By Peter Bae, OD, MS
Communities across the country are becoming more culturally diverse. By responding to your changing patient base—and understanding cultural sensitivities—you can build a multicultural practice.
It is no accident that my staff speaks Korean, Spanish and Tagalog in addition to English. Based in the Bronx in New York City, my practice is decidedly multicultural. I would estimate that 75 percent of my patient base do not speak English at all or not well enough to communicate. The majority are native Spanish speakers. Along with a multilingual staff, I personally can conduct exams entirely in Korean, Spanish and, of course, English.
Being able to communicate in various languages is just the first step in developinga multicultural practice. Just as important is understanding the cultural differences and sensitivities that accompanying the varied groups of people you serve in your community.
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First Exam Ever
Recent immigrants to the United Statesfrequently have never had an eye exam. They all are concerned about their eye health and seek good healthcare, but they have a perspective much different from patients who were raised in the US. Many come to our office for their first-ever eye exam because they’ve never had health insurance, here or in their home country. As a result, the question, “When was your last eye exam?” results in a responses such as, “This is my first exam ever,” or “Ten years ago or when I was a kid.”
Greater Need for Patient Education
With so many recent immigrants new to the eyecare experience, you have an opportunity to educate them about the importance of caring for their eyes and the related products and services you offer. Newly arrived patients often lack the base of knowledge US-born patients possess, so start at the very beginning. Have a staff member explain the format of the exam, including everything that will take place in the office, shortly after the patient checks in. The patient may never have been in an OD’s office before, so point out the optical shop and explain the chance they will have to purchase eyewear or sunwear following the exam. Explain why you (or the form you hand them) are asking the questions that you are asking, what will take place during pre-testing and why and what will occur in the exam room.
Also set expectations in time management by giving them a realistic sense of how long they can expect to be in the office that day. Most importantly, let patients know you welcome their questions. It is likely that those who have never been in an optometrist’s office before and have never had an eye exam will have questions you would not anticipate.
Culturally speaking, most recent immigrants respect their doctors as authority figures. They will take your recommendations seriously and follow your treatment plans.
Different In-Office Accommodations for Different Cultures
The US norm of the able-bodied and sound-mind adult patient alone with a doctor in the exam room is not what many recent immigrants expect. In Hispanic cultures, in particular, it is the norm to try to fit as many family members into the exam room as possible. For example, a mother will come in with three children and only one child is being examined. That mother probably will want to bring all three into the room because they are too young to be left alone and the patient is too young to be examined alone. Hence, they all cram into our small New York City exam room (crying baby and all).
In addition, many mothers pick up other children from school and babysit, so additional children not her own also may tag along. As you can see, it is not uncommon for us to have one mother and as many as four children in the exam room with her. It is also common for the parent to want all these children to be examined the same day as walk-in patients who were not previously booked on our schedule.
What do we do? Just our best. We can’t tell mothers not to bring multiple children into the exam room. My staffers are accustomed to working in a crowded and often chaotic environment and have been trained to remain polite–no matter the demands placed on them. So, we make it work.
Multiple Language Skills Seals Sales
By the time I hand off patients into our optical shop, they are usually at ease knowing that at least some of us can speak their first language. That comfort level we provide primes patients for sales in our optical. We assign a staff member who speaks their first language to show them their eyewear options and explain the benefits of each and how they can best use their vision benefit to cover the cost.
Just as many patients have never before experienced an eye exam, many have never owned a pair of eyeglasses or sunwear. With that in mind, your staff should realize explaining eyewear options and the selection process will take longer than it will for US-raised patients. For example, for many immigrants, you probably will have to explain the difference between monovision, bifocal and progressive lenses. Similarly, you will have an even harder sell than you would with US-raised patients when it comes to sunwear. Many immigrants were raised in communities overseas in which no one they knew owned a pair of sunglasses.
I pre-set patients for these conversations by explaining in the exam room the options that will be presented to patients in the optical shop including the eye health benefits. For example, I may explain why sunwear is important to the health of their eyes and how the right progressive lenses will ease the eye strain they have been experiencing.
Exceed Expectations
I am very blessed to find myself working with this patient base. I try to understand their culture to meet their expectations and wants. The best thing about this patient population is they appreciate the small things that we are able to do for them. My staff and I try to take it a step further and have them leave with more than they expected.
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Create a Multicultural Practice to Expand Your Patient Base
Accommodate Diverse Cultures to Grow Your Practice
Make Your Practice a Fixture in Your Community
Peter Bae, OD, MS, is the owner of Kingsbridge Eye Center in Bronx, NY. To contact him: kingsbridgeeye@yahoo.com.
