This document discusses communication principles and barriers in providing healthcare to Aboriginal Australians. It outlines principles for effective communication, including developing empathy, tolerating ambiguity, and suspending judgement. Barriers to communication are explored, such as physical environment, relationships, and social/cultural factors. Strategies are proposed for improving encounters, including being aware of power dynamics and differences in discourse."

1. Cultural Awareness
Training
Communication Issues in Aboriginal Health
Hung The Nguyen
hunguyen250369@gmail.com
TMT, Cairns 07/02/2013
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2. Outline
!some principles
!some barriers
!some strategies
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3. Communication Principles
Content Process
Perceptual Skills
17
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4. What we communicate about in a
medical interview
Initiating the session
CONTENT
Gathering information
Physical examination
Explanation and planning
Closing the session
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5. Communication Principles
Content Process
Perceptual Skills
17
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6. How we communicate
during a medical interview
Gathering information
patient’s narrative
PROCESS
question style: open to closed
attentive listening
facilitative response
picking up cues
clarification
time-framing
internal summary
appropriate use of language
additional skills for understanding the patent’s perspective
Exploration of the patient’s problem to discover the :
! biomedical perspective ! patient’s perspective
sequence of events ideas and beliefs
symptom analysis concerns
relevant systems review expectations
effects on life
feelings
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7. Communication Principles
Content Process
Perceptual Skills
17
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8. Perceptual Skills
= Our awareness of what the patient is thinking and
feeling and of what we are thinking and feeling.
Our sensitivity to
Our decision
patients’
making, attitudes, values,
attitudes, beliefs and
values, beliefs, thoughts about
thoughts about the illness or the
the patient or
doctor or the
illness; consult;
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9. Communication Principles
Content Process
Perceptual Skills
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10. Cross-cultural
Communication Principles
" Developing empathy
" Tolerating ambiguity
" Suspending judgment
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11. Developing empathy
Empathy is “the capacity to take the
perspectives of others, to be sensitive to their
inner experience and to engage with them
compassionately, rather than simply sharing
their emotions (sympathy)”.
N Haslam eMJA 2007
How do we do it?
Immerse yourself.
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12. Cross-cultural
Communication Principles
" Developing empathy
" Tolerating ambiguity
" Suspending judgment
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13. Tolerating Ambiguity
• Tolerance - endurance, permissiveness,
patience, easiness, acceptance, margin,
allowance, leeway
• Ambiguity – multiple meanings
How do we cope with uncertainty in general
practice?
Be curious.
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14. Cross-cultural
Communication Principles
" Developing empathy
" Tolerating ambiguity
" Suspending judgment
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15. Suspending Judgement
• Being non-judgmental is rarely attainable...
• …until we better understand the situation,
sought and obtained all relevant information
or are asked for our opinion.
• How do we do it?
Build relationships.
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16. Cross-cultural
Communication Principles
" Developing empathy
" Tolerating ambiguity
" Suspending judgment
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17. Barriers to effective communication
Non-verbal cues
Non-verbal cues
Physical Environment
Physical Environment What did not
What did not
Plannedand unplanned activities
Planned and unplanned activities happen?
happen?
Doctor-patient
relationship
You, the GP
Patient factors
Socialenvironment
Social environment
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18. Barriers to effective communication
Non-verbal cues
Physical Environment What did not
Planned and unplanned activities happen?
