We’ve found that with the Latino population, bonding with the patient is the crucial first step. We’re essentially asking our patients to do something for themselves, and, in this particular population, people do not generally do things for themselves; they do things for other people.
They don’t perceive being lean and fit as a reward in itself, but they will do anything— including diet and exercise—for someone else. You have to become a part of the patient’s family and take advantage of very strong family ties to get patients to do something for you. You can’t become part of “la familia” through a translator, and you can’t do it if you’re not there for them consistently.
More educated patients sometimes respond to a college-level approach. You say to the patient, “You have a deadline, a responsibility; you’re promising that you’ll fulfill an obligation.” We may, for instance, contract with a patient to lose two pounds a week. This approach, which appeals to their guilt level, frequently works, but, sometimes patients skip appointments because they haven’t completed the assignment, and that’s the last thing we want them to do.
You’re more likely to be successful if you motivate patients to do something for you because you care, not because you’ll be angry with them if they fail. As a physician caring for someone with a chronic disease, your bedside manner is important; you’re not just taking care of one part of the patient.