An Exploration of culture in the consultation

1. An Exploration of culture in the consultation Dr Chris Harnden Clinical Dean, Rural School of Medicine University of Melbourne

3. 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

4. Australia 21 • New Zealand 12 • Not a world cup prediction!! • Difference in life expectancy between indigenous and immigrant population

5. 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’

6. Reasons for ‘The Gap’ • Socio-economic • Lifestyle factors • Accessabilty to health care • Racism

7. Education is the most powerful weapon which you can use to change the world

8. Training in cultural safety can improve the knowledge, attitude and skills of health professionals. (Beach et al 2005)

9. Cultural Safety • A concept developed in New Zealand

10. DrIrihapetiRamsden 1946-2003

11. The journey to cultural safety

12. 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

13. Cultural Sensitivity • Begins a process of self-exploration. • Own life experiences and realities • Relate these to the impact they may have on others

14. Cultural Safety • Enables safe service which is defined by those who receive the service

15. “Cultural safety means the health professional takes into account the reality of the patient NOT the cultural status of the patient alone”

16. 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)

17. Suggests a need for education materials to show relevance of cultural safety. • To try and break down these barriers

18. Requirements for this tool • Validity – measures what it is supposed to do • Reliable – It can be reproduced • Accountable to stakeholders • Flexible • Comprehensive • Feasible • Relevant

20. 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 doctorswhen consulting with aboriginal people

21. 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

22. 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

23. 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

24. 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