Overcoming cultural barriers to eye care ‘starts with us’
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Diversity in health care is critical as our communities become more diverse in race, ethnicity and culture.
A diverse patient base is ideally served with an equally diverse provider base, particularly for underserved minority patient populations who are greatly impacted by disparities in health care. Greater diversity in health care leads to better health outcomes, as patients are more likely to seek care and follow through with treatment recommendations from providers of the same background as their own.
However, the reality is there is a lack of diversity across many health care specialties, especially in eye care, resulting in many underserved minority patients receiving care from providers of different backgrounds than their own. Quality patient care may still be delivered, but to better connect with underserved patients we must look for different approaches.
Supply vs. demand
Delivering quality eye care to underserved populations is best achieved by increasing the workforce of underrepresented in medicine (URiM) eye care providers. This paramount need for more diverse providers is an uphill battle starting with lack of representation of URiM students matriculating into medical schools and the projected decline in ophthalmologists, as the supply cannot keep up with the demand of the aging population.
According to the Association of Schools and Colleges of Optometry, the percentage of URiM students both matriculating into and graduating from optometry schools has also been low for more than a decade. More effort needs to be placed into recruiting and mentoring URiM students to pursue eye care fields as well as recruiting and retaining URiM faculty.
However, when recruitment does not supply the demand for URiM providers, the shortage may be fulfilled, where possible, with cultural competency.
Early in my career, when Spanish speaking-only patients scheduled with me, I pondered as an Asian American with limited Spanish-speaking skills how I would help them. Throughout several years of practice, I’ve learned to take different approaches. My question now as the patient enters the room is, “Cómo está usted? Comencemos tu examen de la vista,” rather than, “How are you? Let’s start your eye exam.”
As an optometrist and assistant professor of clinical ophthalmology at a university clinic in a major metropolitan area, I strive to deliver culturally sensitive care alongside my ophthalmology colleagues for a patient base widely diverse in races and ethnicities. Spanish-speaking patients are surprised when this Asian eye doctor conducts the entire exam in Spanish. The patients are relieved that I speak their language, imperfect yet respectfully. This lens brings a different focus to the saying, “Treat people how they want to be treated.”
Expanding cultural competency
There are many definitions and interpretations of cultural competence. In general, cultural competence involves the integration of knowledge, awareness, sensitivity and attitudes in order to adequately deliver health care that meets the social and cultural needs of patients.
Research has shown that cultural competence training as part of curricula for current and future providers can improve knowledge and understanding of cultural differences and social determinants of health. Training in cultural competency should be emphasized for all providers to learn how patients of different backgrounds perceive health care and how patients want to be addressed or communicated with, to understand cultural beliefs on treatment and, most importantly, to deliver personalized care.
I contemplate how we as eye care providers can overcome barriers to culturally sensitive care as I enter the next exam room to refract an undergraduate from China and ask him, “How high would you like your degree to be?” I do not mean his major field of study, but his spectacle prescription, because many individuals from Asia refer to spectacle prescriptions as “degrees” and prefer to be under-corrected. Recognizing cultural preferences in health care improves the relationship and collaboration between patients and providers.
Overcoming the barriers starts with us, the providers, but should be a commitment for entire organizations, from large hospitals to individual clinics. Not only must we value diversity and cultural competency, but we must also put it into practice. My Spanish may at times sound broken and I may have to ask patients how to say something, but I am showing them that I understand their viewpoints and respect their concerns.
As we may not have access to providers of every race, ethnicity or other backgrounds, we may learn to effectively and respectfully communicate and care for our diverse spectrum of patients and, thus, diversify our skills, services and cultural competence. In doing so, we can provide care to the best of our abilities, improve outcomes and, as the saying goes, treat people how they want to be treated.
References:
- Ali AA, et al. JAMA Ophthalmol. 2023;doi:10.1001/jamaophthalmol.2023.4476.
- Berkowitz ST, et al. Ophthalmology. 2023;doi:10.1016/j.ophtha.2023.09.018.
- Data Trends in Optometric Education. https://optometriceducation.org/data-reports/data-trends-in-optometric-education/. Accessed Dec. 25, 2023.
- Elam AR, et al. Ophthalmology. 2022;doi:10.1016/j.ophtha.2022.07.010.
- Gluckstein J. Semin Ophthalmol. 2023;doi:10.1080/08820538.2022.2157217.
- Henderson S, et al. Health Soc Care Community. 2018;doi:10.1111/hsc.12556.
- McGregor B, et al. Ethn Dis. 2019;29(suppl 2):359-364.
For more information:
Kent Nguyen, OD, FAAO, is assistant professor of clinical ophthalmology at USC Roski Eye Institute.
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