Told in Competence
Recently, I had the chance to speak with Dr. Elizabeth Szalay, an associate professor of pediatric orthopedics at the University of New Mexico who works at Carrie Tingley Hospital in Albuquerque. Dr. Szalay is a spokesperson for the American Academy of Orthopedic Surgeons, (AAOS) an organization at the forefront of the battle to increase cultural, ethnic and racially competent care for all Americans. This movement is concerned with insuring doctors are aware of the differences between various racial, ethnic and cultural groups in terms of their health risks and health practices and how these differences should shape the healthcare individuals receive. Although I wasn't able to interview Dr. Szalay in time to include her quotes in my article on New Mexico's racial and ethnic health disparities, I've included a few of the questions and answers from our interview below.
What are some important aspects of culturally competent care?
"It all boils down to communication. For example, in many ethnic groups there are home or herbal remedies and we shouldn't view these treatments as ineffective. Many of the most important discoveries in medicine started out that way. We have to communicate with patients so we know that they've been prescribed herbs or folk remedies because these may be quite powerful drugs that do have medicinal powers or may have powers we don't understand. It's particularly important because they may have a significant impact on the patient's care and how I decide to treat them. I have to welcome the patient's input and create an environment in which they are allowed and welcomed to give me that information."
Can you give me an example of the types of cultural differences you encounter in pediatric orthopedics?
"Well, when we do orthopedic procedures, we often use bone grafts from a "bone bank." It's basically freeze dried bone with no living cells that comes from another person. Using a bone bank is not something many Native Americans believe in so you have to know that and you have to make alternative plans. It's situations like that where knowing the person's beliefs up front can help you give them the information they need to make the decision they're most comfortable with."
How close are we to insuring cultural, ethnic and racially sensitive care for all New Mexicans?
"I think we have a long way to go. Patients are still a little intimidated to discuss their beliefs with their doctors and doctors need to do a better job of making them comfortable enough to do so. As phsycians, we''re always behind, always rushed and we need to learn to take the time that patients require to be able to gain the confidence to say, 'these are the medicines I'm taking' and 'I went to the medicine man last week and here's what he's having me do.' A lot of work still needs to be done on both sides."