What+does+Aesculapius+mean+to+you+doctor?

Assessment 3- Artefact  How culturally clued in are our Primary and Emergency Service Providers, when it comes to sex, pain and death?  Multicultural doctor-patient relationships

Name: Shaunna Truskinger Student Number: n8286108 Tutor: Judith Meiklejohn Tutorial: 12pm- 1pm, Thursday

**Emergency Services: ** How culturally clued in are our Primary and Emergency Service Providers, when it comes to sex, pain and death? – Multicultural doctor-patient relationships  **‘Primum non nocere’ **
 * Topic: **
 * Artefact: **

The artefact I have chosen is the Aesculapius symbol. The symbol depicts a serpent wrapped around a cyprus branch. The symbol is from greek mythology and shows the single serpent that could shed its skin and emerge in full vigor, archetypal of the renewal of youth and health -- medicine. The Aesculapius is the true symbol of medicine, not to be confused with the common misconception of the caduceus. As well as the scripture ‘primum non nocere’ which translates as; first, do no harm, the ethical decree, boundary and expectation of a medical practitioner.

This artefact represents what the health care system and medical profession is expected and aspired to be. This essay will reflect on issues within the doctor patient-relationship and the importance of intercultural communication for general practitioners in health care today. It will critically analyse the barriers to successful doctor- patient communication and discuss what happens when patients feel powerless. Furthermore, it will investigate previous controversial treatment of multicultural patients and its reciprocal effect on current attitudes towards the health care system, workers and authority.
 * Public Health Issue: **

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">According to Teala and Street (2009) a culturally competent physician is one who is able to recognise and reconcile socio-cultural differences between the physician and patient, to deliver effective health care. Effective health care is characterised by communication that elicits and understands the patient's perspective and social background, reaches an understanding of the problem and its treatment whilst involving the patient in choices (Aita et al., 2005). Research by Jabaaij (et.al 2008) states that high quality doctor- patient relationships involve communication skills that put any patient from any background at ease, enabling them to freely raise any issue they think necessary. Almost every definition of a competent physician requires cultural sensitivity and good communication skills in order to treat every patient. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Problems arise in the doctor-patient relationship patient because each patient harbors their own individual combination of medical, psychological, social, past history, cultural and spiritual needs that must be acknowledged and respected whilst care is being administered (Slort, 2011). In an attempt to provide culturally appropriate treatment, many physicians focus on specific characteristics of cultural groups such as race, gender, ethnicity and socio-economic status. Unfortunately this inadvertently promotes the reliance on stereotypes (Kripalani et al., 2006) when assessing culturally diverse patients. Research by Teala and Street stipulates the importance of physicians assessing the core cultural matters at hand such as; the situations, interactions and behaviours that have the potential for cross cultural misunderstanding, rather than focusing on characteristics of the patients origin. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Cultural miscommunication in primary and general practice is unfortunately a common occurrence worldwide. For example Vassy (2003) investigates the discrimination of patients in a French emergency department. In a recent study at the Geneva University Hospitals by Hudelson (2007), 1537 patients were surveyed after their stay. A total of 171 (11%) of patients reported at least one instance of discrimination based on nationality, race, language and religion. Moreover in a study by Hasnain et al. (2011) 83% of health providers reported encountering challenges whilst providing care to Muslim women, comparatively 93% of responding patients reported that their health care provider did not understand their religious or cultural needs. Cultural miscommunication extends to all parties involved in the interaction and is regrettably common <span class="medium-font" style="font-family: 'Times New Roman','serif'; font-size: 16px;"> in doctor-patient relationships. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The issue in Australia has been developing for many years and applies to the treatment of Indigenous patients in primary care and emergency departments. The prevalence of this issue is significant, statistics show that an Indigenous person is five (5) times more likely to report an instance of discrimination (in health care) than a non-indigenous patient (Larson, Gillies, Howard, & Coffin, 2007). They are also nineteen (19) times more likely to leave against medical advice (Thomas, Anderson & Kelaher, 2008). Research shows that people of low social status, minority racial and ethnic backgrounds experience the most significant inequalities routinely in their health care (Johnstone & Kanitsaki 2009). <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">If these statistics are not indication enough of the importance of addressing medical equity across cultures within Australia and the world, the outcomes as a result of inadequate treatment bring the issue further into light. Many texts and readings observe the obvious results of doctor-patient misunderstanding and miscommunications. Such as non -adherence to outpatient advice, physical injury, walk outs and misdiagnosis of problems or issues (Thomas, Anderson, & Kelaher, 2008 & Johnstone 2007 ). However not much is known about the more significant and enduring effects of cross-cultural medical encounters. Research by Sherer (2003) investigates traumatic events their effects on patients and subsequent avoidance and mistrust in the health care that spreads through cultural groups like wildfire. Thus creating cultural groups destitute and fearful of treatment that would assist their plight. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">It is difficult to conclude a definitive increase in the prevalence of cultural competency around the world, due to relative political and social forces that are in play worldwide. However, in Australia the task is significantly easier. According the Australian Bureau of Statistics 47% of Australians visited their GP in the year of 1999, whereas a total of 81% of Australians visited a GP in 2009 (ABS). The data suggests that the prevalence of culturally incompetent encounters is decreasing; however this trend is expected in any modern and progressive society. These statistics fail to accurately address the issue, of perhaps the number of patients who received healthcare and have avoided medical treatment henceforth. Furthermore it is difficult to evaluate presence and satisfaction of indigenous Australians in healthcare due to insufficient data in the past and incongruous identification of aboriginal status (Ballie 2010.), which in itself does not bode well for arguments supporting the previous health care regimes. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">A comprehensive systematic review of over sixty (60) longitudinal, cross sectional and laboratory studies was conducted by Williams and Mohammed (2009) to identify the association of ethnicity, language and cultural backgrounds to outcomes of health disparities. According to the results of the study there is a direct relationship between cultural misunderstanding, perceived discrimination and poor health outcomes for ethnic minorities in particular (Williams and Mohammed, 2009).
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Literature Review: **

