Addressing the black-and-white issue
Communicating with African-American patients takes empathy and understanding
The African-American man with an injured leg sits across from the orthopaedic surgeon. He says he is in pain, and is afraid his leg will have to be amputated. The surgeon knows that will not be necessary, and ignores the remark, telling the patient he will need to take further tests. The patient reacts suspiciously and refuses to cooperate. Is this an example of disparity in health care, a lack of cultural understanding between blacks and whites or a standard interaction between physician and patient?
Why it matters
“African-American patients wait longer for diagnoses, receive less aggressive treatment and are undertreated for pain,” says orthopaedic surgeon Valerae O. Lewis, MD. “Racial and ethnic disparities exist even when insurance, status, income, age, education and severity of conditions are comparable.”
Poor communication is a major reason for these disparities. By improving their communication with African-Americans and other minority patients, orthopaedists can improve diagnoses, patient cooperation and treatment outcomes.
“Some doctors walk in with a patriarchal attitude, don’t want to take the time, or are just apathetic,” says Diversity Advisory Board Chair Ramon L. Jimenez, MD. “Others have good intentions, but don’t communicate them. Cultural competence is all about communication. If you don’t communicate, it doesn’t matter what your intentions are.”
Dr. Jimenez urges orthopaedists to change their approach to minorities through the practice of “culturally competent care,” which he defines as the combination of attitudes, skills and knowledge that allows health care providers to better understand and take care of patients whose cultural backgrounds are different than their own.
Many people would agree that culturally competent care for African-American patients—or any cultural/ethnic group—should be an end in and of itself. But it is also the means to an end—better health care for all patients.
“Good orthopaedic surgeons want to deliver the best care they can to all of their patients,” says Dr. Jimenez. “The best method for physicians to improve understanding between cultures is to inculcate compassion, sensitivity, curiosity and awareness.”
Empathy and engagement are the most important elements of culturally competent care, he adds.
Steps toward understanding
The issue of respect is extremely important in interactions between white doctors and African-American patients. This past spring, a Washington Post/Kaiser/Harvard survey found that when white men and black men were asked if they are treated with less respect than other people, twice as many black men said they were.
By showing genuine interest in and respect for African-American patients during a consultation, doctors can pave the way for improving overall quality of care. Orthopaedists who are polite, show consideration, appear unhurried and set a friendly tone can find common ground with their patients. Ask nonjudgmental, open-ended questions, and never be afraid to ask questions if something is unfamiliar or confusing to you. As you show a willingness to listen, patients will more likely respond in greater depth, leading to fewer misunderstandings and ultimately fewer errors.
As Dr. Lewis outlines in “Cultural Competence and the African-American Patient,” (available online at www.aaos.org/diversity), physicians can take the following steps to improve patient consultations:
“If you open up your arms, word gets out, and you’ll have a more successful practice,” Dr. Jimenez says. “You’ll also be able to face yourself in the mirror.”
If you need another reason to fine tune your cultural communication skills, legislation tying a doctor’s “cultural competence” to medical licensing has already passed in California and New Jersey. Advocates are working to introduce similar legislation in Illinois, Texas, Michigan and Arizona, Dr. Jimenez adds.
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