Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

A Lesson in Cultural Humility


Working at a community health clinic serving migrant workers from Mexico, I was confronted with a pervasive stereotype that the female patients were “dramatic.” I learned how important it was for patients’ concerns to be taken seriously.   

“The Mexican ladies can be dramatic,” a male colleague told me on my first day working in a rural Federally Qualified Health Center that served migrant farm workers from Mexico. I felt uncomfortable with his stereotype, but I also didn’t want to make any enemies. So I smiled and nodded. 


Through my first weeks at the health center, women of all ages came in with abdominal pain, back pain, leg pain, chest pain. When they described the pain, they used the word “demasiado.” “Too much, my pain is too, too much.” I did extensive work ups that revealed absolutely nothing. I was stumped. How could so many women have “too much pain,” with completely normal workup? Were these the “dramatic Mexican ladies?” 


One day, a 52-year-old woman presented for severe abdominal pain, with no significant physical exam findings. I looked through her chart: she’d come in multiple times for the abdominal pain, and been worked up extensively by multiple providers, with no definitive diagnosis. Instead of ordering a series of tests, I decided I would just closely monitor. “I’m not sure how to explain your pain, but I don’t suspect it’s life-threatening,” I said through an interpreter. “Let’s check in again in two days.” 


“Will I see this doctora again?” the patient asked my medical assistant. 


“Yes. We’ll make an appointment for you before you leave today.” 


“Está bien,” Maria said. Then, interestingly, she looked . . . better. She sat up a little straighter, and that “demasiado” pain seemed . . . less. 


The next time I saw her, she still had pain, but the pain was no longer “demasiado.” She seemed happy to see me. So we kept following up. And each time I saw her, her pain was a little better. 


One day, I sat down for lunch with my medical assistant, whose mom was a farm worker. I brought up this phenomenon of women coming in with “too much pain.” “What do you think that’s about?” I asked. 


“It’s because they are worried that if they didn’t say that, you wouldn’t take them seriously, doctora”. My assistant said. “Like my mom, these women have never been taken seriously at home or at work.” 


During the next visit with my patient, I inquired more about her as a person, not just a patient with a symptom. I learned Maria was the oldest of seven children, and had worked hard to help raise her siblings. Then a decade ago, she came to America illegally with her four children. While crossing the border, she was raped. Later, her husband joined her from Mexico, who then abandoned the family. She now works in the fields 12 hours a day, five days a week. 


Maria cried as she told me about her life. I listened. We hugged. I still see her sometimes in clinic, but we didn’t need to talk about her abdominal pain. Maria knows I take her seriously. And I will see her through her pain. 


Now, when I encounter a “dramatic Mexican lady,” I ask about their life. I knew now that my colleague was wrong. These women weren’t dramatic, they just had never been taken seriously. 








This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.