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Cultural misunderstandings and inequities in medicine are unfortunately far more commonplace and damaging to victims in today’s society than the population would care to think (Slort, 2011). Johnstone (2009) believes that this public health issue, so enthusiastically labeled ‘cultural incompetence’ and ‘cultural misunderstandings’ by a host of professionals, is in fact something far more sinister. Research by Johnstone (2009) delves into the popular illusion of non-racism in health care, a statement that is supported by the common declaration that apparently ‘racism is not an issue anymore’. <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;"> This argument is supported by Stone and Dula (2002) who assert that there is a genuine belief among physicians, nurses and allied health professionals that ‘racism no longer exists’ in health care and that if racialised practices do exist, they cause little or no harm. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Johnstone (2009) explains this common assumption with the tendency for racism to be under-recognised, poorly addressed, ignored and painted over with terms such as ‘cultural insensitivity’ in health care and hence, never truly resolved. Research by Larson (2007) supports the notion that racism and racialised health care practices are being increasingly linked to disparities in health care of people from various language and cultural backgrounds. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">In order for this new age racism to be unmasked and managed the inner workings and attitudes of society in a hospital context must be investigated and influenced So that those most at risk of being discriminated against can rest assured that they will receive the equitable, safe and quality care they are entitled to receive; from fair and attentive staff who are educated culturally appropriately (Johnstone, 2009).
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Cultural and Social Analysis: **

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">According to the Australian Government Department of Immigration (2011), the number of immigrants arriving into Australia has increased steadily every year since 2004. It is possible that this influx of migrants into Australia is one reason for the increasing focus on cultural awareness in the health care system. Although definitely a positive factor there are a few more driving forces toward a more culturally appropriate health care system. Another significant movement for minorities in health care, particularly for Indigenous Australians includes the impact of government research**.** For example following the 2003 National Indigenous Health Survey, a life expectancy disparity of 17years between indigenous and non- indigenous peoples was found, the Australian government implemented many strategies including the Close the Gap project, a National Strategic framework and a health worker initiative to encourage indigenous employment in health care (Trewin, 2005). A positive step has been taken in ensuring equality of health care by tapping into the media and other social forums.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">According to Johnstone (2009) significant worldwide political and cultural movements have the potential to significantly influence the social harmony and treatment of people in health care, both positively and negatively.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">For example; during the aftermath of the September 11, 2001, terrorist attack on the World Trade Centre Towers an Arabic woman living in Australia, had a son who required monthly hospitalisation for a serious medical condition, noticed a significant and demoralizing change in attitude and behaviour towards her by hospital staff. Where staff had previously been kind and attentive, after September 11, they rejected, shunned and became indifferent to her plight (Johnstone, 2009).

