AAOS Now

Published 10/1/2013

CCC IQ Answers

Culturally competent care (CCC) requires an understanding of cultural differences. The increasing number of Hispanic Americans, in particular, necessitates that we, as orthopaedic surgeons, have a sensitivity to cultural norms other than our own. The scenario on “What Is Your CCC IQ?” presented several opportunities for us to show our CCC IQ. See the correct responses below to find out how well you did.

Meet Maria
You should address the patient as “Senora Salcedo” (D). Even though relatively young, Senora Salcedo is married and a mother. It is very important to show her proper respect by addressing her in a manner appropriate to her cultural norms and expectations. Both she and her husband will sincerely appreciate and respond favorably to such a gesture. “Senorita” refers to an unmarried woman, and calling her by her first name is considered disrespectful. American titles such as “Mrs.” are not culturally sensitive and may offend your patient and her family.

Discussing surgery
In the Mexican family unit, the decision-making capacity of the wife/mother is considered subservient to that of the husband/father’s, so the answer to the second question is (C), 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.”

It is highly unlikely that Maria will consent to anything without her husband’s permission and acknowledgement. You must attempt to gain consent from both of them. “Comprehension checks”—a discussion technique in which the patient explains what you are going to do in his or her own words—are an excellent way to determine the patient understands and is properly informed.

It’s also important to understand what kinds of health practitioners—outside of American norms—are familiar to (and sometimes preferred by) your patients. When Tomas and Maria ask about a “curandero” and a “sobador,” they’re letting you know they wish to consult a “healer” or “massager” (B).

A “curandero” is a “healer” who may use herbs and prayer to help in the healing process and is part of the traditional treatment of injuries and ailments in Mexican and Latino cultures, particularly for recently immigrated families. The “sobador” uses hand-on massage treatment to work the nerves, bones, and other tissues back into their proper positions, similar to the practices of some chiropractors and therapists, and could potentially have a place in the closed treatment of fractures.

Postoperative protocols
Although traditional, free-standing “bontanicas,” which offer medicinal herbs targeted at healing specific organs or diagnoses, coexist with pharmacies throughout Mexico and other Central and South American countries, you’ll need to gently explain that the postoperative pain will likely respond better to the analgesic medication you have prescribed and is available only at a pharmacy (D).

Recognizing that a patient may choose to pursue traditional herbal treatments, you may give tacit approval to try their traditional ways as a first option, but you—and the patient—must be aware of potential drug interactions.

How did you do?
The AAOS Diversity Advisory Board has several programs to help you deliver culturally competent care. Visit
www.aaos.org/diversity to find out more.