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AAOS Now

Published 10/1/2007
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Jennie McKee

It’s time to make time for cultural competency

Media tour promotes the importance of culturally competent care

How sensitive are you to cultural differences? For example, if you were meeting an elderly Asian-American woman for the first time, what would you do? If you entered the exam room and found her with her husband and adult son, who would you talk to? When you begin to examine her, you find circular bruises on her legs. What do you do next?

Being culturally competent—which involves being aware of and sensitive to patients’ cultures, ethnicities, genders, and beliefs—can help you establish a good rapport with patients and their families. In this case, you’d know not to shake hands, but to bow or nod your head. You’d also talk to the men first, asking their permission to examine the woman. In addition, you would ask what home remedies the woman is using to relieve her pain. Rubbing copper coins on the skin, a practice called coining, is fairly common among elderly Asians for relieving pain from arthritis and would explain the circular bruising on the woman’s legs.

Because many physicians and their staff members who interact with patients need to become more familiar with cultural differences, the AAOS has launched a cross-country media tour to emphasize the many benefits of providing culturally competent care.

Getting the word out
AAOS First Vice-President E. Anthony Rankin, MD, and Second Vice-President Joseph D. Zuckerman, MD, are working with four members of the AAOS Diversity Advisory Board—Ramon Jimenez, MD, chairman; William R. Martin, III, MD; Melvyn A. Harrington, MD; and Toni M. McLaurin, MD—as well as with Stuart Hirsch, MD, and Amy Ladd, MD, to encourage enhanced physician-patient communication as part of the culturally competent care media tour.

The AAOS fellows will make presentations at newspaper editorial boards in major cities and will also appear on radio and television programs. The tour got underway in September and continues until November with stops in New York, New Jersey, Illinois, New Mexico, California, and Washington, D.C. These locations were selected based on recent state legislative activity in support of culturally competent care.

In addition to providing tips for communicating with African-American, Hispanic/Latino, Asian-American, and American Indian/Native American patients—as well as tips involving gender- and faith-based issues as they relate to physician-patient communication, the fellows hope to deliver the following messages:

  • Culturally competent care can help reduce the healthcare disparities that minorities and other groups experience.
  • Patients must feel empowered to ask questions and have an open dialogue with their healthcare providers so that they fully understand their diagnoses and treatment options.

“The media tour will position the AAOS as a leader in culturally competent care, which is an expansion of the patient-centered care that we already promote,” says Dr. Rankin. “We also hope to generate media awareness of the important role of the orthopaedic surgeon and to increase overall visibility for the Academy and our commitment to diversity.”

A growing need
Cultural competence is becoming increasingly important for physicians as the demographics of America’s patient population continue to shift. Despite these changes, many orthopaedists haven’t made cultural competency a priority, according to Dr. Jimenez.

“It’s absolutely imperative to be culturally competent to communicate effectively with patients,” he says. “Otherwise, your ability to treat a patient and relay information, such as an informed consent, and to arrive at a shared decision with the patient, is truly hampered.”

Culturally competent care can reduce miscommunications and thereby lessen the potential for incorrect diagnoses. Improved communication with all patients can also have the following benefits:

  • helps an orthopaedic practice grow as patients refer friends and family
  • increases patient adherence to treatment regimens
  • improves patient satisfaction and clinical outcomes
  • potentially decreases medical liability risk

Nicholas A. DiNubile, MD, chairman of the AAOS Public Relations Oversight Group, agrees that cultural competence plays a vital role in good physician-patient communication.

“We need to be sensitive to other people’s cultures and beliefs,” says Dr. DiNubile. “Our country is a melting pot that continues to evolve and change. Patients may respond differently to their orthopaedic surgeons’ recommendations because of cultural issues, so physicians must have a broad mindset when treating patients of different backgrounds, cultures, and beliefs.”

It’s the law—or it may be soon
Tying cultural competency education to medical licensure is a recent trend. Legislation has been enacted in New Jersey, California, and New Mexico; Illinois has legislation pending, and other states are following suit.

“As the demographics of the public change,” explains Dr. Jimenez, “the demographics of the legislatures are changing. Legislators are mandating this education to better serve their constituents.”