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Despite the event occurring on the other side of the world cultural assumptions and negative attitudes were seen strongly afterwards and have a significant impact on the doctor patient relationship. There are many ways in which movements, organisations and events can impact equity in health positively, however to be successful each and every group affected must see these benefits.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Those of ethnic minority, cultural and diverse language backgrounds are groups most continuously affected by language and cultural barriers in the health care system (Babitsch, 2008 & Johnstone 2009). Regrettably this is not an isolated issue rather one that affects people worldwide, for example in America the most culturally misunderstood groups reporting perceived discrimination in health include the Hispanic, African American and Muslim populations ( <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">Askim-Lovseth, 2010 <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">). Closer to home the issue is just as significant according to Johnstone (2009) the most likely social groups to receive inappropriate care in Australia included patients of Muslim, Indian and Indigenous origin. Hertzman and Power (2006) believe that circumstances and inequities can be changed and countered in a number of ways; however a position of relative disadvantage from birth (for Indigenous people) combined with adverse circumstances predisposes a trajectory that constrains the capacity for a healthy life. Hence, it can be drawn from research that the Indigenous population of Australia is one social group that is impacted significantly from ongoing culturally insensitive health care. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">In a recent study by Butow (2011) three dominant themes emerged from cultures in health care; cultural isolation, alienation, language and communication difficulties and interpreter issues. Participants, described feeling alone and misunderstood, failing to comprehend medical instructions, being unable to communicate questions and concerns and a lack of consistency in interpreters and interpretation. Evidence from Butow (2011) and previous examples in this essay have demonstrated indisputably the importance of culturally appropriate treatment and the eradication of any lingering discrimination in health care. In conclusion health experts should focus their efforts on analysing the social mileu of the times, how people are reacting to these different cultures in society and health care, implementing a significant paradigm shift. For this notion to be effective, who must be target organisations or individuals? Simply put both, both the health care workers and health care system must be targeted for the paradigm shift, to eliminate the reciprocal blame game and achieve equity for all cultures in health care (Williams and Mohammed, 2009).

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">My artefact is symbolic in terms of expressing the meaning and core concepts that have built the foundation of health care today. The Aesculapius to me represents a safe haven in medicine, for the disadvantaged, the different and the misunderstood. The lettering ‘Primum non nocere’ translates to; first do no harm, and constitutes part of the Hippocratic oath. An oath <span class="st" style="font-family: 'Times New Roman','serif'; font-size: 16px;">historically taken by doctors and other healthcare professionals swearing to practice medicine ethically. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> To see the safe haven of medicine turned into a source of disquiet, for those that it is meant to shelter, is an absolute renege of the Hippocratic Oath. The direct harm caused to patients of a diverse culturally, ethnic and linguistic background is difficult for me to comprehend. Especially when the instigators of such treatment belong to what is supposed to be an egalitarian and benevolent profession. The mistreatment of any patient that seeks aid from a medical practioner anywhere in the world is in my opinion a contravention of what the caduceus and medicine are based on.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Artefact Analysis/ Learning Reflection: **

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">By critically analysing this research topic, I have come to the conclusion that the treatment of cultures in health care is a topic that requires far more attention, to elicit any type of change that may assist in the provision of equitable services to all patients. Although efforts are being made by the government to correct this situation, in some areas; to bring about the required changes there must be a shift in the attitudes of society as a whole, as well as departments of health care (e.g with culturally appropriate education schemes). This assessment has influenced my opinion of what I thought to be an equitable system, and also brought to my attention an appreciation of the difficulty diverse cultures face, as well as the relative difficulty associated with influencing a change of any kind in society.


 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Comments **

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Wiki one: 'Sport and femininity don't mix, says who?'

Great wiki! The artefact you have chosen ties very well into your argument and supports your notion that women are portrayed as objects of lust even in the sporting arena.I also liked how you identified the reasons for womens participation in sport and juxtaposed them together; that is the notion that sport is played to become thinner and more feminine versus the competitiveness and camaraderie aspect. I really liked your reasoning regarding the amount of funding and media coverage that female sports and teams receive, despite dominating their chosen sporting field. Lastly the way you related Marxism theories here was succinct and easy to understand. :)

Wiki two: 'Girl, my mascara runs faster than you!'

Great title!! It's hilarious, caught my eye and ties in so well with all your arguments. You picked an excellent artefact (i can't believe the horses!! haha). Your analysis was very enlightening i had no idea that it would be possible for the government to justify exclusion from sport based on preserving womens femininity! You analysed your topic very well and justified your arguments with good research.This is an awesome wiki :)

**<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">References ** <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Aita, V., McIlvain, H., Backer E., McVea, K., & Crabtree, B. (2005). Patient-centered care and communication in primary care practice: what is involved? //Patient Education and Counseling//, 58, 296–304. doi:10.1016/j.pec.2004.12.008

<span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">Askim-Lovseth, M.K. & Aldana, A. (2010): Looking beyond “affordable” <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">health care: Cultural understanding and sensitivity; Necessities in addressing the health care disparities of the U.S. Hispanic population. //Health Marketing Quarterly//, 27(4), 354-387. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">doi.org/10.1080/07359683.2010.519990

