April 2001 Bulletin

Cultural competency needed

‘. . . put yourself in the shoes of your immmigrant patient.’

By Carolyn Rogers

"Como estas? Soy el Doctor Williams. Soy medico ortopedista y traumatologo."

If you don’t know what that sentence means, but you would like to expand your patient base in a Hispanic/Latino population, you may want to brush up on a few key Spanish phrases. (The sentence translates as "How are you? I’m Dr. Williams. I am an orthopaedic surgeon.")

The Hispanic population, numbering roughly 35.3 million in the U.S. according to the 2000 census, is the most rapidly growing segment of our population. Hispanics represent about 12.6 percent of the population–a percentage that is projected to double (25 percent) over the next 50 years.

"The Latino population will become the largest minority by 2004. In fact, there’s no longer a majority," says Ramon Jimenez, MD, an orthopaedic surgeon of Mexican descent who has practiced in San Jose, Calif. for 26 years.

There remains a significant disparity, however, between the number of Hispanic/Latinos in the United States and the number of orthopaedic surgeons of Hispanic/ Latino origin who might best serve their respective cultures. At the present time only 2.4 percent of orthopaedists are of Latino origin.

"Ideally, Latinos would prefer to see doctors of their own origins not only for language reasons, but for cultural sensitivities," Dr. Jimenez says. But because of the disparity in numbers, this preference cannot be fulfilled. Non-Latino orthopaedists will increasingly be presented with the opportunity as well as the necessity to treat patients who are of difference cultures and origins than they are, and who perhaps speak a different language.

"This leads to orthopaedists perhaps not being able to provide the highest quality of musculoskeletal care to their patients–the American public," Dr. Jimenez says. "If you can’t communicate, or comprehend or treat a patient with due respect to their culture and environment, then you have failed to provide the highest quality of care. This is why we have to learn the techniques of cultural competency."

Dr. Jimenez defines cultural competency as "a complex integration of knowledge, skills and attitudes that allow healthcare providers to understand and take care of people from cultures that are not their own."

Basic to rendering this type of care is respect, communication and compassion, says Dr. Jimenez, who recently led the instructional course, "Marketing your practice to the exploding Latino population" at the Academy’s Annual Meeting in San Francisco. "This isn’t easy because we are taught from the beginning to diagnose and treat diseases and not people," Dr. Jimenez says. "One of the best ways to accomplish this is to take off your hat of knowledge and expertise and put yourself in the shoes of your immigrant patient."

First, be wary of stereotyping, Dr. Jimenez warns. "Stereotyping results from efforts to use racial or ethnic background as straightforward, simplistic predictors of beliefs or behaviors. It’s harmful to the patient/physician partnership–no one likes to be stereotyped."

At the same time, awareness on the part of the orthopaedic surgeons toward the particular fears and attitudes Hispanic patients may have regarding death, disability, medications, diagnostic examinations, physical therapy and surgery is key.

When a physician is not fully aware or culturally sensitive, a cultural ‘faux pas’ can occur, says Dr. Jimenez. For instance, did you know that it is considered culturally courteous to address Latinos according to their country of origin, "Salvadorans," "Cubans" or "Mexicans"? Or that it’s important not to act too familiar with Latino patients, particularly during the initial office visit? Latinos hold physicians with high regard and respect and will often be put off by too much familiarity. The Spanish language even provides for this situation, because it differentiates between formal and informal salutations… "usted" vs. "tu." (Formal "you" vs. familiar "you".)

Also, when speaking to a Latino patient, Dr. Jimenez says, do not simply ask the question "Do you understand?" A Latino patient may just nod affirmatively, too proud to admit that they do not. Rather, be interactive with the patient and use comprehension checks.

"Ask the patient, ‘Tell me what am I going to do in the surgery.’ Have them explain to you what you are planning to do and why," Dr. Jimenez suggests.

So your practice is ready to expand and diversify its patient base and would like to reach out to the Hispanic/Latino community. What steps should you take?

In terms of marketing your practice to Hispanic/Latino patients, "you don’t have to turn your office into a multicultural environment," Dr. Jimenez says. "You don’t have to be fluent in several languages. You just have to be open and receptive." Here are some specific suggestions:

Richard J. Haynes, MD, a pediatric orthopaedist, represented the non-Hispanic orthopaedist on the symposium panel led by Dr. Jimenez. His practice at the Shriner’s Hospital in Houston, Texas accepts and treats many patients from Northern Mexico.

Some of Dr. Haynes recommendations for working with Latino patients include:

All of the information imparted here will be to no avail, Dr Jimenez says, "unless we as orthopaedic surgeons are willing to open up our minds, our hearts and our arms. You will discover this will result in a win-win situation for ourselves, our orthopaedic practices and our patients."

Did you know?

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