an exploration of culture in the consultation
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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
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