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Australian government Department of Immigration and Citizenship. (2011). Immigration Update 2010-2011.Retrieved from http://www.immi.gov.au/media/publications/statistics/immigration-update/update-2010-11.pdf

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Babitsch, B., Braun, T., Borde, T., & David, M. (2008). Doctor's perception of doctor-patient relationships in emergency departments: What roles do gender and ethnicity play? //BMC Health Services Research//, 81-10. doi:10.1186/1472-6963-8-82

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Bailie, R., Si, D., Shannon, C., Semmens, J., Rowley, K., Scrimgeour, D. J., & ... Gardner, K. (2010). Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples. //BMC Health Services Research//, 10129-139. doi:10.1186/1472-6963-10-129

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Butow, P. N., Sze, M., Dugal-beri, P., Mikhail, M., Eisenbruch, M., & Jefford, M. (2011). From inside the bubble: Migrants' perceptions of communication with the cancer team. //Supportive Care in Cancer, 19//(2), 281--290. doi:10.1007/s00520-010-0817-x

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Hasnain, M., Connell, K. J., Menon, U., & Tranmer, P. A. (2011). Patient-Centered Care for Muslim Women: Provider and Patient Perspectives. //Journal of Women's Health (15409996)//, 20(1), 73-83. doi:10.1089/jwh.2010.219

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Hertzman, C. & Power, C. (2006). A life course approach to health and human development. //Healthier societies: From analysis to// //action//, pp 83–106. Oxford: Oxford UniversityPress.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Hudelson, P., Kolly, V., & Perneger, T. (2009). Patients perceptions of discrimination during hospitalisation. //Health Expectations,// 13, 24–32. doi: 10.1111/j.1369-7625.2009.00577.x

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Jabaaij, L., Fassaert, T., Van Dulmen, S., Timmermans, A., van Essen, G. A., & Schellevis, F. (2008). Familiarity between patient and general practitioner does not influence the content of the consultation. //BMC Family Practice//, 91-8. doi:10.1186/1471-2296-9-51

<span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">Johnstone, M.J. & Kanitsaki, O. (2009). The spectrum of ‘new racism’ and discrimination in hospital contexts: A reappraisal. //The// //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Collegian //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">, 16, 63—69.doi:10.1016/j.colegn.2009.03.001

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Kripalani, S., Bussey-Jones, J., Katz, M.G., & Genao,I. (2006) A prescription for cultural competence in medical education. //Journal of General Internal Medicine//, 21(10), <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1116–1120 .doi: <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">10.1111/j.1525-1497.2006.00557.x

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Larson, A., Gillies, M., Howard, P., & Coffin, J. (2007). It’s enough to make you sick: The impact of racism on the health of Aboriginal Australians. //Australian and New Zealand Journal of Public// //Health//, //31//(4), 322—329.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Sherer, J. L. (2003). Crossing cultures: Hospitals begin breaking down the barriers to care. //Hospitals & Health Networks, 67//(10), 29-29. Retrieved from http://search.proquest.com/docview/215309693?accountid=13380

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Slort, W., Schweitzer, B., Blankenstein, A., Abarshi, E., Riphagen, I., Echteld, M., & Deliens, L. (2011). Perceived barriers and facilitators for general practitioner-patient communication in palliative care: A systematic review. //Palliative Medicine//, 25(6), 613-629. doi:10.1177/0269216310395987

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Stone, J. R., & Dula, A. (2002). Wake-up call: Health care and <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">racism. //The Hastings Center Report//, //32//(4), 48—50.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Teala C.R., & Street, R.L. (2009).Critical elements of culturally competent communication in the medical encounter: A review and model. //Social Science & Medicine//, 68(3), 533-543. doi:10.1016/j.socscimed.2008.10.015

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Thomas, D. P., Anderson, I. P., & Kelaher, M. A. (2008). Accessibility and quality of care received in emergency departments by Aboriginal and Torres Strait Islander people. //Australian Health Review//, 32(4), 7.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Trewin, D. & Madden, R. (2005). The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples. //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Australian Institute of Health and Welfare //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">. Retrieved from, www.abs.gov.au

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Vassy, C. (2001). Categorisation and micro-rationing: access to care in a French emergency department. //Sociology of Health & Illness//, 23(5), 615-632. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Wachtler, C., Brorsson, A. & Troein, M. (2006). Meeting and treating cultural difference in primary care: a qualitative interview study. //Oxford Journals; Family Practice,// 23 (1): 111-115. doi: 10.1093/fampra/cmi086

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. //Journal of Behavioral Medicine, 32//(1), 20-20-47. doi:10.1007/s10865-008-9185-0