Bill Klaproth (Host): Today, we are highlighting Spanish-speaking clinics in Northwestern Medicine with two Northwestern Medicine physicians on Better Edge, a Northwestern medicine podcast for physicians. I'm Bill Klaproth. And with me is Dr. Irene Blanco, Professor of Medicine in the Division of Rheumatology, and Dr. Paulina Gonzalez-Latapi is an Assistant Professor of Neurology. Welcome, Dr. Blanco and Dr. Gonzalez-Latapi.

Irene Blanco, MD: Great. Thanks so much for having us, Bill.

Paulina Gonzalez-Latapi, MD: Hi, Bill. Very nice to be here

Host: Yeah. Thank you so much for your time, looking forward to talking with both of you. Dr. Blanco, let me start with you. So, how was the idea of establishing Spanish-speaking clinics introduced at Northwestern Medicine?

Irene Blanco, MD: Sure. Thanks so much for that question. So, it's actually part of the reason why I came to Northwestern. My work has been predominantly focused on addressing health disparities, particularly in patients affected by systemic lupus erythematosus. And it's an autoimmune condition that predominantly affects mostly women of color actually. And so, there's a very high prevalence in Hispanic communities. And given the fact that we're in Chicago with a large Latino community, in building up the Lupus Center here, it was a main focus to be able to like bring in those patients and to set up a clinic to be able to help service these patients.

Host: It just seems to make sense to have Spanish-speaking clinics here in the Chicago area. That absolutely makes sense. And Dr. Gonzalez-Latapi, could you provide an overview of your clinics and how they aim to improve health outcomes?

Paulina Gonzalez-Latapi, MD: Of course. One important component of the clinic is actually being able to provide that care, not only in Spanish, if that's the patient's preferred language, but also in a culturally sensitive manner. So, having the staff and the resources that take into account what's the heritage of the patients that we're seeing. There's several ways in which this can improve health outcomes. First of all, my experience has been that a lot of patients feel very comfortable being able to speak in Spanish. And so, that language barrier is helped. So, as physicians, we're better able to understand what their issues are. And also, we're better able to have a conversation about why are we making the recommendations that we are making? Why are we suggesting certain interventions? And then in the end, this also will improve some of the ways that the patient themselves approach their own healthcare and it increases their agency to advocate for themselves. They feel like they have that team that's really taking care of them.

Host: Well, making patients feel comfortable, I could see where that would really be a benefit, as you say. And Dr. Blanco, what are some common challenges then faced by Spanish-speaking patients in a traditional healthcare setting, and how do these clinics help solve them?

Irene Blanco, MD: As Dr. Gonzalez-Latapi alluded to, language is a major barrier, not only just the basic being able to communicate in your own language, but then the added layer of addressing health literacy within a culturally and language concordant setting, because just because we're actually speaking in Spanish does not necessarily mean that I won't be using a ton of jargon, et cetera. Because I may be speaking what I like to call medicalese, right, as opposed to a layman's version of Spanish. So, I think really understanding and taking the time to understand where your patients are coming from, not only linguistically but also culturally, having these clinics sort of bridging those two concepts is critical to be able to provide that support. So, it's not only like language, but it's also understanding that oftentimes familial and extended support networks are critical for patients that typically identify as Hispanic. And so, you need to understand that you're probably going to be speaking with someone's mother, partner, spouse, sister, et cetera, because a lot of decisions, particularly around healthcare, are made as a unit, as opposed to in certain other cultures, a patient may take a very individualistic approach, like, "This is what I decided to do for my health." In a lot of Latino communities, it's oftentimes the broader family, the broader family unit that makes decisions together. And that's not necessarily a very Western model of practicing medicine. And so, being understanding of certain cultural norms in addition to addressing health literacy and language barriers is critical to providing care.

Host: So many positives that you just mentioned, and I can imagine the language alone, as you say, is really important where someone really listens to them and they feel heard, Dr. Blanco, that's really got to be a help. Is that right?

Irene Blanco, MD: Most definitely.

