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Cross Cultural Awareness Practices, Cultural Diversity & Ethical Boundaries: Freedom from Stereotypes
Experts offer advice for better communication with your patients
According to Valerae O. Lewis, MD, many physicians take their communication skills for granted—but shouldn’t.
By increasing their cultural competence, orthopaedists can improve their ability to communicate effectively with patients from backgrounds other than their own.
"Conscious awareness of one’s communication habits requires considerable work and energy," said Dr. Lewis. "And yet, it can make such a difference."
Dr. Lewis noted that cultivating cultural competence—awareness of and sensitivity to patients’ cultures, ethnic backgrounds, genders, and beliefs—is essential to good communication.
"Providing culturally competent care can have a favorable impact on patient behavior, outcomes, and satisfaction," said Dr. Lewis, "and can therefore also reduce the incidence of malpractice lawsuits."
Dr. Lewis and other faculty members of an instructional course lecture held at the 2009 AAOS Annual Meeting—Daryll C. Dykes, MD, PhD; Norman Y. Otsuka, MD; and Ramon L. Jimenez, MD—explored ways that orthopaedists can enhance their cultural competence. The following five tips can help improve your interactions with African-American, Hispanic/Latino, and Asian-American patients, as well as with patients from other backgrounds.
Tip 1: Follow the "Golden Rule," when appropriate.
"It’s important to acknowledge differences," said Dr. Lewis. "We sometimes need to treat people differently to treat them equally."
For example, said Dr. Otsuka, people in many Asian cultures are reserved, ask few questions, and respect authority figures. He recommends using open-ended statements such as, ‘Please tell me about your problem in your own words.’
It’s also important to remember that some patients, such as Asian-Americans born outside the United States, may be more comfortable with formal communication.
"Greet elders first, and address everyone by using their title and last name," said Dr. Otsuka. "Watch out for inadvertent ‘signs of contempt,’ which include crossing your legs, leaning on a table or desk, or pointing your foot."
Dr. Dykes said that African-American patients should also be addressed with formal titles. He also cautioned against using the terms ‘you,’ and ‘you people.’
"Be friendly, but not overly familiar with Hispanic/Latino patients," advised Dr. Jimenez.
"Asking about their country of origin is a good icebreaker."
Tip 2: Understand community demographics.
African-Americans born in the United States, for example, may have very different attitudes and expectations than more recent immigrants.
"Historically, African-Americans came to the United States from the west coast of Africa as part of the slave trade," explained Dr. Dykes. "Since 1860, growth in the U.S. population of people of African descent has come about primarily through birth. Recent immigrants have come from countries such as Egypt, Ethiopia, and Ghana."
The Hispanic/Latino population is exploding and expected to make up 25 percent of the U.S. population by 2040, said Dr. Jimenez. The terms "Hispanic" and "Latino" are not synonymous, he explained.
"Hispanic" refers to the people and culture of Spain, although it has evolved to include the Spanish-speaking nations of the Americas. "Latino" usually refers to people from the countries of Latin America, including Mexico, Puerto Rico, the Dominican Republic, Cuba, and Central and South America.
According to Dr. Otsuka, Asian-Americans, who make up 5 percent of the U.S. population, are a diverse group of people from 50 different countries who speak 100 different languages/dialects. "Asian-Americans are as diverse as European-Americans," he said.
Dr. Otsuka noted that although a significantly higher percentage of African-Americans and Hispanic/Latinos are uninsured compared to the general U.S. population, 82 percent of Asian-Americans have health insurance compared to 86 percent of the general population.
Tip 3: Watch for healthcare disparities and common conditions.
"For example," he said, "Hispanic/Latino patients do not receive total joint replacements at the same frequency as Caucasian patients. These disparities have been attributed to the lack of access to the healthcare system, lack of access to patient education, and not being offered the opportunity.
"Latino patients also have an increased prevalence of type 2 diabetes mellitus and its deleterious effects on the lower extremities" continued Dr. Jimenez. "So, foot and ankle surgeons should have a heightened awareness of this condition in both preoperative and postoperative phases of treatment."
"Asian-Americans have an increased risk of osteoporosis because of diets low in calcium and a high rate of lactose intolerance," said Dr. Otsuka "They also react differently to some medications. For example, diazepam has a high risk of toxicity in Asian-Americans, who metabolize the drug poorly. Orthopaedists should also be aware that between 30 percent and 60 percent of Asian-Americans use herbal medicine that can affect coagulation."
Dr. Dykes noted that African-Americans are more susceptible to conditions such as hypertension and sickle cell anemia.
"If not addressed," added Dr. Lewis, "these conditions can affect the outcome and postoperative course of the orthopaedic patient."
Tip 4: Involve the family—or not.
Dr. Jimenez said that Hispanic/Latino patients, particularly recent immigrants and first-generation individuals, are still influenced by the paternalistic medicine practiced in their native countries.
"You must be aware of the circumstances and attitudes about health care that these patients bring with them to your office," he said.
Tip 5: Don’t discount spirituality.
"Orthopaedists should inquire about religious beliefs," he said. "Patients’ religious beliefs are tied to how they handle the diagnosis of a disease—especially cancer.
"African-American patients may be suspicious of your diagnosis, may seek another opinion, or may pray for healing and intervention from a higher power," he continued.
Dr. Jimenez added that many Hispanic/Latino patients’ health beliefs are culturally determined rather than based on scientific facts.
"You must be sensitive to the differences and avoid stereotyping," he said. "If you combine this with compassion as a physician and good communication skills, you will be very successful at delivering culturally competent care."
- McKee, J. (2009). 5 Tips for Boosting your Cultural Competence. AAOS Now.
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