Comparison of Cultural Values

Anglo Culture: The main values related to time in the USA are efficiency, precision, and protection.

Latino culture: The main values related to time in the Latino culture are enjoyment, flexibility, and improvisation.

Efficiency vs. Enjoyment

In Anglo culture time is something to be conquered, managed, and used to its maximum efficiency. The Protestant work ethic epitomized by "idle hands are the Devil's workshop", drive us towards a utilitarian and very productive use of time, almost as a form of spiritual salvation. Time is harnessed to achieve goals. Not surprisingly in the USA we show up on time, hold each other accountable for timelines and deadlines, and bill by the minute. Because time is in such short supply, devices, strategies, or people that save time are highly valued.

The support base for Americans is mainly derived from their individual capacity and merits (college degrees, skills, physical health, wealth, ingenuity, etc.) and on numerous governmental programs: Social security, unemployment insurance, retirement plans, welfare, Medicaid and Medicare, etc. Compared to other cultures, less reliance is placed on personal relationships and in consequence less time is invested in them. For example, the notion exists that at age 18 a young adult is considered emancipated and is released into the world to fend on their own to "make something of themselves" and "to stand on their own two feet".

In Latino culture time is to be enjoyed, spent rather than saved; we spend time with those we care about. Relationships are more important than saving time just for time's sake. Personal relationships are cultivated, invested in, cared for, and all this requires time: to listen, to share, to empathize, and to support. All of this nurturing creates a deep and robust social support system that can be confidently relied on in times of need, but it also comes at an appreciable cost of lesser economic output and means, slower material progress, and missed opportunities for personal advancement and achievement. So there is less loneliness, depression, and suicide, but more professional frustration and economic dependence. Rather than basing the fulcrum of support on weak governmental institutions, it is placed on a sophisticated network of family members, friends, and colleagues.

Precision vs. Flexibility

For the last five decades the States has experience unprecedented wealth and stability and this has allowed us to live within a very predictable environment where it is entirely possible to schedule commitments months and even years in advance. When we schedule commitments we do so with precision, e.g. "The meeting will start at 12:15 PM", and this extends to our laws, e.g. "It is also unlawful for any person to knowingly purchase any alcoholic beverages between the hours of 2:00 a.m. and 6:00 a.m." (California Business and Professions Code, Section 25631).

The economies and politics of Latin American countries have been too unpredictable and volatile to nail down events to precise dates and times. The compounding effects of labor strikes, run down infrastructure, hyperinflation, corruption, abject poverty, Coup d'état, gang and drug violence, and civil wars, has created societies where it is important to be flexible and to know how to improvise. Time is often expressed with deliberate vagueness to provide necessary room to maneuver around expected complications. So the English precision of "Let's meet at 4:00" is replaced with "Let's meet tomorrow afternoon", "It will be done by July 18" is morphed into "It should get done around mid-July". In general, there is more forgiveness and understanding when there are delays or things do not go as planned.

Protection vs. Improvisation

Because in the States there are constant demands on our time from our employer, commuting, family responsibilities, house chores, etc. we guard jealously and protect any free time we have. We bristle at any encroachment into our sacred protected time whether the intrusion is from telemarketers, spammers, or technology that forces us to punch numbers with our phone instead of being able to talk to a real human being.

In Latin American countries the work-life balance is tilted much more towards life. This means smaller accomplishment, less income, smaller home, etc. but more time to enjoy it all. It is not uncommon to have friends show up at your doorstep unannounced to share a meal or spend some time with you. In the States that would be very taboo and good manners would dictate that you call and check with your host before coming by.

Examples of Cultural Misunderstandings

Scenario A

Situation: During a clinical visit the Anglo provider shows that he cares by attempting to get the patient "out of here as soon as possible" and jumps right into discussing the latest imaging study that came back. This is exactly what the Latino patient is not looking for. The patient feels rushed and feels processed, rather than seen by the doctor.

Mitigation: Provider explains to patient the time limitations under which American doctors work (e.g. 15 minutes per visit) and reassures the patient that, even thought their time together will be short, he cares about them. The provider suggests that the patient comes prepared to each clinical visit with a small note that summarizes: (a) Updates since last visit, (b) Questions, and (c) Requests, instead of trusting their memory and improvising the information it in the moment. This will make best use of their time together and the patient will leave with the essential help they need. Within their schedule constraints, the doctor spends the initial couple of minutes making eye contact, greeting, and exchanging pleasentries with the patient, before transitioning into discussing the medical issues at hand.

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Scenario B

Situation: At a clinic a Latino patient is waiting to be seen by his doctor; however, the doctor is running late and nobody has informed the patient of this. The patient calmly waits because he does not want to pressure the doctor unnecessarily and was brought up to be flexible with time matters. After waiting for almost an hour the patient approaches the front desk and complains that other people seem to have gone before him, that he has been waiting for a long time, and that he is going to be late for work. He is visibly upset and this affects all subsequent interactions. The front desk staff are puzzled at why the patient waited so long before telling them that something was wrong.

Mitigation: If a delay in service is short (e.g. 30 minutes or less) there is no pressing need to notify patients, if however the delay will be longer, the front desk staff notifies patients not only that the doctor is running late, but also by how much. The staff will not assume that a Latino patient will approach them for an update at the first sign of a delay.

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This article is part of a series on Latino Culture and Healthcare.
View the main article here.