To properly evaluate and treat patients, we, as orthopaedists, need to be aware of the principles of culturally competent care (CCC). This requires us to be knowledgeable of cultural differences in the way that individuals view and respond to medical care. As noted in the AAOS Culturally Competent Care Guidebook, edited by Ramon L. Jimenez, MD, and Valerae O. Lewis, MD, “Communication is the cornerstone of good quality care.”
Test your CCC knowledge by reading the following scenario and answering the questions. You’ll find the correct responses, along with an explanation, in the article CCC IQ Answers.
Maria Luisa Salcedo is a 28-year-old mother of three children (ages 8, 5, and 2 years). She and her husband, Tomas, recently migrated to Salina, Calif., from Michoacan, Mexico. Tomas works as a migrant farm laborer and speaks little English. Maria speaks some English, but is not conversationally proficient.
Maria is brought to the emergency department after falling and severely twisting her ankle. Radiographs show a comminuted trimalleolar fracture with displacement. You have been called in to her as an orthopaedic consultant. What is the proper way to address her?
- “Mrs. Salcedo”
- “Senorita Salcedo”
- “Maria Salcedo”
- “Senora Salcedo”
You wish to get an informed consent for an immediate open reduction and internal fixation of Maria’s ankle fracture. What is the best way to accomplish this?
- Inform her, through a licensed interpreter, that she has no treatment choice other than surgery.
- Show her the radiographs and a model of the ankle to convince her it is necessary to operate.
- Ask if she would like you to consult with her husband, so you can explain the pros and cons to both of them using “comprehension checks.”
- Have an interpreter and nurse obtain consent.
Both Tomas and Maria express some doubt and skepticism regarding surgery. They wonder whether different options—more familiar to them—are available. They mention “curanderos” and “sobadors.” What are they talking about?
- They are inquiring about the availability of natural, traditional Mexican medicines.
- They wish to consult a “healer” or “massager.”
- They are looking to consult a “chiropractor.”
- They are interested in seeking help from a doctor within their family.
You prescribe an analgesic to alleviate postoperative pain. Your patient explains that in Mexico people usually get their “medicine” at a “botanica.” You surmise that a “botanica” is a store where medicinal herbs are sold. How should you react?
- Warn that herbal remedies are not scientific or safe.
- Direct her to a local herb and health food store, suggesting she may substitute herbal remedies as she sees fit.
- Explain that she is in America now and she should conform to American medical practices.
- Gently explain that the postoperative pain will likely respond better to the analgesic medication you have prescribed, which is only available at a pharmacy.
Letha Y. Griffin, MD, is the Diversity Advisory Board liaison to the Communications Cabinet and a member of the AAOS Now editorial board.