Culture,+Trust+&+Communications+with+our+Primary+Service+Providers.

Bryan Green N8279276 Tutor; Katie Page

 The illustration below showing a group of aboriginals sitting in the scrub, drinking beer and surrounded by dozens of empty cans, to me depicts the ailing health system issues surrounding their culture. As you can see, this is a frequently used meeting place and it may give some sense of belonging or membership to the people within the group. However, when they leave, where do they go? What happens to their long term health, do they visit their local GP? Are they misunderstood and do they misunderstand the advice they are given by the doctor?
 * __ Cultural Artefact __**



The above artefact represents a major public health issue in Australia today, Aboriginal health. The questions I will want to examine are; what issues and problems are arising within the doctor-patient intercultural relationship? What kind of power do doctors hold in this relationship and what is the importance of high quality doctor-patient communications?
 * __ Public Health Issues __**

//**__Literature Review __**// //What are some of the ////issues and problems arising within a doctor-patient intercultural relationship? // According to all evidence, Aboriginal Australians continue to suffer poorer health than the rest of the population. Overall they experience much lower levels of access to medical services and are more likely to be hospitalised for most of the more common medical conditions and diseases. They are more likely to suffer a reduced quality of life, experience some sort of disability and they have a reduced life expectancy compared to non-indigenous Australians (Australian Institute of Health and Wellness, 2011).

The factors attributed to this include proximity to health services and whether it is a culturally appropriate service, transport availability, the affordability of health insurance and their English language proficiency. The major health risk factors for Aboriginal and Torres Strait Islanders consist of, but are not limited to, poor nutrition, alcohol consumption and smoking. Conditions such as cancer, renal disease, respiratory complications, rheumatic heart disease and ear problems are all contributors to the ill health experienced by Indigenous Australians compared non-Indigenous (Australian Institute of Health and Wellness, 2011).

//What kind of power do doctors hold in this relationship? // The doctor-patient power relationship can be described in different ways. At one extreme the doctor could make a decision about the medical treatment of a patient without their input. It may be made on what is perceived as to what the patient would prefer. This type of decision making or power comes under the heading of paternalism. At the other extreme the doctor takes on a purely informative roll, giving as much advice as possible, so that the patient can make his or her own decision based on the information given. There are various methods of power and decision making that lay between these two extremes. However, after all of the information has been given, the patients’ preferences taken into account and a sharing of the decision making process, the doctor usually holds the balance of power (Goodyear-Smith & Buetow, 2001). This would be even greater when it comes to Indigenous Australians.

Looking closer at the power issues, they can be defined into three different sources of power in the doctor/patient relationship. These have been label ‘muscle’, ‘money’ and ‘mind’ (Goodyear-Smith & Buetow, 2001). There is a legal and social authority which is known as //Muscle.// This sees the doctor with a high social authority and status within the community which is typical of times gone by. The patient source of power in this instance could involve their individual social standing amongst the community. Of course all patients have a legal right which also empowers them. In this instance the Indigenous patient may have some power in the relationship.

Secondly there is material wealth or //money.// The doctor has the means to provide a medical resource which is in high demand. The patient may have the financial wealth to pay for this resource and could include insurance, medical disability or Department of Veterans Affairs cards. Here the Aboriginal community would be at a major power disadvantage. According to the Australian Bureau of Statistics (2011) the weekly average earnings for Australians in 2006 was $840.90. Compare this to the 2006 average weekly earnings of an indigenous person of $374, is less than half, thus diminishing their power to access health services.

Finally there is information and knowledge which is //mind.// The doctor has received extensive training and has a vast wealth of knowledge and skills. The patient on the other hand may have some knowledge and beliefs, which they hold to be true about their own medical situation. However in this new era of technology the patient can now easily access the internet and search an array of different symptoms and then self-diagnose. This does give the patient more power in one instance but is fraught with danger if the patient is to self-treat.

//What is the importance of high quality doctor-patient ////c ////ommunications? // There is an abundance of barriers that can inhibit the effectiveness of Aboriginal cross cultural communication. It is intricately related to a number of issues including educational levels, racial discrimination, poverty, dispossession, marginalisation, cultural and language differences. . The obvious one is a language difference. Cass, et al. (2002) studied effective communications between medical staff and indigenous Australians, revealing a huge language barrier in staff and patient interactions. These differences had impeded on the flow of information especially when prescribing medicines and the applications of them (Cass, et al., 2002).

