What’s In a Frying Pan?

the best Teaching Tools are Simple and Relevant

I recently visited a practice in Aurora, CO with a client base made up largely of immigrants and refugees. Dr. P.J.  Parmar, MD is doing some tremendous work with people from a variety of cultures who come to Colorado with limited English proficiency, limited understanding of western medicine, and low health literacy. I was seeking Dr. Parmar’s ideas about using motivational interviewing techniques to achieve better behavioral health outcomes for patients who need to change their diet, exercise more, and self-manage chronic diseases such as diabetes and asthma, etc. My strong instinct as an interculturalist is that the MI approach might work well with educated mainstream Americans, but with immigrants and refugees it seemed problematic to me. I did have an interesting discussion about the phrasing of motivational interviewing questions with P.J., but my biggest takeaway from the conversation had more to do with his use of teaching tools to increase patient understanding even when there are language, literacy, and cultural barriers.  

Visual and Relevant Examples

• P.J. Parmar has devised visual aids that say everything! For example, on one wall there are zip lock bags containing various amounts of sugar. Above each bag, a photo of the can or bottle containing the corresponding amount of sugar is displayed – Arizona Iced Tea, Ocean Spray Cranberry Juice, bottled water, etc. What an accessible way to explain nutrition labels, sugars, calories, and carbs.
• Similarly, right beside P.J’s office desk is a shelf stocked with over-the-counter medicines in their original boxes. He can use these boxes to show patients exactly what they will be looking for in the pharmacy – and he has handouts with photos of OTC medicines that he recommends his patients take. These handouts show the cheaper brands of medicines – i.e., the Walgreen’s brand or the Safeway brand.  It isn’t hard to imagine how confusing a Walgreens aisle can be for someone who has never entered a western drugstore before. There are ten feet of cough syrups alone. Why do some brands cost more than others if the medicine is the same? For people struggling to make ends meet, the difference in price can be important.
• On the wall behind P.J.’s desk are pictures of women doing stretching exercises. The women are wearing Islamic head scarves – hijab.  The message is perfect. Exercising fits the lifestyle of women from all cultures. You don’t have to look like the perfect yoga body on the cover of a magazine.
• Last but not least, just as I was thanking Dr. Parmar for the tour of Ardas Family Medicine, he slid open the bottom drawer of his office desk. Inside were two frying pans. One contained a lot of cooking oil, the other only a tablespoon or so. “This is how I show my patients how much is too much oil for cooking. They don’t need to fill the pan half full.”  So simple, so practical, so obvious and yet so creative.

I left Ardas Family Medicine inspired and somewhat less interested in nuanced motivational questions about human ambivalence towards change. There is a way to use MI with the kinds of people P.J. is serving in his community, but it would only be effective with some attention paid to the kinds of creative teaching devices he comes up with. Skillfulness in cross-cultural communication requires the ability to meet patients and their families at the level of their individual experience. I have to wonder why the obvious, cost-effective, and easiest things to implement get overlooked in our complex system of care. The solution is for each doctor, nurse, PA, etc. to being willing to simplify concepts, demonstrate and use teach-back, emphatically encourage questions, etc. Two frying pans in a desk drawer work for Dr. Parmar’s patients. What might work for patients and families in other medical homes in Colorado? Click here for 15 tips for culturally responsive patient care by Dr. P.J. Parmar.