The importance of culturally appropriate healthcare spaces

Morgan Liotta

28/05/2018 1:45:56 PM

To mark National Reconciliation Week, newsGP looks at the importance of cultural safety in general practice and highlights some useful resources for GPs and practice teams.

Chair of RACGP Aboriginal and Torres Strait Islander Health Assoc Prof Peter O’Mara believes GPs can make important contributions towards creating safe and culturally welcoming healthcare spaces.
Chair of RACGP Aboriginal and Torres Strait Islander Health Assoc Prof Peter O’Mara believes GPs can make important contributions towards creating safe and culturally welcoming healthcare spaces.

Given GPs are considered the first point of contact for most Australians when accessing healthcare, a culturally responsive general practice environment can play a significant part in improving that access, and can be crucial to closing the gap in health outcomes.
Associate Professor Peter O’Mara, Chair of RACGP Aboriginal and Torres Strait Islander Health, believes GPs can make important contributions towards creating a safe and culturally welcoming environment for Aboriginal and Torres Strait Islander peoples.
He views National Reconciliation Week (27 May – 3 June) as an opportunity to improve the relationships between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians.
‘Patients have the right to respectful care that promotes their dignity, privacy and safety,’ he told newsGP.
‘Equipped with greater cultural awareness and the ability to ensure cultural safety, GPs will provide better quality and more appropriate care to all of their patients.
‘It will also ensure they are well-rounded and more effective doctors.’
Ada Parry is a community representative on the RACGP Aboriginal and Torres Strait Islander Health Board. She agrees that cultural awareness benefits all aspects of a healthcare relationship – from a patient’s greeting as they enter a practice to fostering an ongoing connection throughout the care.
‘A really simple step is to have a friendly face at reception. Many Aboriginal and Torres Strait Islander people go to mainstream health services and want to be treated like everyone else,’ Ms Parry told newsGP.
‘It is important to understand that some Aboriginal and Torres Strait Islander patients may have a different culture or cultural practices to non-Indigenous Australians.
‘If [healthcare professionals] don’t show that they care about those differences, this can really affect their patients.’
Ms Parry strongly believes that taking the time to get to know patients, to hear their story and help them understand their illness and treatments can make a big difference.   
‘People need to get past stereotypes and stop making assumptions,’ she said.
‘The approaches that work for most of your patients may not always work for Aboriginal and Torres Strait Islander patients.
‘Treat patients the way you would like to be treated.’
Associate Professor O’Mara agrees, emphasising that the strength of culturally responsive care is not only for patients.
‘The role healthcare professionals, organisations, medical colleges and governments have in providing safe and appropriate spaces for Aboriginal and Torres Strait Islander patients could not only benefit the patients, but also the healthcare providers themselves,’ he said.
GP resources
The RACGP has a number of educational resources and standards that help to support the cultural needs of Aboriginal and Torres Strait Islander peoples:

Aboriginal-and-Torres-Strait-Islander cultural-awareness cultural-safety National-Reconciliation-Week

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Dr Peter Strickland   29/05/2018 12:48:10 PM

Unfortunately Ms Parry is separating aboriginal and Torres Strait patients from everyone else. Everyone is equal, and every adult needs to take responsibility equally for their health outcomes for themselves and their dependents. The definition of an aboriginal is not known, and being aboriginal does not mean being disadvantaged or to be given special privileges above everyone else in the community as seen in the present health and other systems, e.g. for vaccinations or medications on the PBS; this latter organisation (PBS) is discriminating on racial grounds with certain medications such as dermal antibiotic ointments etc, influenza vaccines etc., and it should cease. The Australian health system should not be based on race, but on need, and I know many poor patients (who are not aboriginal) not being able to access health, education and work opportunities simply because they cannot prove indigenous heritage. My grandchildren are indigenous (more than 6th generation), but not aboriginal, and should not be discriminated against in any aspect of their lives as seen at present, and because they are not aboriginal.

Dr Tim Senior   30/05/2018 9:33:16 PM

Dr Strickland is right that our health care should be based on need, so it seems strange that he would criticise measures designed to meet the health needs of Aboriginal and Torres Strait Islander Australians. To take three examples, different immunisation schedules are based on different epidemiology related to pneumococcus; much higher rates of cardiovascular disease are addressed by access to low dose aspirin on the PBS; high rates, with severe consequences, of otitis media with effusion is addressed by access to ciprofloxacin ear drops.
We know that Indigenous Australians are hugely overrepresented in low income groups, and have lower rates of expenditure per person by Medicare and the PBS, despite higher need.
And yet none of these measures can have any effect if Indigenous patients are reluctant to attend health services for whatever reason. Indigenous people tell us these reasons include cost, transport, and a lack of cultural sensitivity - too often Indigenous people have bad experiences in our health system. This is something we, as GPs can do something about, and should if we wish to improve the health of our Indigenous patients.
Far from discrimination, this is responding to the the very real needs of our Indigenous patients.
(For stats, see the most recent Health performance Framework)

Dr Tim Senior   30/05/2018 9:38:34 PM

It's also worth noting that, contrary to what Dr Strickland says that "the definition of an aboriginal is not known," the definition is very clear. The definition for Aboriginal communities to be able to confirm Indigenous status is that the person should be of Aboriginal descent; they should identify themselves as a member of the Aboriginal community; and they should be identified by that community as Aboriginal. (That's the gist, not the exact wording!)
However, GPs do not need to police this. All Medicare requires is that the person identifies themselves as Aboriginal and/or Torres Strait Islander. More information can be found in the RACGP Position paper on Identification of Aboriginal and Torres Strait Islander patients in general practice. The Lowitja Institute also published an excellent summary of the evidence about how this was done and the barriers to doing it well a few years ago.

William Young   31/05/2019 10:34:33 PM

I am with Peter Strickland on this and would go a bit further and say that separating health services on the basis of indigenousness borders on apartheid. I am all in favour of appreciation and recognition of cultural differences but they should NOT interfere with the delivery of the best possible medical care..

stephen fennell   6/10/2021 11:22:17 AM

Tim Senior as a recent resident in WA , I tend to disagree regards the cost of per head regards Health for indigenous groups. Seeing the huge medical specialty health facilities in Broome plus I understand Alice Springs has the biggest number of Renal Dialysis machines in the southern hemisphere. Travelling from Perth to Kununarra there are numerous medical facilities in place with a lot related to self inflicted health problems(feotal alcohol syndrome, blood pressure, diabetes, heart disease) from alcohol smoking and poor diet. Aside from that recent question s have asked regards the Welfare costs per head were every dollar spent on non-indigenous person a $1.60 on indigenous person. I assume the extra 60 cents is soaked up by education and health costs and current KPI's have indicated there is no improvement on outcomes both in education and health. So cultural awareness is a cop out regards health for the same set of symptoms , treatment is based on science not culture.