Social environment
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19. Indigenous Encounters
Things you can do:
"before any encounters
"during the encounters
"after the encounters
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20. Before Any Encounter
Be aware of impeding factors
Patient may feel that they are not in control
• power
• numeracy and literacy
• time
• environment
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21. Before Any Encounter
Be aware of impeding factors
Differing modes of discourse
• indirect
• use of narrative
• non-verbal communication cues
• gratuitous concurrence
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22. Before Any Encounter
Be aware of impeding factors
Process of the medical interview can be
inflexible
• multiple and complex issues
• presentation of more than one patient
• use of narrative
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23. Before Any Encounter
Be aware of impeding factors
tendency or dominance of the biomedical
exchange
• disease vs social concerns
• clinical caring vs holistic caring
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24. Before Any Encounter
Be aware of impeding factors
staff knowledge of local indigenous culture
• behavioural norms
• communication styles
• cultural world views
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25. Before Any Encounter
Be aware of impeding factors
importance of family and advocacy
• significant family members
• AHWs
• ALOs
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26. Before Any Encounter
Establish credibility
be a good communicator and educator
• body language
• rapport and relationship
• holistic approach
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27. Before Any Encounter
Establish credibility
show respect for old people
show respect for AHW
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28. Before Any Encounter
Establish credibility
dealing with death and dying
• elders, children
• deceased names
• blaming or cause of death
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29. Before Any Encounter
Establish credibility
have a low threshold for seeing acute cases
early
• late presentation
• men
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30. Before Any Encounter
Establish credibility
be aware of the different health patterns and
presentations
• health status
• specific guidelines
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31. Candice
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32. During the Encounter
develop rapport from the beginning
Connecting
• the social situation
• talk the “lingo”
• informal speech
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33. During the Encounter
Gathering information
get a grasp of their “world view”
• cultural dimensions
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34. During the Encounter
Gathering information
Allow the patient to be in control
• time
• active listening
• clarify agendas
• speculate rather than interrogate
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35. During the Encounter
Gathering information
communication strategies
• be comfortable with silence
• be comfortable with no eye contact
• use the “3 minute rule”
• use preface for sensitive questions
• beware of “yes” only answers
• be sensitive to non-verbal cues
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36. During the Encounter
Gathering information
involve the family
• collaborative history
• serious diagnoses - decision making,
support, communication
• social issues, emotional wellbeing issues -
part of the management
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37. During the Encounter
Gathering information
ask for personal meaning of physical illness
• spiritual causation (through signs in the
natural world)
• role of social events
• personal relationships and blaming
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38. During the Encounter
Gathering information
use patients’ terms and language
• comfort
• “break the ice”
• focuses on the patient
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39. During the Encounter
Gathering information
gender issues
• be sensitive
• check with the person
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40. Henry
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41. During the Encounter
communication strategies - keeping things “simple”
Telling “their story”
• appropriate short sentences
• speak slowly and distinctly
• avoid unnecessary detail
• provide one idea at a time
• use simple words
• listen to patient’s choice of words
• avoid using the negative form in questions
• avoid using prefixes on abstract words
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42. During the Encounter
Telling “their story”
communication strategies - impact
• use repetition - throughout management
phase, use summarising technique, future
meetings
• talk with pictures - avoid eye contact,
tackle lower literacy and numeracy
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43. During the Encounter
Telling “their story”
deal with one issue at a time
• the one the patient nominates in this
consultation
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44. During the Encounter
Telling “their story”
avoid disempowering the patient
• provide choice
• “keep it simple” does not meaning
holding back on relevant information
• provide handouts
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45. During the Encounter
medication management issues
Telling “their story”
• effective communication - shared understanding,
education tools, involve AHW
• “to be taken with food”; “do not take when
drinking alcohol”
• be aware of terms like “dinner”, “tea time”
• simplify drug regimen
• routes of administration
• does administration aids
• storage issues
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46. During the Encounter
Telling “their story”
use AHW
• patient support
• interpretation - language, body language,
social situation, ‘unspoken words’
• cultural broker
• buffer, safety reasons
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47. During the Encounter
Telling “their story”
use family members
• serious and complex problems -
palliative care, domestic violence, aged
care, emergency care
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48. During the Encounter
when and if things go wrong
• costs
Safety netting
• transport
• procedural access
• visible and available services
• expected course of the condition
• family obligations
• cultural safety concerns
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49. During the Encounter
clear follow-up advice
Closing
write down tasks
provide handouts
give referral letters
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50. After the Encounter
any uneasiness about the encounter?
Reflective practice
• administrative or practice management issues
• medical nature
• social and emotional concerns
• cultural nature
• ethical and legal concerns
• communication process
• your role and responsibilities
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