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An Exploration of culture in the consultation
Dr Chris Harnden
Clinical Dean, Rural School of Medicine
University of Melbourne
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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
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• Australia 21
• New Zealand 12
• Not a world cup prediction!!
• Difference in life expectancy
between indigenous and immigrant
population
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• 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’
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Reasons for ‘The Gap’
• Socio-economic
• Lifestyle factors
• Accessabilty to health care
• Racism
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Education is the most powerful weapon which
you can use to change the world
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Training in cultural safety can improve
the knowledge, attitude and skills of
health professionals.
(Beach et al 2005)
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Cultural Safety
• A concept developed in New Zealand
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Dr Irihapeti Ramsden 1946-2003
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The journey to cultural safety
Cultural Safety
Cultural Sensitivi
ty
Cultural Awarene
ss
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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
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Cultural Sensitivity
• Begins a process of self-exploration.
• Own life experiences and realities
• Relate these to the impact they may
have on others
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Cultural Safety
• Enables safe service which is defined
by those who receive the service
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• “Cultural safety means the health
professional takes into account the
reality of the patient NOT the cultural
status of the patient alone”
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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)
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• Suggests a need for education
materials to show relevance of
cultural safety.
• To try and break down these barriers
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Requirements for this tool
• Validity – measures what it is supposed to do
• Reliable – It can be reproduced
• Accountable to stakeholders
• Flexible
• Comprehensive
• Feasible
• Relevant
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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
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• 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
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• 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
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• 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
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• 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