OnemdaVicHealth Koori Health Unit

Dr Dick Sloman

Rethinking teaching studentsabout working with clients from diverse backgrounds

OnemdaVicHealth Koori Health Unit

Consultation Frameworks• Pendelton model: doctor centred• McWhinney model: patient centred• Mead & Bower: ‘doctor as a person’• US evidence of racial disparities in health providers’ behaviours

OnemdaVicHealth Koori Health Unit

Beyond ‘Essentialism’• Students’ & doctors’ preference for recipes• External soluble problems vs internal reflection• No ‘essence’ of Indigenous Australia• Alternative:

‘provide students with opportunities to look at their biases, challenge their assumptions, know people beyond labels, confront the effects of power & privilege, and develop a far greater capacity for compassion & respect’

OnemdaVicHealth Koori Health Unit

Personal Approach• Inner Melbourne multi-cultural, low income community GP experience:

- no recipes - tried to find connections from clues about history, language, country of origin, and other sources- seemed to be welcomed,

• Instead of stereotyped assumptions, engaged with how patients saw themselves

OnemdaVicHealth Koori Health Unit

Inequalities Discourses & Australia• Carlisle: public discourses about inequalities

- Redistributionist Discourse (RED)- Social Integrationist Discourse (SID)- Moral Underclass Discourse (MUD)

• NT Emergency Intervention & opinion poll research shows people divided in themselves about Indigenous issues

OnemdaVicHealth Koori Health Unit

Cognitive Errors in Medicine • Jerome Groopman ‘How Doctors Think’• Pat Croskerry, Emergency Medicine Academic: - majority of doctors’ errors are ‘thinking’ errors, rather than poor knowledge - all people use unconscious shortcuts, including experienced doctors - can lead to cognitive & affective errors - strategies used to prevent these include: metacognition, simulation, cognitive forcing

OnemdaVicHealth Koori Health Unit

OnemdaVicHealth Koori Health Unit

Strategies from Social Psychology • Recent publication proposing strategies to reduce racial bias of health care providers• Based on social psychology research about ‘implicit’ or unconscious biases• These biases affect non-verbal behaviour & not readily changed• Despite this, strategy proposed to improve interactions through ‘individuation’

OnemdaVicHealth Koori Health Unit

Specific Strategies to Enhance:1. Internal motivation & avoid external pressure

to reduce bias 2.Understanding of psychological basis of bias3.Confidence to interact with socially dissimilar

patients4.Emotional regulation skills specific to

promoting positive emotions5.Perspective taking & affective empathy6.Ability to build partnerships with patients