 3 Due to a lack of bilingual staff members, ad hoc interpreters such as family and friends of the patient are often used, but this can lead to inaccurate translation and interpreta- tion. Whenever possible, trained interpreters should be used, since use of appropriate interpretive servic- es is associated with improved quality of care. 4 When a trained interpreter is not available, each sentence of the clinician-patient discussion should be translat- ed individually so that both patient and clinician can follow the conversation closely. 4 Cultural Issues Aspects of Asian culture that can affect the delivery of health care to Asian patients include the following: • Attitude toward suffering. Many persons from South- east Asia, including Vietnamese, Cambodians, Lao- tians, and Hmong, follow Buddhist teachings, and many from China are influenced by Confucianism; both of these belief systems view human suffering and illness as an unavoidable, natural part of life. 5 Holding these beliefs can cause patients to delay seeking health care. Similarly, Asian culture in gener- al values stoicism and emotional self-control, includ- ing maintaining a stoic attitude in the face of pain or illness, which also can lead to delays in care seeking. • Cause of illness. Many Asians' conception of what caus- es illness or disease differs from the Western health care model, which focuses on identifying and treating specific organic problems. For example, the traditional Chinese view holds that certain illnesses are caused by an imbalance of yin and yang or an obstruction of life energy, or chi (see Traditional Chinese Health Practices ) and can be cured by traditional therapies such as acupuncture, coining, or herbal medicines. The influ- ence of traditional Chinese health practices can be seen in many other Asian cultures. For example, tradi- tional Vietnamese culture combines up to three mod- els of health: a model based on the Chinese traditional healing with its focus on yin-yang imbalances, an or- ganic model in which illness is related to the nervous system, and a model that attributes mental illness to supernatural causes. 5 Traditional beliefs regarding health are another reason Asian patients can delay seeking care. If they believe their illness is the result of a nonorganic cause, they often will seek traditional remedies first or in lieu of Western health care. Clini- cians should ask patients about their use of tradi- tional therapies and herbal medi- cines when taking the history of an illness. • Indirect communi- cation styles. Asian styles of communicating reflect cultural values that emphasize politeness, re- spect for authority, and avoidance of shame. 3 As a result of these cultural factors, Asian patients can be reluctant to ask questions, express reservations about a diagnosis or treatment out of fear of show- ing disrespect, or contradict or indicate that they do not understand the clinician. When interacting with a clinician, Asian patients may nod, smile, or say "yes," seemingly to indicate their approval or under- standing of what the clinician has said, when in fact, they do not understand, consent, or agree. 6 • Attitudes toward mental health issues. Asian cultures tend to view mental illness as stigmatizing and a form of personal weakness. As a result of this nega- tive cultural attitude, Asian patients often avoid seeking care for psychological disorders and in some cases (eg, first-generation immigrants) are Asian culture in general values stoicism and emotional self-control, including maintaining a stoic attitude in the face of pain or illness, which also can lead to delays in care seeking. Certification Q&A;