Joseph Betancourt’s difficult patient

“People don’t get a manual on how to interact with health care.”
Illustrated by
Elena Cerri

People don’t get a manual on how to interact with health care.

Years ago, internist Joseph Betancourt was prepping for an appointment with a Latina patient whose chart had a large red sticky note on it, characterizing her as “difficult.” “She always wants to be seen early,” his colleague told him. Betancourt managed to see the patient a little sooner than scheduled. He braced himself for the encounter, speaking to the patient in Spanish, and found her to be lovely—not at all difficult as the red note indicated. He asked the scheduler to arrange for her to get the earliest appointment next time. “Sure,” he was told; the woman was given a 9 a.m. slot.

When the day came for the woman’s next appointment, he learned she had been outside waiting when the clinic was unlocked at 5 a.m.

Betancourt had to ask her, “Why do you arrive so early?” During a subsequent visit, she took a photo out to illustrate her answer. It showed a rural community health center in her native country in the early morning, with what must have been 100 people lined up at the entrance. He realized that she was used to overwhelmed first-come, first-served clinics, where she was expected to wait hours in line. The woman didn’t want to be seen early; but she did want to get in to see the doctor. That was not guaranteed in her previous health care experience.

She was not at all difficult. But because of language and cultural barriers, she was thought to be a prima donna.

Betancourt, senior vice president for equity and community health at Massachusetts General Hospital and associate professor of medicine at Harvard, shared this story at Pitt’s School of Medicine Diploma Day in May. His lesson for graduates: Keep an open mind. Don’t let assumptions or unconscious bias get in the way of your patient interactions. They can lead to unequal or inaccurate treatment.

Betancourt is an internationally recognized expert in health policy who’s served on several Institute of Medicine committees producing landmark reports about addressing health care disparities and diversifying the health care workforce. Because he grew up in Puerto Rico in a bilingual, bicultural household, the difficulties of achieving health equity are also a personal matter for him:

“The challenges I tackle today are the ones I, my family, my community faced as I was growing up—discrimination, racism, the social determinants of health and language barriers in health care. These are things I’m intimately familiar with.”

During his address, he asked the future physicians in the audience to show grace. He reminded them that people “don’t get a manual on how to interact with health care,” and that curiosity, empathy and respect are critical to caring for patients effectively.

“Listening takes time,” he said, “but not listening can take more time and lead to poorer outcomes.”