How Orthopaedic Surgeons are Addressing Florida’s Cultural Diversity

Florida is a state with a rich diversity of cultures and ethnic groups. The state has long been associated with Cuban and Haitian peoples. However, these days Florida’s residents include migrant workers from Central America, Vietnamese and Hmong peoples, and even one of the United State’s largest populations of Palestinians, concentrated in the city of Jacksonville.

What kind of challenges does this diversity pose to physicians, most specifically orthopedic surgeons? Dr. Patrick Hutton, an orthopaedic surgeon and member of the Diversity Advisory Board of the American Academy of Orthopaedic Surgeons (AAOS) is someone who cares deeply about providing quality care to diverse populations. He explains, “The fallacy is that treating all patients the same is identical to giving everyone equal treatment. You have to take into account the fact that an explanation for example of knee surgery, which may be clearly understood by most patients, could leave an Hispanic person with an incomplete understanding of the proposed procedure. Then there’s the factor of what kind of care that patient has received in the past, his or her preconceived notions and bad experiences. Patients with varied cultural backgrounds often walk into our offices with fearful, or at the very least, different expectations of treatment, as compared to many middle class people who’ve had basically good care their entire lives.”

Dr. Hutton is a past president of the Florida Medical Association. It was during his tenure there that he started to focus on healthcare access for the underinsured. He began to understand the real disparity that exists in healthcare for minorities and diverse ethnic groups. AAOS’s Diversity Advisory Board interested him because the group conducts free training to orthopaedic surgeons. Culturally Competent Care: An Orthopaedist’s Responsibility is a free seminar being offered to orthopaedic residents across the country. Dr. Hutton and Dr. David Font-Rodriguez are two orthopaedic surgeons who are heavily involved in that effort in Florida.

“We’ve divided the orthopaedic programs in Florida. I’ll be conducting the training in northern Florida orthopaedic programs, while Dr. Font-Rodriguez is covering schools in the south. Each school will get a visit from one of us during their five year residency cycle”, Hutton explains. The program is conducted with a grand rounds format, with both didactic and interactive elements. Presenters discuss various patient scenarios that require cultural competence. At session’s end, residents receive a free “Cultural Competency Challenge CD-Rom,” and “Culturally Competent Care Guidebook,” created by the AAOS.

Chairman of the Diversity Advisory Board, Dr. Ramon Jimenez, outlines what he considers the basic ingredients of culturally competent care: curiosity, awareness, sensitivity and communication. Dr. Hutton describes how he carries out those qualities in his orthopaedic practice. “Doctors have to be willing to accept the things patients do that give them a sense of well-being – as long as what they’re doing doesn’t hurt them in any way. For instance, if patients treat injuries with a hot soak in Epsom salts because it’s grandma’s old remedy, let them do it. Even if it realistically doesn’t improve the condition, it still means something to the patient’s well-being.”

He’s also observed that some African American male patients may be reluctant to take medications to treat hypertension due to possible side effects. “They can also be unwilling to participate in clinical trials because of what happened during the Tuskegee experiment. Doctors need to be sensitive to why people have those fears.” In addition to conducting the Cultural Competency seminars, Hutton continues to learn about diversity first hand. He regularly volunteers in a healthcare clinic his church runs for migrant workers.

When asked how doctors can be expected to exercise sensitivity and awareness in the age of managed care Hutton suggests, “During the very first patient visit, doctors should really try to get to know the patient and create an understanding of who that person is. Push through to make a connection on the first visit and you can build on that in later visits. We’ve found that a good first interview can make a big difference.”

Across the country, AAOS has found residents to be very receptive to the seminars, and they give the program good marks. The rewarding part of championing the cause of culturally competent care, for Dr. Hutton, comes with reaching out to younger people to teach them, “It’s all part of giving back some of what I’ve learned from my patients and mentors,” he says.