• Cross-Cultural Challenges: Creating an Inclusive Practice

    A physician treating patients will encounter diverse ages, health histories and conditions. One of the sessions at Mid-Year Forum 2019 explored what ophthalmologist can do to respond to a changing America.


    Today, and even more so in the future, our patients are from diverse backgrounds. How do we create real patient-centered care in which our patients and their families feel welcomed and at ease in our practices? This session will explore the cross-cultural challenges we all face in order to improve outcomes and maximize patient satisfaction.

    Background Information

    With an increasingly diverse U.S. population, it is critical that physicians ensure that their practice is prepared to provide a culturally-appropriate and positive experience to the patients it serves. This helps ensure that patients are comfortable and forthcoming in communicating their health issues and concerns and to help ensure consistently high-quality eye care to all.

    Summary of Comments from Guest Speakers


    Lynn K. Gordon, MD, PhD, council chair, American Academy of Ophthalmology
    Keith D. Carter, MD, PACS, past president, American Academy of Ophthalmology

    Delivering Culturally Competent Care in Clinical Practices

    Denice Cora-Bramble, MD, MBA, CMO & EVP Ambulatory & Community Health Services, Children’s National Health System 

    Dr. Cora-Bramble stated that cultural competence definitions haven’t changed much over time. It is the ability to establish an effective working relationship that supersedes cultural differences, the ability to communicate effectively with people from different backgrounds.

    She offered practical ways to apply the theoretical tenets of cross-cultural competence, describing experiences reported by African Americans and Latinos which were perceived as inappropriate or culturally unaware.

    Dr. Cora-Bramble related studies that have documented medical adverse effects that language barriers can have on health care encounters. She stressed the importance of using professional interpreter services for patients with limited English proficiency. Untrained interpreters make errors.

    It is important to ask your patient whether they partake in any traditional practices for their health care.

    In focus group studies with minority populations, they expressed a desire for patient-centered care.

    Why Is This Important in Your Everyday Practice?

    Tamara R. Fountain, MD, professor, Rush University Medical Center

    Dr. Fountain described interactions with patients with an assortment of impairments emphasizing the importance of communicating empathetically. Try to put yourself in the patient’s shoes.

    Separate the person from the disability. By this she meant to put the person first, not the disability. For example, think of him or her as a child with Down Syndrome and not a Down Syndrome child.

    With visually impaired patients, identify yourself as the doctor. She noted that cognitive impairment among the elderly – ophthalmologists’ largest patient group – is now at 6 million people and is expected to affect 15 million by 2060. Patients are usually aware of their impairment and are frightened by it.

    Dr. Fountain recommended enlisting their care partner during encounters and to triangulate the conversation, having eye contact and communicating with both the care partner and the patient. Schedule shorter visits, simplify your message and slow down. Never forget the power of human touch.   

    How to Maximize Communications with Millennials and Baby Boomers

    Robert F. Melendez, MD, MBA, secretary for online education, American Academy of Ophthalmology

    Dr. Melendez stated that the millennial generation (1981-1996) differs greatly from previous generations. They want digital access to you and will evaluate you through online reviews before making that first appointment, and they expect a great patient experience. This generation wants a strong connection with their physicians.

    Millennials are the most educated generation and are twice as likely to search review sites. Sixty percent support the use of telehealth and 71% would like their physician to adopt a mobile health map.

    Dr. Melendez encouraged ophthalmologists to know and use their patients’ communication preferences as much as possible. Further, he recommended that you redesign your website every three years, create and use a professional Facebook presence and to check what reviews are being written about you.

    Summary of Audience Comments

    • Cultural humility is an even stronger way to connect with patients by asking them questions, learning about them first in order to provide the most appropriate care.
    • How best to create an infrastructure that addresses unintended bias? Most of the time, it is best when senior leadership sets in motion an assessment of bias in the institution.
    • There are lower cost ways to secure interpreter services than having someone in the practice, including telephone pay-by-the-minute services, video conference services and mobile apps.
      • The concern with mobile apps – what is your fallback position when the technology fails you?
      • Build “interpreter” time into the schedule.
      • Consider this extra time as equivalent to the extra time you would spend with someone with a complicated history or cognitive impairment.
    • Use a risk-management technique of Parrot Talk to ask the patient to tell you what you just said. It will highlight and guide you to clarify areas that the patient missed or misunderstood.
    • It is important to be aware of socioeconomic determinants of health.
    • Remember that many patients come to the office with a fear that their eye condition will cause blindness. A lighthearted office can be discordant with that. Keep your office tone respectful of this fear.

    High Priority Objectives

    • Create a bubble of inclusion for everyone in your work environment, from the patient to the staff, referring doctors and so on. Treat all with respect.
    • There was concern expressed about the additional time and money required when caring for those needing interpreter services, particularly for those in small practices. It is an unfunded mandate which will actually help the physician provide more appropriate care to the patient and add to the patient-doctor relationship.

    Read the full Mid-Year Forum 2019 Report: View as webpages or as a PDF (360 KB).