Pterygium

Cultural sensitivity is a key driver to practice growth and better patient care.

America today is vastly changed and far more diverse than in generations past. In some areas of the country, delivering the best possible eye care and building a successful practice are fundamentally linked to how well you and your staff understand and are sensitive to the cultural complexities of your patient base and community.

Clinically, we consider ethnicity in differential diagnosing and in developing treatment plans. However, ethnicity and culture are not only key in medical management but are also important factors in practice management and practice growth. In this series on cultural competency, we look beyond our medical and ethical responsibilities and examine how implementing a practice standard of cultural competence improves patient care and contributes to practice growth and professional success.

DEFINING CULTURAL COMPETENCY

What is "cultural competency" and how does it affect eye care?

Simply put, cultural competency means acquiring knowledge of, and sensitivity toward, a patient's culture and applying this information to your practice to provide the best health care possible. Compelling reasons why achieving and maintaining cultural competency should top your list of practice goals:

1. Improving patient interactions. Communicating in a culturally sensitive manner helps create a comfortable environment that ensures patient compliance and good health outcomes.

2. Growing your practice. The eyecare marketplace is changing as rapidly as the general population. Patients want a healthcare provider who understands them and makes them feel comfortable and wanted. Embracing diversity is critical to delivering eyecare to a changing population and essential to growing an eyecare practice in a changing marketplace.

3. Recognizing high-risk patients. Some ocular and systemic conditions are more prevalent among different ethnic groups. As we know, glaucoma is more prevalent in the African-American community, rates of myopia are especially high in Asian communities, and Hispanic patients have a higher incidence of pterygium. In addition, common systemic conditions, such as hypertension and diabetes, affect African-American and Hispanic patients at high rates and are often diagnosed first in our offices.

HISPANIC CULTURAL COMPETENCY

Medical management of the Hispanic patient is beyond the scope of this article. We will focus on market insights and the growth of the Hispanic market. This is a remarkable story that eyecare professionals should understand and address.

Hispanics now comprise the largest minority group in the nation. In 2004, some 14.1% of our population was Hispanic, according to the U.S. Census, an increase of 3.6% from the previous year. This growth accounts for over half of the nation's annual population growth.

These Census numbers contain several critical facts. First, Hispanic Americans are young. Half of all Hispanics are under age 27, and one of every five Americans under age 18 is Hispanic. Education levels in Hispanic communities are rising, and Hispanics are increasingly found in all regions of the country, all occupations and all levels of society - changes that are likely reflected in the patient base of typical eyecare practices. U.S. corporations have long recognized the buying power of this group.

Now the important questions: Have the cultural demographics of your practice changed? Are you aware of the trends in your community? Are you and your staff prepared to meet the needs of this population? Are you missing out on a big opportunity to grow your practice? Here's how two eyecare practitioners have integrated cultural competence into their practices.

CULTURAL COMPETENCY IN OPTOMETRY

Charles Ficco, O.D., is one of 11 practitioners in a large multidisciplinary practice in the Atlanta suburb of Morrow, Ga. Over the eight years he has been with the practice, the patient base has grown increasingly diverse. Much of that growth includes Hispanic patients. Dr. Ficco, who earlier practiced in Miami, taught himself to conduct an exam in Spanish, which led many patients to refer other family members to him. "We'll see a construction worker because he has something in his eye," Dr. Ficco says. "We'll treat him, and a week later three of his family members will come in because he said, 'see this doctor, he speaks Spanish.'"

Dr. Ficco recognizes the limits of his Spanish proficiency, however, and his practice has made a concerted effort to hire a bilingual receptionist and an optician who can assist the doctors in translating if necessary. "I'm comfortable conducting an exam in Spanish," Dr. Ficco says. "But if I need to discuss more critical issues or answer questions, I want to make sure we communicate accurately."

Dr. Ficco says his office staff, is extremely accepting of varied cultures because it reflects the diversity of the patient base. "If the Hispanic population in your area is growing, it is well worth your time to take a Spanish course or to hire a bilingual staff," he says.

Steven L. Schneid, O.D., has taken a proactive approach to accommodate the changing demographics in the communities around his Washington, D.C., offices, which include increasing numbers of Hispanics and other ethnic groups.

To accommodate Hispanic patients, Dr. Schneid took a multi-pronged approach. First, he improved his language skills so he was comfortable conducting an exam in Spanish. Second, he had patient forms printed in Spanish. Finally, he advertised his practice on Spanish cable TV and in Spanish newspapers, and he hired Spanish-speaking staff.

"My practice benefits from the close-knit nature of Hispanic families by receiving referrals from family members," Dr. Schneid says.

APPLYING CULTURAL COMPETENCY

Every cultural competency effort should begin with an analysis of diversity trends in your patient base and community. You can obtain cultural diversity data from your local government or Chamber of Commerce or compare a random sample of your patient base five years ago to your patient base today. Next, you should identify cultural characteristics shared by Hispanic-Americans and apply this information to your practice. One survey found that Hispanic-Americans are similar to the total U.S. population because both groups value hard work, tolerance, individualism, and the importance of family. However, several significant differences set this population apart. Did you know:

* A higher percentage of Hispanic patients pay by cash rather than by insurance or credit card? Be flexible: Present partial-payment options as well as incentives for same-day full payment.

* Hispanic patients are more accustomed to walking in rather than appointing? Be welcoming: Explain you will see them, but they may have to wait. Most are willing to do so, especially if you keep Spanish language magazines in your reception area.

* In the Hispanic culture, there is a strong sense of family? Patients tend to be accompanied by several , family members or friends who often also need eyecare services. Enlarge your reception area to accommodate more people and train your staff to recognize this situation as a practice growth opportunity. While these patients wait, present information on the importance of regular eye care with bilingual brochures and videos.

* Physical appearance and style are more important in the Hispanic culture than in other U.S. population groups? Marketing consultants recommend maintaining a contemporary office decor and providing high-fashion products and services that improve appearance. For example, color contact lenses are more popular among Hispanics than other groups. Consider keeping a variety of diagnostic color lenses and high-fashion frames in your office.

Take time to learn about your patients' culture and put this information into practice. You will improve the quality of care you offer your patients and increase your chances of success.

By Derrick L. Artis, O.D., M.B.A.

ABOUT THE AUTHOR

Derrick L. Artis, O.D., M.B.A., is director of professional affairs at Vistakon, Division of Johnson & Johnson Vision Care Inc.

Copyright Boucher Communications, Inc. Oct 2005
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