Can we do better than “We treat everyone the same?”

Tim SeniorMary MartinDepp JosephRachael MouldenSimon MorganJenny Reath

Background

• National Heart Foundation data on heart disease not appropriately treated in Aboriginal people presenting with chest pain

• Stroke survey showing similar data for stroke.• 26% of Aboriginal and Torres Strait Islander people say it is difficult

to access primary care (2008 NATSIHS)• In Victorian survey 97% of Aboriginal and Torres Strait Islander

people had experienced racism in previous 12m;• Nearly one third had experienced racism in a health setting.

Learning objectives

At the end of this workshop, participants should be able to:

1. Identify examples of cultural miscommunication between patients and health services2. Recognise and challenge attitudes which promote cultural stereotyping in health service staff3. Develop strategies for our own practice to enable patient of different cultural backgrounds to feel comfortable.

In the RACGP Curriculum

Demonstrate openness to learning about the diverse range of Aboriginal and/or Torres Strait Islander worldviewsIdentify resources for review and improvement of consultation skills with Aboriginal and/or Torres Strait Islander patients.Describe strategies for review and improvement of management strategies that reflect Aboriginal and/or Torres Strait Islander views on health and social determinants of health

In the RACGP Curriculum

• Describe methods to regularly review personal values and priorities when working in Aboriginal and Torres Strait Islander health

• Indicate how a clinician’s professional and personal practice promotes health equity, and work against racism

What cultural groups do we have in this room?

What cultural groups do we have in this room?

• What ways do these groups have of greeting each other?

What stereotypes exist of the groups you belong to?• Which of these stereotypes apply to you?

• Which of these stereotypes are completely false?

Any conclusions?

What stereotypes about others might slip by? Any examples?Have you seen this happen?

What stereotypes do we have about our patients?What is the first word that comes to mind?Call it out as soon as you see the word…

Pensioner

Homeless

Obese

Schizophrenic

Schizophrenic

Aboriginal

Implicit bias

Shown to be present in obesity and race.

Shown to affect clinical reasoning

Test yourself at Project Implicithttps://implicit.harvard.edu/implicit/

Health beliefs

What different cultural health beliefs are you aware of?• Causes of disease• Treatments that are likely to work• Who is likely to be able to help?• Who is responsible for deciding, and who does what.• Conceptualisation of mental health (social and emotional wellbeing)• Getting better – in a group or alone? Where – hospital, home, with

family, out bush? What activities help?• Health as signifier of other things – spirituality (doctors as priests;

witch doctors;)

What is the experience of Aboriginal and Torres Strait Islander people in health services?What stories have you heard?

Durey A, Thompson SC, Wood M. Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication. Internal Medicine Journal. 2012;42(1):17-22.

Peiris D, Brown A, Howard M, Rickards B, Tonkin A, Ring I, et al. Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment. BMC Health Services Research. 2012

What do you do now in practice?

Who do you need to speak to?

What conversations do you need to have?

Thank you

Questions

Comments.

Write down advice for yourself in your current work

Evaluation - Learning objectives

At the end of this workshop, participants should be able to:

1. Identify examples of cultural miscommunication between patients and health services2. Recognise and challenge attitudes which promote cultural stereotyping in health service staff3. Develop strategies for our own practice to enable patient of different cultural backgrounds to feel comfortable.