Impacts of racism on health: The GP’s role

‘I won’t have any blacks in my hospital.’
 
Those are the words my mother heard from the head nurse in a country hospital in NSW when applying for the nurse training program in the 1960s.
 
Already having endured years of physical and verbal abuse through denial of culture and assimilation growing up in an Aboriginal girls’ home, she never felt like she was good enough or that she fitted in, always being judged on the colour of her skin. This impacted not only her general health and wellbeing, but her trust in the healthcare system in general.
 
It was through her own resilience and perseverance that she eventually pursued a career in nursing, which then inspired me, a proud Wiradjuri woman and now GP, to also pursue first a career in nursing and then in medicine.
 
Racism comes in many forms and is directed towards many minority groups in Australia. Certainly, we have come a long way from the 1960s, but racism still does exist today.
 
Indigenous Australians are too often the victims of racism. This does not always have to be in the form of subtle remarks or judgements, but can be overtly obvious in the sporting arena as we have all too often heard. What is important for us is to recognise it when we see it; whether that be in the workplace, amongst friends and family, or as something that may be impacting our patients.
 
Whereas racism is not unique to First Nations people in Australia, it is important that as GPs we are able to recognise if it is something that is affecting our patients, enabling us to then ensure the care that we deliver to them appropriately addresses the issue.
 
Racism can create feelings of anger, frustration, disempowerment and of not belonging. It adversely affects its victims, often leading to poorer physical health, but more importantly mental health, and is a key contributor to the onset of ill-health and disease.
 
As GPs it’s important to recognise Indigenous patients in your practice. Allowing patients to identify as Aboriginal and/or Torres Strait Islander upon registering is a good starting point. Often, asking patients during a consult can be helpful, as well as while updating their medical record.
 
I have been to quite a few medical practices where I was never asked, or I didn’t feel comfortable disclosing my Indigenous status.
 
Identifying Indigenous patients changes your risk assessment for chronic illness and opens opportunities for more comprehensive health assessments, but it also allows GPs to explore whether racism has impacted the patient, allowing the issue to be dealt with appropriately and thereby reducing the impact it can have on an individual’s overall health.
 
A good therapeutic relationship encompasses all aspects of an individual’s health. For an Indigenous person, that includes having a respect for and understanding of the holistic definition of health, which includes physical, emotional and spiritual components, as well as the importance of family and country.
 
It was very fortunate that my Aboriginal mother found an understanding and supportive GP in country NSW who she felt comfortable talking with, who listened to her, validated her and allowed himself to learn from her about her culture, her life experience and the importance of her country, her spiritual wellbeing and her family.
 
This relationship built up over many years and was invaluable at the end of her life, where she felt safe, respected and thankful for his years of understanding, respect and empathy.
 
As leaders within our healthcare system and community, we can all have that same impact. The change starts with us.
 
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Aboriginal and Torres Strait Islander health healthcare racism