On my cardio placement on a medical ward, one of my patents is an Indigenous man. He lives in a remote area and identifies with traditional Aboriginal culture. I found the subjective examination extremely difficult. He is a cooperative patient, appears to understand the questions I ask and always answers me, however I have been unable to obtain a specific subjective history. His accent is different to what I am used to hearing and he speaks softly and quickly. He also avoids eye contact which makes it difficult to read facial expressions and comprehend fully what he is saying. His answers to my questions are indirect and I feel I am missing the point of his answer.
I am aware that I understand little about Aboriginal culture and that there are cultural differences between Australians from urban areas and Indigenous Australians who identify with traditional culture. The experience with this patient has given me some appreciation of how big those differences are. It amazes me that we can be citizens of the same country and not be able to verbally communicate when speaking the same language.
I spoke briefly with a friend who has lived and worked with Aboriginal people from communities in remote areas. She said that to offer information as the conversation progresses, rather than asking and answering questions may be the way things are usually done in this man’s culture. Next time I see the patient I will try explaining my reasons for wanting information and rephrase things so I am not asking direct questions. Hopefully this will lead to obtaining a better subjective history.
If anyone has any other ideas please let me know.
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2 comments:
Sounds like your plan on how to approach this patient next time will be effective. Having recently done my seminar on aboriginal health, I learnt a few strategies that you can use to improve your interaction with indigenous patients and make your treatment as effective as possible. One issue with aboriginal patients can be that they are more visual and verbal compared with non-aboriginal clients who are perhaps more numerate and literate. Maybe it would help to be more visual with your questioning by demonstrating movements or pointing to body parts and avoid any use of jargon or detailed instructions.
You might already be doing this, but it's just a suggestion that might help. I think it's great though that your trying to think of strategies to make your treatment more effective. Good luck!
On one of my recent pracs, i did a bit of work with an aboriginal guy who was from a remote community. I encounted the same sorts of problems. I have to say though I found it so amusing (in a good way) how they go about things. This fella came in for liver transplant, which really knocks a person around a lot and the only thing he had with him was his clothes and a piece of paper with a family members phone number on it, who he hadnt met before and was meant to call when he was discharged, because he needed to stay in perth for a few weeks after discharge. Also it was really hard for him to understand why he shouldnt do some things. He obviously felt fine a few days after surgery. So he was sneaking down stairs still attached to his drip stand/catheter, compression stockings etc to get some sun. :)
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