Supporting the message
The AAOS Culturally Competent Care Guidebook, edited by Dr. Jimenez and Valerae O. Lewis, MD, offers practical advice for providing culturally sensitive care to patients of different genders, ethnicities, cultures, and faiths by covering issues such as the following:

  • using culturally competent care to help minimize healthcare disparities
  • adapting the physical examination to respect a patient’s cultural beliefs
  • patients’ use of alternative medicine
  • involving family members in healthcare decision-making

The book also contains tip sheets that offer advice about greeting the patient, using an interpreter, educating patients, and avoiding communication pitfalls.

Being culturally competent can facilitate good physician-patient communication and lead to better patient outcomes.

The complementary Cultural Competency Challenge CD-ROM includes 18 case studies, each with a series of multiple-choice questions to test the user’s cultural competence. Orthopaedists who use the guidebook and CD-ROM may earn up to 6 continuing medical education credits (American Medical Association Physician’s Recognition Award Category 1).

The most recent addition to the Academy’s educational efforts on culturally competent care is the J. Robert Gladden Orthopaedic Society (JRGOS) supplement to the September 2007 Journal of the AAOS. JRGOS, which is dedicated to advancing the ideals of excellent musculoskeletal care for all patients, particularly underserved groups, addressed the topic of Perspectives in Orthopaedic Professionalism, Diversity, and Health Disparities with eight symposia during its 2006 inaugural meeting in Switzerland.

The supplement contains presentations from that meeting, focused on ethnic and racial disparities in orthopaedic care and the low percentage of women and minority medical students who pursue orthopaedics.

On the radio
The AAOS also is promoting cultural competence with audio news clips in English and Spanish. The radio spots explain the important roles that orthopaedic surgeons and patients play in facilitating good communication. They have been broadcast on Wal-Mart radio, Sirius Satellite Radio, National Public Radio, XM Satellite Radio, Health Radio Network, Voice of America, and American Forces Radio.

For more information

To learn more about the Academy’s efforts in promoting diversity and to obtain your free copy of the Culturally Competent Care Guidebook and accompanying Cultural Competency Challenge CD-ROM, visit www.aaos.org/diversity.

The information in the Culturally Competent Care Guidebook is offered from the American Academy of Orthopaedic Surgeons (AAOS) in the form of guidelines, recommendations, and tips. This information is general in nature and not meant to be all-encompassing. It is suggested as a starting point to raise awareness of patients’ needs and preferences.

AAOS does not assume an individual from a particular ethnic or cultural group necessarily shares the traits of that ethnicity or culture.

To find out more about the AAOS culturally competent care media tour, contact Catherine Dolf in the AAOS public relations department at dolf@aaos.org.

Jennie McKee is a staff writer for AAOS Now. If practicing culturally competent care has benefited your patients and your practice, e-mail her at mckee@aaos.org. Your comments may be included in future articles.

View Minority Population (pdf format)

Cultural competence in action
Ramon Jimenez, MD,
who has practiced medicine in California for more than three decades, has treated many patients of various ethnic backgrounds, including Latino-Hispanic, Asian, Portuguese, Italian, and Middle Eastern. Dr. Jimenez says that providing culturally competent care should begin before the physician meets the patient.

“Before I see a patient, I check the name on the chart,” explains Dr. Jimenez. “That can be a clue, giving me an opportunity to ask where the patient is from. The information I learn might help me relate to my next patient from that area.”

The important thing, says Dr. Jimenez, is to engage your patients by showing that you respect them—and any family members who accompany them.

“I’ll greet the husband and shake hands with the kids,” says Dr. Jimenez. “If the patient is Muslim, for instance, I ask permission to touch him or her before beginning the physical exam. If the patient is a Latina or Asian-American woman whose husband is with her, I involve the husband in informed consent discussions because he’s the one who gives permission according to those cultures.”

E. Anthony Rankin, MD, who has treated a diverse patient population in Washington, D.C., for the past 33 years, uses his cultural sensitivities when providing care.

“An example of cultural sensitivity with African-American patients is recognizing their general reluctance to agree to surgical solutions to their problems,” he says. “Giving them a chance to meet or speak with other patients who have had the same surgery can help. I have recruited patients willing to discuss their surgeries and outcomes with patients who are contemplating the same or similar procedure.”