Host: Yeah, absolutely. And Dr. Gonzalez-Latapi, how do you plan to keep improving care for Spanish-speaking patients?

Paulina Gonzalez-Latapi, MD: Well, just the fact that these clinics exist and that Northwestern has been so supportive in the building of this clinic is a very important first step. But of course, one way to improve the clinics is to add more team members. Unfortunately, the amount, the percentage of physicians that are of Hispanic origin or that are bilingual is small. So definitely, encouraging and mentoring those newer generations to go into medicine, and that's also an important part of Northwestern. We get to interact with so many trainees that there is an opportunity to do that.

But as far as the healthcare and the clinic care, also increasing the resources. So, knowing what are the resources available. Again, in my specific area of expertise, I see a lot of people with neurologic conditions that really takes a whole team to address. So, it's Physical Therapy, Occupational Therapy, Speech Therapy, Psychology, Psychiatry. So, really identifying what all the resources are available for patients, again, and those resources that are also bilingual and culturally available for patients to access.

Host: And then, Dr. Blanco, it would be great to hear any patient success stories that you can share with us highlighting the importance of having culturally sensitive care.

Irene Blanco, MD: I mean, I think that, in terms of thinking about and addressing the needs of the patients. We've had multiple success stories here at NM. We provide amazing care to a very large swath of patients in the broader Chicagoland area, right? So, we don't turn patients away. So, we see Medicare patients, we see Medicaid patients, et cetera. We've been very welcoming. Chicago, as we know, many Venezuelan, for example, refugees came, and one of them was actually newly diagnosed with lupus and lupus nephritis. And we were able to get her really great support, not only through Rheumatology, Nephrology, but also with the transitions clinic through Internal Medicine, to really be able to facilitate her transition here to the United States, but really get her cutting edge care that potentially would not have been afforded to her given the political situation in Venezuela. But even to many, many, unfortunately, you know, Spanish-speaking patients here that oftentimes fall through the cracks because they can't communicate, because they can't self-advocate, because they don't necessarily have the resources and the means to get that support. I think Northwestern was really able to help this patient and she's doing amazingly well, whereas, you know, she was really looking at potentially not doing so well.

Host: Every human deserves to be taken care of. So, I think it's great what you're doing there. And thank you for sharing that story. And then, Dr. Blanco, how do you envision the future growth and development of the clinic moving forward?

Irene Blanco, MD: As alluded to by Dr. Gonzalez-Latapi, adding team members is critical. So in thinking, how can we add on added layers of that support. Right now, I'm very lucky in that my patient liaison, one of my nurses, many of our support staff in the front desk all speak Spanish. And so, it creates a sort of seamless transition, right? If a patient needs to call me, if I need to ask the nurse to contact the patient, I have those team members readily available. But we need to think about that broader team, right? What does that mean? Social work support potentially, other providers, how do we really create that broader care network to support our patients?

Host: Well, it seems like what you're doing would be a model for other healthcare systems across the country. So, Dr. Gonzalez-Latapi, what advice would you give to other hospitals and health systems managing Spanish-speaking patients but don't have designated clinics?

Paulina Gonzalez-Latapi, MD: Of course, the ideal situation is where they could have the support to serve those clinics. But of course, that can be hard to do if there's not the staff and the team as, Dr. Blanco and I have already alluded to. So, certainly, in those cases, it's really finding who in their area, in their geographical area has those resources and trying to come up with at least a list of resources that can be available for patients so that they can know where to go to access the care and the interventions that they might need.

Host: And then, Dr. Blanco, how can other healthcare providers support the growth and success of Spanish-speaking clinics?

