AAOS Bulletin - February, 2005

Improve your communication across all cultures

CD-ROM, symposium focus on patient diversity

By Kathleen Misovic

A 65-year-old woman comes to your office complaining of pain in her right knee. She tells you she has had an ache in her knee for years and has attempted to treat the pain by consulting a local healer, using herbal rubs and taking over-the-counter drugs. You suspect osteoarthritis and order radiographs of the knee. Should you tell her there is no evidence that herbal rubs help arthritis? Or, taking a clue from her choice to consult a healer, should you ask about her ethnic and cultural background?

If you ask about her ethnic and cultural background, you might discover she is Native American and, as is traditional in her culture, often consults healers for treating physical illnesses. And you’d score well on the new Cultural Challenge CD-ROM produced by the AAOS Diversity Committee. The interactive CD features 18 patient cases and 90 questions to help orthopaedic surgeons learn about dealing with cultural diversity in patients. A variety of cultures, ethnicities and religious issues are explored in the Cultural Competency Challenge—from African American and Asian to Jehovah’s Witness and Muslim patients.

Take the cultural challenge

You can pick up your free CD-ROM during the 2005 AAOS Annual Meeting held this month in Washington D.C.

Visit the Diversity in Orthopaedics booth in Academy Row, located in Hall D across from the AAOS Resource Center. Members who complete the exercise can receive up to three CME credits, according to Ramon Jimenez, MD, chair of the AAOS Diversity Committee.

The CD-ROM is suitable for practicing orthopaedists, residents and students. “It makes a great teaching tool,” Dr. Jimenez said, adding that funding for the CD-ROM was provided in part by an educational grant from Zimmer.

The AAOS Diversity Committee will also sponsor a symposium on cultural diversity on Wednesday, February 23, from 6:30 p.m. to 8:30 p.m. at the Washington Convention Center, Room 204. “Cultural Competency: Enhancing your Communications” will present corroborative material to the CD-ROM, so members who attend the program and complete the CD-ROM will receive optimum educational information, Dr. Jimenez said.

“Both the CD-ROM and the symposium cover the material in an enjoyable manner,” he said. “They’re provocative and inspire you to think about cultural issues related to patient care.”

Dr. Jimenez said that the topic of patient diversity has gotten a lot of attention in the past few years, although some medical specialists still don’t understand the importance of learning better communication skills for dealing with patients of different cultures. “Half the battle has been getting people to at least think and talk about it,” he said. “But the people who are behind it are strongly committed to the cause.”

One of these champions of patient diversity awareness is Ellen Raney, MD, a pediatric orthopaedic surgeon in Honolulu and a member of the AAOS Diversity Committee. She wrote and edited several of the scenarios for the new CD-ROM.

“I was able to write some of them from my own experiences; there is such a diverse ethnic population here in Hawaii,” Dr. Raney said. “One culture does not dominate here. Rather than dealing with two or three cultures on a daily basis, I deal with about 10 to 15.”

Diverse patients, diverse needs

Research has shown that while minorities often face health care disparities, those disparities are reduced when they are treated by physicians of the same ethnic group. The Diversity Committee is working to encourage more individuals from minority and cultural groups to become orthopaedic surgeons.

In the meantime, the committee is also working to increase orthopaedists’ awareness of cultural differences among their patients.

Dr. Raney said she has learned of many situations where the medical community failed minority patients because it did not understand their culture and traditional behavior.

“One of the most obvious examples is that people of some cultures hesitate to ask questions of the doctor because they feel it would be disrespectful,” Dr. Raney said. “So they may agree to surgery when they don’t even understand it.”

The wide variation in the way different cultures express pain has also led to problems.

“Some cultures don’t like to complain so a doctor may not realize a patient is in a lot of pain,” she said, adding that these patients may suffer needlessly because their physicians don’t prescribe them adequate pain relief.

One of the cultural differences Dr. Raney had the most difficult time accepting early in her career was that the patient might not be the person making the decision about his or her treatment. “Some patients had to go back and discuss it with their husband, father, mother or grandmother,” she explained.

She also learned to take the time to introduce herself to patients and make them feel comfortable before jumping immediately into the diagnosis. “Young surgeons tend to be very direct and to the point, but I needed to learn to get to know my patients a little bit before saying, ‘OK, let’s talk about your leg,’” she said.

No stranger to culture shock

Perhaps one of the reasons Dr. Raney is so sensitive to culture differences is because she has been a victim of cultural intolerance herself as a female orthopaedic surgeon in a traditionally male-dominated specialty. She recalled that she was not encouraged to become an orthopaedic surgeon and encountered a lot of resistance during her residency.

“Many of the attendings had wives who stayed home and took care of the kids,” she said. “They felt women were not decisive enough to be doctors, especially orthopaedic surgeons.”

Dr. Raney turned to the Ruth Jackson Orthopaedic Society for support. The society, which is named after the first board-certified female orthopaedic surgeon in the United States, promotes the practice of orthopaedics for women and by women. She found hope in the fact that many of the members had gotten past the discrimination and enjoyed successful careers.

“It was helpful to get support from other women orthopaedists and find that they had faced similar problems,” she said.

Dr. Raney became active with the society in 1985 and is now president. Through the society she learned of the AAOS Diversity Committee, which she joined two years ago.

Cultural sensitivity benefits physicians

Learning about other cultures and how to respect their beliefs and traditions in her office has resulted in definite benefits for her career, Dr. Raney said.

“I think it has made me a better orthopaedic surgeon,” she said. “The better I can communicate with and understand my patients, the better health care I can give them. I also enjoy interacting with them more, and they are happier because they feel they have gotten better care.”

If this argument doesn’t convince physicians of the importance of respecting cultural diversity, Dr. Raney suggests pointing out the financial benefits.

“What does this mean to our pocketbooks? Happier patients are less likely to file a lawsuit against you and more likely to refer other patients to your office, increasing your patient base,” she said.

Dr. Raney encourages members to test their understanding of the issue on the Diversity Web site (http://www.aaos.org/diversity), where they can preview the Cultural Competency Challenge. It will provide an introduction to the types of scenarios and questions presented in the new CD-ROM and in the symposium.

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