reading section to encourage understanding of the principles
of cultural competence in the health care setting.
Jimenez finds the one-page tip sheets on patients’ cultural
and communication preferences helpful. “I’ve looked at the tip
sheets from time to time to refresh my memory on a particular
culture,” he says.
More than 7,000 guidebooks have been distributed. “The
CD and the guidebook have been a runaway success,” Haynes
says. “We’re still printing and distributing them.”
While the guidebook contains guidelines on treating
patients within a particular cultural context, AAOS staff and
members are quick to note its limitations.
“The guidebook is not meant to be a ‘rule book,’” Lewis
explained. “It’s not prescriptive, [just] suggestive. We want to
continue to raise awareness of the need for culturally competent care and encourage a doctor to say, ‘Oh, I might not have
considered that; maybe I should.’ You may need to treat people differently to treat people equally.”
WHY IT’S IMPORTANT
In the guidebook, authors Jimenez and Lewis make the point:
“Never assume that an individual who comes from an ethnic
culture shares the traits of that ethnicity or culture.”
With such a caveat, why should physicians add learning
about cultural competency to their busy schedules?
The guidebook references a recent report from the American Medical Association that notes “a breakdown in communication is the most common cause of errors that harm patients.”
Rankin, AAOS’s president, isn’t surprised. “Good communication is fundamental to patient care.”
Rankin admits that he needs to be aware of lapsing into “age
bias.” “Sometimes I find myself talking to an elderly patient’s
daughter or son, instead of directly to them,” he says. “When this
happens, I stop and say, ‘I’m sorry. I should be talking to you.’”
“It’s also about respect,” says Haynes. Having worked in
Arizona with Native American patients, Haynes encouraged his
patients to discuss their treatment plans with their medicine
man, if that was important to them.
Putting it into perspective, Lewis says: “You can’t be expected
to know the nuances of every culture, but you should familiarize
yourself with the cultures that you are treating. If you practice
in Minnesota, you may not need to fully understand the Hispanic
culture, but you do need to know about the Hmong.”
Lewis also says that knowing more about the patient’s
background and lifestyle helps physicians determine the best
treatment plan for an individual.
AN ORTHOPAEDIST’S RESPONSIBILITY
“If you fail to pay attention to cultural differences, you risk:
• Alienating your patients
• Misdiagnosing their medical problems
• Having them not adhere to your treatment plans
• Poorer outcomes
• Bad word-of-mouth from patients.”
Excerpt from the seminar for orthopaedic residents, Culturally Competent
Care: An Orthopaedist’s Responsibility
YOU MAY NEED TO TREAT
PEOPLE DIFFERENTLY TO
TREAT PEOPLE EQUALLY.
“In the case of a woman who is the sole caretaker of her
young children, I may recommend a partial meniscectomy so
that the patient will be able to walk with a cast, whereas a
meniscus repair would require her to remain off her foot for an
extended period of time. We adjust treatment plans for football
players; we should take culture into account. It’s about giving
the patient the best care depending on the situation.”
When in doubt, Jimenez says to remember the “four basic
ingredients” of culturally competent care: curiosity, awareness,
sensitivity and communication. “If you have those four ingredients, you can use them to treat anyone in a culturally competent manner,” he says.
Jimenez adds the importance of treating your colleagues
with cultural sensitivity. “If you can’t relate in a culturally
competent manner with, for example, the anesthesiologist, the
patient may suffer.”
MANDATORY COMPLIANCE
While providing culturally competent care is the “ethically and
morally responsible” thing to do, there is an even greater incentive for physicians to make it a priority, says DAB member Raj
Rao, MD. Several states are considering or have passed legislation requiring physicians to obtain CME units in culturally
competent care.