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">This communication barrier is illustrated through a doctor patient relationship that took place in a community 500 kilometres from Darwin. The participants were a 24 year old Aboriginal man who was suffering from chronic renal disease. He had previously been admitted to the Royal Darwin Hospital for a prolonged period for the treatment of this disease and had since returned back to his community. He did not speak English well but was fluent in his own dialect. In time he will need to be relocated back to Darwin so his condition can be properly treated. The doctor had many years’ experience in treating and working within an Aboriginal community.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">During the appointment the Doctor had clear goals that he wanted to communicate to the patient and his family. He wanted to reinforce that the patient was at real risk of dying from kidney failure and that his blood pressure should be treated along with other ailments such as anaemia. The main point was that he did not need dialysis at this point, but was to be monitored and he was to keep taking his medication.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">After the consultation the family had the belief that he had been cured whilst in hospital. They had no appreciation of how severe the illness was and of the need of regular testing and that he was simply to carry on taking his medication. The interaction had not achieved the desired result in the family understanding the true state of the patient’s kidneys. The family had understood little and had jeopardised his life.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Also during the interaction the doctor did the majority of the talking and any questions that were asked were replied by non-verbal responses (Cass, et al., 2002). This is clear evidence of and highlights the importance of quality doctor-patient communications. A language barrier and its effect on communications could have disastrous consequences for someone’s health.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Indigenous Australians remain one of the unhealthiest populations in Australia. For years now the debate of Aboriginal health and how it should be tackled has gone on and on. Nevertheless, it seems that whatever action is taken by the predominantly white governments, there seems to be only modest advances and with a small reduction in the mortality rate. Some would say it has actually gone backwards. The reasons for this are varied and complex but include such issues as education, employment, income as well as issues that are specific to the health sector.
 * __ Cultural and Social Analysis __**

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Alcohol over the years has been removed from most of the indigenous communities around Australia. This has been welcomed by the communities and I see this as a positive step in an effort to curb the public health issues associated with alcohol. However in saying this, the 2007 National Drug Strategy Household Survey (NDSHS) found that Indigenous people were more likely to abstain from alcohol than other Australians. Conversely though, they were also more likely to drink alcohol at high risk levels. Over the five year period ending in 2004, 1,145 Indigenous Australians died from alcohol related injury or disease. The average age of those who died was 35 (Chikritzhs et.al, 2007).

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Advances in technology have swung the balance of power, to a certain extent, back to the patient. Although, I suggest a community of Aboriginals living 500km from Darwin would have very limited internet access let alone a computer to search on line in an attempt to educate themselves about their health issues. Without clear communication relating to the extent of the condition and what treatments are necessary, there will always be problems. Cass, et al. (2002) had identified in their study, that staff training in cross cultural communications had been underutilised and had an insignificant effect. More training in this area could only be beneficial. In 2010, 26.8% of Australians were in fact born overseas (Australian Bureau of Statistics, 2011). This futher highlights the need for doctors and their medical staff to be more proficient in their cross cultural communicatons, not only with Indigenous Australians but with the many other cultures now living in Australa.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">I also believe that trust and communications go hand in hand. If the medical staff has good communications skills, then through this, comes the trust that is wanted by both parties. It would be more likely that the advice given by a doctor, who is trusted, would be more closely followed by the patient. If the doctor is not trusted by way of their inadequate cultural awareness, the patient will simply seek a second opinion from someone that they trust more. The problem then with this is that in the private health system and out of the major population centres, you unfortunately may not have that luxury.


 * __ Analysis of the Artefact __**

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">I first saw this image when it was emailed to me a few years ago. My first impressions were that I have a comfortable home; I have a balanced diet and have a well-paid job allowing me to provide my family with these necessities. I also reflected about the opportunities that this group of people may have. I considered their opportunities to access food, shelter and work. Do they have access to health services like doctors, dentists and hospitals and were they appropriate? My immediate response was probably not and that much needs to be done. By the looks of the scene in the illustration above and the evidence provided the one thing that I have learnt while doing this assignment is that I may well have been right.

<span style="display: block; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: center;">References Australian Bureau of Statistics. (2011, June 16th). //Migration, Australia, 2009-10//. Retrieved October 31, 2011, from Australian Bureau of Statistics: http://www.abs.gov.au/ausstats/abs@.nsf/Products/A6B6AC80B29DE8F3CA2578B000119758?opendocument Australian Bureau of Statistics. (2011, July 11). //Population Characteristics, Aboriginal and Torres Strait Islander Australians, 2006//. Retrieved October 29, 2011, from Australian Bureau of Statistics: http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/8E4A1018AFC6332DCA2578DB00283CCE?opendocument Australian Institute of Health and Wellness. (2011). //Indigenous health//. Retrieved October 20, 2011, from http://www.aihw.gov.au/mental-health/ Cass, A., Lowell, A., Christie, M., Snelling, P. L., Melinda, F., Marrnganyin, B., et al. (2002). Sharing the True Stories: improving communication between Aborigina patients and healthcare workersl. //Medical Journal of Australia Vol 176//, 466-470. Chikritzhs T, P. R. (2007). //Trends in alcohol-attributable deaths among Indigenous Australians, 1998–2004//. Retrieved from National Drug Research Institute: http://ndri.curtin.edu.au/local/docs/pdf/naip/naip011.pdf Goodyear-Smith, F. B. (2001). Power issues in the Doctor-Patient Relationship. //Health Care Analysis,9//, 449-462.