Commentary

Culturally competent care is the most effective care

Care that is understanding of the diverse characteristics of each patient, including but not limited to sex, race, ethnicity, sexual orientation, gender orientation and faith, is critical to the health and outcomes of patients. Our ability to establish the highest quality relationships with patients relies on developing trust and respect so patients listen to our opinions and participate in shared decision-making.

Trust and respect go both ways. Our efforts to understand cultural influences and perceptions build the relationship in which we work as a team to pursue the most effective care. When we fail to bridge the gap between our culture and that of our patients, significant disparities in health care and dissatisfaction are elevated. These differences limit our ability to promote patient responsibility and empowerment to be a vital part of the overall health care process. When trust is not a healthy part of our relationship, it creates an environment for increasing health care issues and medical liability.

Anthony A. Romeo

We are the cultural outlier

Most orthopedic surgeons are the cultural outlier, not our patients. The average orthopedic surgeon is male, mid-50s in age, Caucasian, has English as a first language and advanced educational degrees, earns more than three times the middle-class income, has children, owns a home, and is heterosexual and cisgender. For most orthopedic surgeons, a patient with these same demographics is less than 10% of a practice. Additionally, orthopedics has the lowest percentage of women of all medical and surgical specialties, which is less than 10%, and less than 2% of orthopedic surgeons identify themselves as African Americans.

During the past 30 years, orthopedic leaders have tried to improve the representation of women and minorities in the profession. Data from the 2018 census from the American Academy of Orthopaedic Surgeons suggests some improvement as 16% of practicing orthopedic surgeons younger than 40 years are women. For the first time, the president of the AAOS is a woman, and multiple women are also chairs of their respective academic orthopedic departments. However, recent data suggest that despite the efforts of many in orthopedics and the increase in diversity among medical student populations, little has changed in the representation of African Americans and Hispanics in orthopedics. Current levels suggest we are at least another generation away from approaching the changes seen in other medical specialties.

Another culturally distinct group is the LGBTQ community. The LGBTQ community is becoming more public and vocal about disparities in social and health care services. It has been documented that members of the LGBTQ community may have higher rates of disparities in mental, behavioral and physical health. Although not carefully studied, it is likely that stressors affect their musculoskeletal system in ways we have yet to fully understand. If we mistakenly believe this community is only about sexual orientation, then we will not establish a trusting and respectful relationship with many patients. This will affect our ability to provide compassionate and culturally competent care.

Understand patients

To provide culturally competent care, we must develop the ability to understand and protect patients from our personal biases to establish a relationship that leads to the best shared decisions for orthopedic care. We need to understand the diversity present every day in our practice. Failure to truly accept patients’ cultures and communities will marginalize patients to where they will seek their musculoskeletal care from other medical professionals. We should act as if we have a mandate that we will be the most advanced in providing culturally competent musculoskeletal care without exception based on sex, gender, race, ethnicity, faith and the many facets of culture we experience with our patients every day.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau, is a consultant and does contracted research for Arthrex; receives institutional grants from MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Wright Medical.

Care that is understanding of the diverse characteristics of each patient, including but not limited to sex, race, ethnicity, sexual orientation, gender orientation and faith, is critical to the health and outcomes of patients. Our ability to establish the highest quality relationships with patients relies on developing trust and respect so patients listen to our opinions and participate in shared decision-making.

Trust and respect go both ways. Our efforts to understand cultural influences and perceptions build the relationship in which we work as a team to pursue the most effective care. When we fail to bridge the gap between our culture and that of our patients, significant disparities in health care and dissatisfaction are elevated. These differences limit our ability to promote patient responsibility and empowerment to be a vital part of the overall health care process. When trust is not a healthy part of our relationship, it creates an environment for increasing health care issues and medical liability.

Anthony A. Romeo

We are the cultural outlier

Most orthopedic surgeons are the cultural outlier, not our patients. The average orthopedic surgeon is male, mid-50s in age, Caucasian, has English as a first language and advanced educational degrees, earns more than three times the middle-class income, has children, owns a home, and is heterosexual and cisgender. For most orthopedic surgeons, a patient with these same demographics is less than 10% of a practice. Additionally, orthopedics has the lowest percentage of women of all medical and surgical specialties, which is less than 10%, and less than 2% of orthopedic surgeons identify themselves as African Americans.

During the past 30 years, orthopedic leaders have tried to improve the representation of women and minorities in the profession. Data from the 2018 census from the American Academy of Orthopaedic Surgeons suggests some improvement as 16% of practicing orthopedic surgeons younger than 40 years are women. For the first time, the president of the AAOS is a woman, and multiple women are also chairs of their respective academic orthopedic departments. However, recent data suggest that despite the efforts of many in orthopedics and the increase in diversity among medical student populations, little has changed in the representation of African Americans and Hispanics in orthopedics. Current levels suggest we are at least another generation away from approaching the changes seen in other medical specialties.

PAGE BREAK

Another culturally distinct group is the LGBTQ community. The LGBTQ community is becoming more public and vocal about disparities in social and health care services. It has been documented that members of the LGBTQ community may have higher rates of disparities in mental, behavioral and physical health. Although not carefully studied, it is likely that stressors affect their musculoskeletal system in ways we have yet to fully understand. If we mistakenly believe this community is only about sexual orientation, then we will not establish a trusting and respectful relationship with many patients. This will affect our ability to provide compassionate and culturally competent care.

Understand patients

To provide culturally competent care, we must develop the ability to understand and protect patients from our personal biases to establish a relationship that leads to the best shared decisions for orthopedic care. We need to understand the diversity present every day in our practice. Failure to truly accept patients’ cultures and communities will marginalize patients to where they will seek their musculoskeletal care from other medical professionals. We should act as if we have a mandate that we will be the most advanced in providing culturally competent musculoskeletal care without exception based on sex, gender, race, ethnicity, faith and the many facets of culture we experience with our patients every day.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau, is a consultant and does contracted research for Arthrex; receives institutional grants from MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Wright Medical.