Irene Blanco, MD: I think it takes a certain amount of intentionality to say, "This is what we're going to do. This is the staff that we need to hire. These are the resources that we're going to need to engage." And starting small, not every health system really puts in the time, effort, and funding to get adequate translation services. So, to really think about, you know, what is the translation services available within your practice and, you know, is it really servicing the needs of the broader community that you're actually seeing? And if it isn't, you can start there and then start thinking about my front desk staff, right? They're that first line that the patient first interacts with, how welcoming, how inviting would it be if someone's just there to answer the phone, say hello, when this community that's entering your practice can interact with them in a language concordant way, right? I mean, we talk about Spanish here because that's the largest language that's spoken other than English in this country. But I came from New York City before I was here, and there's many other languages that are spoken here as well, Polish, et cetera. So, how can we be very intentional and really thinking about our broader community, who we need to hire and how we could support the patient.

Host: Dr. Blanco, thank you for sharing those tips. I like when you said start small. Think of the different touch points that your patients would go through. Then, you also said be intentional, which I think is really a good way to view this. And then, Dr. Gonzalez-Latapi, thoughts from you, tips. How can healthcare providers begin to implement changes to better serve their Spanish-speaking patients?

Paulina Gonzalez-Latapi, MD: Yeah, that's very good question. Thank you for asking it. It comes back to intentionality. It comes back to finding out what do the patients need. I think sometimes there can be certain hubris in the medical communities, less so now as our practices have changed, but also really understanding what are the patient's needs. Maybe the particular issues that we're thinking about are not the same that our patients are facing or are not the same that they find as important. So really, understanding better what communities they're serving, what are the needs, whether it's translation, whether it's internal medicine services. Is it findings of specialty services? Is it this addition of therapies? So, that's a key component of really the success of these clinics and also interacting with any community really, but focusing on the Hispanic community.

Host: Yeah. Start by understanding the patient's needs. Well, this has really been informative and delightful. I've enjoyed speaking with both of you. Before we wrap up, if I could get final thoughts, as we wrap up talking about Spanish-speaking clinics at Northwestern Medicine. Dr. Blanco, let me start with you. Any final thoughts?

Irene Blanco, MD: Sure. Going back to the idea of what can providers do, I think oftentimes we don't really think about some of the ways that patient support communities can really help us in extending our reach to broader patients. So for example, I partner really closely with the Lupus Society of Illinois. And a lot of times when they can't help me find community resources, that's my first call because they're embedded within the community, right? So if I don't have those resources here at NM, for example, you know, how do I help a patient with housing? How do I help a patient with other potential legal issues, et cetera? Oftentimes, they're boots on the ground. So, you know, for providers that may not necessarily have those resources themselves to really think about starting to talk to community-engaged organizations, which, you know, at Northwestern we have so many partnerships, especially through NUCats, the Center of Community Health, the Office of Community Health, so we can really do so much, as an individual provider where sometimes it could feel so overwhelming, but actually you may be able to just make a couple of phone calls and really get the patient what they need.

Host: So, it sounds like you can help people with more than just their healthcare needs, because they have so many other needs as well. That's a great point. So, thank you for saying that. And then, Dr. Gonzalez-Latapi, final thoughts from you?

Paulina Gonzalez-Latapi, MD: I think one key aspect as well is knowing what's out there, what resources are out there. And that's why I appreciate having this podcast opportunity speak here because I think as also as our system grows, as the Northwestern system grows, it becomes more complex. And just for all of physicians to know that these clinics are available, that if they have a patient who perhaps has a rheumatologic need or a neurologic need, we do have these clinics that provide these services. And also, as I would echo what Dr. Blanco said, there are so many foundations and community outreach groups that thankfully have put a spotlight on reaching out to the Hispanic community that, again, those resources are out there. So, just trying to find them is the key.

Host: Very well said. Well, thank you both for your time today. I appreciate it. Dr. Blanco and Dr. Gonzalez-Latapi, thank you again.

Irene Blanco, MD: Thanks so much for having us

Paulina Gonzalez-Latapi, MD: Thank you for having us today. This was great.

Host: You bet. And once again that is Dr. Irene Blanco and Dr. Paulina Gonzalez-Latapi. And to refer your patient, or for more information, head on over to our website at breakthroughsforphysicians.nm.org/rheumatology to get connected with one of our providers. And that wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians.