Albuquerque, N.M.

When a doctor doesn't look an Asian-American patient in the eye, that might be seen as a sign of respect. But making eye contact is encouraged with Black patients, according to the American Academy of Orthopaedic Surgeons, which has published a guidebook for culturally competent care.

As the ethnic profile diversifies in the United States, some states are trying to assure that health care providers are trained in "cultural competency."

New Mexico passed a law last year requiring that higher education institutions with health education programs provide such training, though the state still is grappling with how it will be implemented.

New Jersey and California are among a handful of states with similar measures in place.

"We don't expect that a provider is going to know everything about every nationality," said William Flores, chairman of New Mexico's task force charged with developing the curriculum. "The critical thing here is developing sensitivity and the understanding that not every culture responds to medical providers in the same way, sees medicine in the same way."

Dr. Elizabeth Szalay, an associate professor of pediatric orthopedics and pediatrics at the University of New Mexico's Carrie Tingley Hospital, said that it's important for doctors to understand how patients may be different, but patients also need to be open about themselves, by asking questions and revealing their beliefs, concerns or fears.

Navajo Indians often are reluctant to do so, without the coaxing of a social worker, said Linda Henderson, who interprets for Navajo patients. They view Western health care as foreign and won't question a doctor even if they don't understand what is being recommended, she said. It's a matter of respect.

"From our people's point of view, we're offending the doctors, because they're the experts as far as modern contemporary medicine," Henderson said.

Cynthia Lin, 55, of Taiwan, says she never has experienced a cultural barrier between herself and doctors, which she attributed to her open attitude.