How+culturally+'clued+in'+are+primary+care+physicians+today?

Name: Chase Price Student number: 08302022 Tutor: Judith Meiklejohn Topic: How Culturally ‘Clued-In’ are our Primary and Emergency Service Providers when it comes to Sex, Pain, and Death? (Panel member 1, primary health care cultural competence issues)

// ... cultural competence means having the beliefs, knowledge, and skills necessary to work effectively with individuals different from one's self; that cultural competence includes all forms of difference; and that issues of social justice cannot be overlooked. // (Krentzman & Townsend, 2008) = = = = =Cultural Artefact =

The artefact chosen for this work is actually a hybrid of two. The circling images of a variety of symbols represent the diversity of peoples found in this country both religious and ethnic. The symbol in the middle is the Caduceus, and is recognised world wide as the primary symbol for medicine. The full picture illustrates the cultural diversity found within the industry, whether it be on a professional level from one practitioner to another, or in a doctor – patient relationship.

= = = Public health issue =

The issue at hand here is with the cultural competence of general practitioners and other primary health services. This is a pertinent public health issue for Australia in particular, as we are a largely multicultural society. According to the Australian Bureau of Statistics (2006) 25% of Australians were born overseas, from a large range of countries with different ethnic properties and religious beliefs. With at least a quarter of the population being so diverse in nature, cultural competence is critical. The topic also incites great debate within the country, making the issue convoluted. Conservative claims arise on blogs everywhere about the lengths that our systems must go to in order to appease what some consider “alien” beliefs and customs; While more liberal voices espouse that our health system and its workers are not doing enough in consideration of those whose cultures require “special” treatment.

= Literary Review =

A study performed by Allan, Schattner, Stocks and Ramsay (2009) gauged the level of patient satisfaction in regards to Australian general practice to be quite high. The aim of the study was to isolate trends in patient satisfaction over time. In a collection of surveys containing feedback from over a million patients, collected over a decade, it was found that 99% of patients presented a very high level of satisfaction with Australian general practice. The decade long collection process began in 1994, and involved roughly 3,500 distinct general practices. The study took into account 10 variables, including the year of completion, patient age, gender, practice size and attendance at other practices. They included more refined satisfaction details by taking 12 of the survey questions and pooling them, resulting in greater variance than that provided by the single satisfaction question. It was concluded that the surveys themselves presented difficulty in demonstrating any change over time, the authors recommended that a more useful survey would be sensitive enough to detect negative patient opinions and therefore display better results.

The article //Identifying and overcoming the barriers to Aboriginal access to general practitioner services in rural New South Wales// (Andrews, Simmons, Long & Wilson, 2002) details a project that was undertaken collaboratively by an Indigenous council and general practitioners. The aim of the project was simply to improve Indigenous health in the area by overcoming identified barriers to general practitice access, as well as creating a sustainable partnership between the Indigenous community and the general practitioners. The project was funded for one year by the Commonwealth Government, it was a partnered initiative between the Midwest Wiradjuri Aboriginal Health Council (MWAHC) and the NSW Central West Division of General Practice (CWDGP). A series of meetings were held with general practitioners and Aboriginal health workers present, with the goal of identifying the barriers and suggesting ways to dismantle them. Several initiatives were enacted, of particular interest to this work were: A set of contact lists that allowed the GP’s and the Aboriginal health workers to maintain effective and co-operative communication, Aboriginal cultural awareness training that provided the basis for cultural competent practice in the region, and Aboriginal art purchases for the clinics to allow a feeling of cultural safety for Indigenous patients. Feedback from Indigenous patients was found to be ‘positive and supportive’ of the project, and it was extended for 3 months due to a high level of patient satisfaction. This project showed how important effective cross cultural communication and collaboration is to general practice.

= Cultural and social analysis =

General practice, as outlined in the study performed by Allan et. al. (2009) is regarded in Australia with a great deal of respect. This respect is earned through proper dealings and good information provided in the interest of caring for their patients. It can therefore be understood just how crucial good communication techniques are to the care process. When this communication breaks down patients feel insecure and the diagnostic process can be hindered. Patients feel safer when general practitioners employ effective active listening skills, thorough explanation and empathetic reassurance. (Lings, Evans, Seamark & Seamark, 2003) To effectively utilise these techniques cross-culturally, a degree of cultural awareness and competence is required.

The religion of Islam has a pertinent effect on Australia’s health care related cultural competence awareness. Unfortunately for those who practice the religion, it tends to carry a fierce stigma within the Australian population. Since the September 11 attacks, media portrayals of Muslims have been almost entirely negative in view. This allows for easy judgments and stereotypical behaviour to fester, which is why keen attention to culturally competent practice towards Islamic patients is required in Australian healthcare. Within the health industry, the religion requires a great degree of special care (Queensland Health and Islamic Council of Queensland, 2010, p.8). These requirements can sometimes create tension within the healthcare workforce. Of particular interest are the intense regard for modesty and a preference for same sex patient – carer relations. According to the Queensland Health guidelines, all attempts possible should be made to accommodate this requirement. (Queensland Health and Islamic Council of Queensland, 2010, p.10) Mishandled, this can create situations in which Muslim patients feel their rights cannot be exercised, and cultural barriers become an issue. Even greater than religious barriers, a language barrier can very well be present with many Islamic patients. In a qualitative study involving 80 Muslim female refugees various resettlement issues were discovered, and of those issues language barriers were a primary concern. (Casimiro, Hancock & Northcote, 2007) As expressed by one of those women, sometimes even hospital interpreters fail to break this barrier effectively:

“I had the worst experience. The Arabic language is dynamic and has different accents... So when I was at the hospital they got an Iraqi interpreter and it was very hard for me to communicate with him because I couldn't understand his accent. He [interpreter] passed on wrong information to my doctor and until now for a year and a half I didn't get the right treatment because of the communication problem (Iraqi woman, 50).” (Casimiro, Hancock & Northcote, 2007)

In cases where a language barrier is present, effective culturally competent practice is vital.

