An Exploration of culture in the consultation

Dr Chris Harnden

Clinical Dean, Rural School of Medicine

University of Melbourne

WHO Declaration of Alma-Ata

Health is a fundamental human right

• Gross inequality in the health status of

people in a country is politically socially

and economically unacceptable

• People have a right to participate in the

planning of their health care

• Australia 21

• New Zealand 12

• Not a world cup prediction!!

• Difference in life expectancy

between indigenous and immigrant

population

• Australia New Zealand 8

• United Kingdom 0

• Difference in life expectancy at time

of colonization end of 18th century

• Australia RACGP working to ‘Close

the Gap’

Reasons for ‘The Gap’

• Socio-economic

• Lifestyle factors

• Accessabilty to health care

• Racism

Education is the most powerful weapon which

you can use to change the world

Training in cultural safety can improve

the knowledge, attitude and skills of

health professionals.

(Beach et al 2005)

Cultural Safety

• A concept developed in New Zealand

Dr Irihapeti Ramsden 1946-2003

The journey to cultural safety

Cultural Safety

Cultural Sensitivi

ty

Cultural Awarene

ss

Cultural Awareness

The beginning step. That there are

differences in people’s rituals, beliefs

and practices

Different to the political, social,

economic and emotional context of life

Cultural Sensitivity

• Begins a process of self-exploration.

• Own life experiences and realities

• Relate these to the impact they may

have on others

Cultural Safety

• Enables safe service which is defined

by those who receive the service

• “Cultural safety means the health

professional takes into account the

reality of the patient NOT the cultural

status of the patient alone”

Need for research• ‘GPs have negative experiences from

past teaching of cultural awareness.

They have a lack of interest in the

topic. They make assumptions about

culture and race’

• (Nguyen 2008)

• Suggests a need for education

materials to show relevance of

cultural safety.

• To try and break down these barriers

Requirements for this tool

• Validity – measures what it is supposed to do

• Reliable – It can be reproduced

• Accountable to stakeholders

• Flexible

• Comprehensive

• Feasible

• Relevant

Research project in association with Univ. Western Sydney

• Find out from Aboriginal cultural

mentors, what are important cultural

issues that need to be respected by

doctors when consulting with

aboriginal people

• Develop and then video a role play incorporating

these cross cultural issues

• Use several different clinical scenarios

• Ask GPs to view the video

• Blind the GPs to the cultural aspects of the

consultation

• Ask GPs to fill in forms about knowledge of cultural

issues in the consultation before the meeting

• Ask them to comment on

• what went well

• what could have gone differently.

• How could the doctor improve the

consultation

• What educational resources are available for

the doctor to improve in these areas

• Then cultural aspects of the video will be discussed

after a de brief of cultural issues

• Facilitate group discussion of how to be culturally

safe

• Evaluate awareness of cultural aspects of

consultation at end of session

• The participants will fill in the same evaluation after

6 months to see if skills maintained

• Study will see if this is a valid

method of raising and maintaining

awareness of cultural safety

• However it will not measure any

clinically measurable outcomes