October 1998 Bulletin

Crossing the barriers

'We find a multicultural area an exciting place to practice medicine.'

As the demographics of the U.S. changes orthopaedists find ways to make their practices more hospitable for minorities

Dr. Fernandez translates the discussion of Cruz's concerns to Stephen Conrad, MD, (right)

By Bonnie Booth

In the 21 years that Stephen Conrad, MD, has been practicing orthopaedics in California's San Francisco bay area, the region's demographics have changed dramatically.

Dr. Conrad and Peninsula Orthopaedic Associates' partner, Eugene Baciocco, MD, chose to embrace the change and as the practice grew they signed on surgeons who added diversity-first, Cuban-born Alfredo Francisco Fernandez, MD, and, most recently, Victoria Barber, MD, an African-American.

The office and clinical staff are also ethnically diverse and most patients can expect to see someone who reflects their own ethnic background at some time during their appointment. "We changed with our community," said Dr. Conrad. "We find a multicultural area an exciting place to practice medicine. As I look back, I think that's been helpful. It makes people more comfortable if they walk into a doctor's office and don't just see a bunch of white people, but also see African-Americans, Orientals and Hispanics working in the office milieu," Dr. Conrad said.

Hiring minorities also helps address one of the biggest issues physicians confront when making their practice more hospitable for some minorities - the language barrier.

While there are courses physicians can take to learn medical terms in other languages, Dr. Conrad and Ramon L. Jimenez, MD, said that often is not enough. "Put yourself in their shoes," said Dr. Jimenez, who practices in San Jose, Calif. "Say you go to a Vietnamese doctor who speaks very little English. Would you feel like you are making an informed consent decision? Would you want to go back? Only if you are stuck with no other options."

While some practices, especially those in large medical buildings or near hospitals, have translators available for patient consultations, that option can be costly for smaller practices, who often opt to hire bilingual employees instead.

"One of our early questions in the hiring process is 'do you speak another language,'" said Dr. Conrad. "If they do, that is a tremendous asset. That individual is expected to translate, that's in the job description and it's in the job description of every bilingual employee we have."

When Walton Curl, MD, began seeing more and more Hispanic migrant workers in his Winston-Salem, N.C. practice, he and the other doctors in the medical building identified bilingual people working in the medical center who were willing to be interpreters. "We can just call and say we have someone over here and we need an interpreter," Dr. Curl said.

Breaking the language barrier between patient and physician is pivotal in successfully treating patients who speak another language. But there are also some subtle ways physicians can make their practices more welcoming, starting in the waiting room.

"This may seem relatively minor, but it is not insignificant," said Augustus White MD, chairman of the Academy's Diversity Committee. "You should have magazines that reflect some breadth of the patient population and the art or photographs (in the office) should include someone of similar cultural background.

Dr. Jimenez said Spanish reading material in the waiting room signifies to Latino patients that the practice is interested in making them comfortable and he would like to see that taken one step further. "Brochures to better and further explain what non-Spanish speaking doctors are talking about are excellent means of educating and informing the patient," he said. "Spanish translated videos are also good."

Patient surveys also can be used as a tool for communicating with minority patients and assessing their opinion of whether the practice is meeting their needs. "(The surveys) should indicate the practice's desire to be culturally helpful," said Dr. White. "They should give patients an opportunity to point out any insensitive treatment and note the practice's willingness to do something about that."

Dr. White also suggested that practices appoint an ombudsman to address cultural issues as they come up. He said having this person available signals to minority patients that the organization wants to know about issues of cultural or gender insensitivity, but he said the ombudsperson should be available to all patients and does not have to work solely on behalf of minorities.

An orthopaedic surgeon who truly wants to be culturally competent should also be willing to experience the culture of his patients, said Dr. Conrad. "I think we are talking about a broad-minded, nonprejudicial individual who is willing to transcend our cultural and enter the culture of others" he said. "Someone who will attend social functions, not because he has to to keep his practice alive, but because he enjoys it. If I had to define that ideal doctor, he or she would befriend people of different cultures."

Dr. Jimenez agreed. "Any large community with a large Hispanic/Latino population will have fiestas," he said. "These are the things you should take part in, immerse yourself in. Enjoy them as part of the diversity that makes the United States a great place to live."

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