Orientations for new patients are one technique for setting the stage for positive patient experiences with a new clinic, especially for those who are unfamiliar with the healthcare system. These orientations have been shown to be successful in reducing stress for cancer patients, preparing patients for beginning psychotherapy, and reducing no-show appointments in a primary care setting, which improves clinic efficiency.
As the Patient Navigator at a Federally-Qualified Health Center (FQHC) from 2016 to 2017, I was tasked with creating this type of program for immigrant and refugee patients, whose cultural differences and unfamiliarity with the American healthcare system often serve as a barrier to successful clinic interactions. From speaking to clinic providers on various levels, as well as patients from refugee communities, I established the following priorities for the orientation curriculum:
- Prescription refill process
- Calls to our clinic – what to expect, how to request an interpreter, how to speak to a nurse
- Difference between preventative and acute care, and emergencies, and benefits of seeing your provider at least once a year
- How to make and cancel appointments, and why no-shows reduce our efficiency
- Different occupations that clinic staff hold, and how staff can connect patients to other resources they may need
- General information about the American healthcare system that may be confusing, such as insurance coverage and social services application processes
- Patient rights and responsibilities
- Interactions with providers – letting patients know that they can and should ask questions when confused, or when misunderstood by an interpreter or provider
I quickly found that creating a curriculum like this presents several challenges. For example, “refugees and immigrants” is a broad group of people, representing those from wildly different education levels and familiarity with Western healthcare systems. Many times, it was impossible to know patients’ backgrounds before meeting with them to discuss our clinic. I had to be careful to be informational without seeming patronizing, while basing communication strategy on the perceived level of understanding of the patient, which can also be influenced by cultural norms.
Patient orientations have a great potential to reduce patient stress, improve understanding of clinic operations, and give the power back to the patient when it comes to their own health. However, cultural differences must be given weight when developing this type of program. Using community leaders or liaisons for curriculum development and delivery may be a way to bridge that gap.