The American Academy Of Orthopaedic Surgeons Launches: Culturally Competent Care Program

Main Category: Primary Care / General Practice
Also Included In: Bones / Orthopaedics
Article Date: 03 Oct 2007 - 12:00 PST

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The American landscape, including its patient population is rapidly becoming more diverse. The cultural competence of physicians is imperative to enhancing positive health care outcomes. The American Academy of Orthopaedic Surgeons (AAOS) recognizes this and is taking the lead by creating and launching a new Culturally Competent Care program. This program aims to familiarize and raise awareness of orthopaedic surgeons about specific beliefs, customs, ethnic, racial and gender-based differences, so they can better meet the needs of patients with diverse backgrounds and specific needs.

The AAOS recognizes that providing culturally competent care to its patients encompasses a combination of:

- Attitudes
- Skills and knowledge which allow health care providers to better anticipate, understand and care for patients whose cultural backgrounds are different from their own.

Recent legislative action across the U.S. underscores the need for culturally competent care in all areas of medicine.

- New Jersey was the first state to pass a law that ties cultural competence education to medical licensure.
- California and New Mexico have enacted similar legislation.
- Illinois has legislation currently pending and other states are following suit.

"In my own practice, I have seen firsthand the benefits of training our young surgeons to be more sensitive to and more deeply aware of, diverse backgrounds. Physicians who can put their patients at ease and connect with them authentically are more likely to find that their patients follow through with a prescribed treatment," said Ramon L. Jimenez, MD, orthopaedic surgeon, consultant, Monterrey Peninsula Orthopaedic and Sports Medicine Institute, Monterey, California and chairman of the American Academy of Orthopaedic Surgeons (AAOS) Diversity Advisory Board.

Recent studies have documented many areas in which minority populations in the U.S. have worse health outcomes than those in the majority. Minority patients typically:

- Wait longer for diagnoses
- Receive less aggressive treatment and are under-treated for pain

Research also shows that these racial and ethnic treatment disparities exist, even when insurance, social status, income, age, education and severity of conditions are comparable.

Many patients feel most comfortable with physicians who share their racial or ethnic background and/or language.

The AAOS also believes patients should:

- Voice their concerns and any specific needs because of their condition
- Know that is it always ok to ask questions and make their needs known.
- Discuss religious, dietary or privacy requirements with the doctor.
- Ask for a translator if necessary.
- Express any fears or conflicts they may have with Western Medicine.
- Discuss any herbal or traditional remedies they currently use.
- Come prepared with lists of all the medications they are taking, their surgical history with dates, their family medical history and any questions they want answered.

The following examples illustrate just a few of the many patient differences an orthopaedic surgeon can use in order to help them become more sensitive and culturally competent.

African-American Patients

- African-American patients can often carry with them a long-standing distrust of the health care system in the U.S. The notorious Tuskegee study, in which treatment was withheld deliberately from black men in the name of research, is well known within the African-American community. Show respect to gain trust. Greet patients with a calm demeanor, a firm handshake and direct eye contact.

Hispanic/Latino Patients

- Practice pronouncing the patient's name correctly, before entering the room. Smile and look directly at the patient. Be aware that other family members will likely be with the patient. Greet patients formally and speak Spanish whenever possible.

Asian-American Patients

- Eye contact may be avoided as a sign of respect. Greet the elders in the room first, address patients formally and take time with the patient visit.

American Indian/Native-American Patients

- Speak in a quiet tone. Loud voices can be considered to be aggressive. Take your time when speaking, and avoid large or frequent gestures.

Gender-Based Issues

- When planning to examine a patient from a conservative religious or traditional background (e.g., devout Muslim), first ask permission from the man/men accompanying the patient to the appointment.

Faith-based Issues
• For many patients religious and spiritual beliefs can often outweigh the advice of their doctor.

Disclaimer: The culturally competent care information in this document is offered from the American Academy of Orthopaedic Surgeons (AAOS) in the form of guidelines, recommendations and tips. This information is general in nature, and not meant to be all-encompassing. It is a suggested starting point to raise physicians' awareness of patients' needs and preferences. AAOS does not assume that an individual from a particular ethnic or cultural group necessarily shares the all traits of that ethnicity or culture.

American Academy of Orthopaedic Surgeons