Indigenous Australians also have found it difficult to engage in healthy relations with general practice in the past and currently. Issues surrounding cultural sensitivity, including language barriers and perceived weaknesses have kept the indigenous population from seeing general practitioners. This has led to a “primary care gap” that has resulted in shorter life expectancies for Indigenous Australians, 9.7 years less for females and 11.5 years less for males when compared with non-Indigenous Australians. (Nguyen, 2008) In an Australian private general practice, Majellan Medical Centre, Scarborough it was found during a one-year period after cultural competence training that the amount of registered indigenous patients increased from ten to 147, and that monthly attendance increased from five to forty. (Johanson & Hill, 2011) This is a clear indication that attaining cultural competence is an integral part in today’s general practice method for caring for indigenous Australians.

= Artefact and learning reflection =

I went out on a limb and created the artefact myself by merging two symbolic images together. The mosaic of smiling faces from different ethnic groups in gowns and uniforms that was present on the screen after ‘googling’ //cultural diversity in medicine// was unsatisfactory. What were left were abstract symbols representing diversity on a world scale; with the erasure of the world and the replacement of a Caduceus, a firm image was imprinted upon my mind. The hybrid artefact ideally represents the cultural diversity found by those within the health industry, and thus adequately showcases the need for a high level of culturally competent practice to be exercised by health care professionals. While researching this topic, I was entirely focused on the public health issue at hand, determined to find as many faults in our system as possible and rant about how incompetent we are as a society towards bridging cultural gaps. I found, however, that during my research there were lights of hope twinkling within academia, medical journals and policies. My opinion of the matter has become more fixed to the middle, neither damning nor entirely praising our current models of approach, but certainly content in our efforts to promote and ensure culturally competent practice by health care workers. While reading I was reminded of the extremely racist policies found in our history, a history that many today were alive to be a part of. The sudden realisation that we have come so far in so short a time gave me quite a lot to reflect on. There are always improvements to be made for the future, and I believe that with the right training and attitudes it is possible for the vast majority of health care workers to be culturally competent.

= = **Reference:**

Andrews, B., Simmons, P., Long, I., Wilson, R. (2002). Identifying and overcoming the barriers to Aboriginal access to general practitioner services in rural New South Wales. //Australian Journal of Rural Health//. 10, 196-201. Retrieved from EbscoHost Database.

Allan, J., Schattner, P., Stocks, N., Ramsay, E. (2009). Does patient satisfaction of general practice change over a decade?. //BMC Family Practice//. //10//. doi:10.1186/1471-2296-10-13

Australian Bureau of Statistics. (2006). //State and Territory Composition by Country of Birth//. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Products/30581AC0EDF2974BCA2578B0001197D0?opendocument

Blogspot. (2010) //A Dose of Dannie: The ups and downs of family life// [image]. Retrieved November 4, 2011 from []

Casimiro, S., Hancock, P., & Northcote, J. (2007). Isolation and insecurity: Resettlement issues among muslim refugee women in perth, western australia. //Australian Journal of Social Issues, 42//(1), 55-69,8. Retrieved from Proquest database

Gadarian Digital. (2011) //Social Media and Doctors: A few lessons from hospitals// [image]. Retrieved November 4, 2011, from []

Johanson, R. P., & Hill, P. (2011). Indigenous health: A role for private general practice. //Australian Family Physician, 40//(1), 16-16-19. Retrieved from Proquest Database.

Krentzman, A., & Townsend, A. (2008). Review of multidisciplinary measures of cultural competence for use in social work education. //Journal of Social Work Education, 44//(2), 7-31. Retrieved from Proquest Datbase.

Lings, P., Evans, P., Seamark, D., & Seamark, C. (2003). The doctor-patient relationship in US primary care. //Royal Society of Medicine (Great Britain).Journal of the Royal Society of Medicine, 96//(4), 180-180. Retrieved from Proquest Database

Nguyen, H. T. (2008). Patient centred care: Cultural safety in indigenous health. //Australian Family Physician, 37//(12), 990-990-4. Retrieved from Proquest Database

Queensland Health and Islamic Council of Queensland. (2010). //Health Care Providers’ Handbook on Muslim Patients Second Edition// [Handbook]. Brisbane. Qld.: Author.

= Replies =

Frances Ziesemer, n7540876
I love the artefact! A great pick for illustrating the decline of realistic values in most people belonging to generation Y. I like the way you relate consumerism to mental health, I hadn’t quite thought about it that way before. When I was suffering from depression I always thought to myself whether I was actually given the ‘luxury’ of experiencing this mental illness because I lived in a first world country. After all there are many in the third world that have far less and are far happier, so what could it be? Your write up gave me a potential answer to reflect upon, thank you.

Amanda Giang, 07388187
Your title says it all. It never ceases to amaze me how much pride many members of gen Y put into their ability to consume mass amounts of alcohol on a bender. I really enjoyed reading your page, and I like the artefact, I feel like it truly represents the chaos you'll see in the valley on a Friday night. I’m glad to see someone put a lot of thought about the cultural identity that alcohol manifests, I would like to see someone tackle exactly what it means in Australia, as I believe we have a very entrenched alcohol related culture. I’m not surprised at all about the statistics on binge drinking that you presented, what did surprise me was that the WHO lists alcoholism as an epidemic, I knew binge drinking was a problem but was unaware of how serious it is considered. Thank you for the great read and more power to you for rising above the peer and societal pressures placed upon us with regards to alcohol.