|Questions for you to consider
|Communication and consultation skills
- If this was the first time you had met Jonathon, how would you ask how he identifies himself or his cultural heritage? What are the barriers to a patient identifying as Aboriginal and/or Torres Strait Islander? Why might an Aboriginal or Torres Strait Islander person choose not to identify?
- How might you build rapport with Jonathon?
- Consider what assumptions you have made about Jonathon (including biases and stereotypes). Where do these come from? How might you adjust your perspective?
- Do you know what ‘on Country’ and ‘Sorry Business’ mean? How might you find out more about terminology commonly used by Aboriginal and Torres Strait Islander people in your community?
- What kind of language and communication style does the patient use in their local community? What is your own cultural communication style? How might you adjust your natural style to accommodate your patients?
|Clinical information gathering and interpretation
- What are your priorities for this first consultation? Consider priorities beyond clinical investigation and management.
- How would you tailor your history-taking to explore important sociocultural elements of this consultation?
- What might you need to consider if Jonathon was a member of the Stolen Generations or had only recently discovered his Aboriginal heritage?
- What is trauma-informed care? How might repeated episodes of grief and trauma impact on Jonathon’s social and emotional wellbeing or mental health? How might that impact on your engagement with him?What strengths can you identify in Jonathon?
|Making a diagnosis, decision making and reasoning
- How might you respectfully incorporate knowledge about population-level risk factors for Aboriginal and Torres Strait Islander people into your assessment, without stereotyping the individual patient?
- What additional conditions would you consider screening for if Jonathon lived in a remote community?
- How would you approach the complex interplay of potential multimorbidity?
|Clinical management and therapeutic reasoning
- How might you incorporate a strength’s-based approach to manage some of the cultural determinants of health?
- How might you respectfully incorporate Aboriginal and Torres Strait Islander models of health and wellbeing into your management plan, including use of traditional medicines, if patients choose?
- What is your approach to navigating differences between your own and your patient’s priorities (such as family or cultural obligations) when developing shared management plans?
- What differences in clinical management guidelines exist for specific conditions in Aboriginal and Torres Strait Islander communities, including for patients who live rurally or remotely?
|Preventive and population health
- What do you need to learn about Jonathon’s local community both here and on Country?
- How would you provide culturally safe care if Jonathon was unable, or preferred not, to access services provided by an Aboriginal community-controlled health organisation, Aboriginal and Torres Strait Islander health worker/practitioner, or Aboriginal and Torres Strait Islander liaison officer?
- What is your role in helping patients to develop biomedical health literacy, without judging existing health beliefs? How will you assess and support this patient’s health systems literacy (the ability to navigate and access health services and systems)?
- Is there a time you can think of when someone has held a belief about health/causation of disease that was different to that of the biomedical model of disease? How might you navigate these differences?
- How might you endeavour to approach this consultation through a lens of anti- racism?
- How will you respond to Jonathon’s disclosure about culturally unsafe care in previous healthcare interactions?
|General practice systems and regulatory requirement
- What care elements can you identify that might have been culturally unsafe for Jonathon in the past? What barriers might exist in your clinic that inhibit cultural safety?
- What Aboriginal and Torres Strait Islander-specific PBS or MBS items is Jonathon eligible for? What is the rationale for these population-specific measures?
- What are some practical barriers to accessing healthcare services that Jonathon might have? How might you help overcome or reduce these?
- Are there cultural considerations you might need to respond to during examinations and procedures; for example, gender preferences (sometimes known as ‘women’s business’ or ‘men’s business’)?
- How would you negotiate what is or is not acceptable to Jonathon in the consultation? What creative solutions might you use to manage patient preferences?
- How will you approach the issue of not knowing the previous medical history, in a culturally respectful manner?
- How will you approach limitations in your cultural knowledge about Jonathon?
- For example, how might you find out more about his use of and access to traditional medicines?
|Identifying and managing the significantly ill patient
- How will you assess the severity of a patient’s illness in situations where cultural differences might change the presentation of symptoms; for example, pain? Are you aware of the published coroners’ case reports on Aboriginal and Torres Strait Islander deaths due to misinterpretation of illness severity and systemic racism?
- Do you understand the local cultural considerations for communicating with family members, and how would you approach this with the family of a patient who is critically unwell if needed?
- What might you need to consider if your patient requires an urgent medical retrieval from your clinic, including in rural and remote contexts?