Overseas‐trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains

Durey, Angela; Hill, Peter S; Arkles, Rachelle; Gilles, Marisa; Peterson, Katia; Wearne, Susan; Canuto, Condy; Pulver, Lisa Jackson

doi:10.1111/j.1753-6405.2008.00301.x

Cited by 25 publications

(46 citation statements)

References 20 publications

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“…modifying the waiting room to be more culturally appropriate (playing Aboriginal radio, and displaying appropriate artefacts and posters); raising cultural awareness of the staff; 25 and liaising with local Aboriginal and Torres Strait Islander networks. The number of Aboriginal and Torres Strait Islander consultations increased tenfold following the introduction of these strategies.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study of staff perspectives of patient non-attendance in a regional primary healthcare setting

Akter

Doran

Avila

et al. 2014

AMJ

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Section: Discussionmentioning

confidence: 99%

A qualitative study of staff perspectives of patient non-attendance in a regional primary healthcare setting

Akter

Doran

Avila

et al. 2014

AMJ

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“…Thus the higher risk in rural Australian hospitals may reflect lower confidence of patients in smaller hospitals, poorer responses from hospital staff who may have less experience, fewer resources, lower skills and/or be overworked, less anonymity for patients in small rural centres, and a sense of less serious illness if transfer is not required. International medical graduates are over-represented in Australian rural hospitals and often have limited orientation, education and training in working with Aboriginal patients, potentially resulting in Aboriginal patients feeling unwelcome and misunderstood [25,26]. …”

Section: Discussionmentioning

confidence: 99%

Voting with their feet - predictors of discharge against medical advice in Aboriginal and non-Aboriginal ischaemic heart disease inpatients in Western Australia: an analytic study using data linkage

Katzenellenbogen

Sanfilippo

Hobbs

et al. 2013

BMC Health Serv Res

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BackgroundDischarge Against Medical Advice (DAMA) from hospital is associated with adverse outcomes and is considered an indicator of the responsiveness of hospitals to the needs of Aboriginal and Torres Strait Islander Australians, the indigenous people of Australia. We investigated demographic and clinical factors that predict DAMA in patients experiencing their first-ever inpatient admission for ischaemic heart disease (IHD). The study focuses particularly on the differences in the risk of DAMA in Aboriginal and non-Aboriginal patients while also investigating other factors in their own right.MethodsA cross-sectional analytical study was undertaken using linked hospital and mortality data with complete coverage of Western Australia. Participants included all first-ever IHD inpatients (aged 25–79 years) admitted between 2005 and 2009, selected after a 15-year clearance period and who were discharged alive. The main outcome measure was DAMA as reflected in the hospital record.Multiple logistic regression was used to determine disparities in DAMA between Aboriginal and non-Aboriginal patients, adjusting for a range of demographic and clinical factors, including comorbidity based on 5-year hospitalization history. A series of additional models were run on subgroups of the cohort to refine the analysis. Ethics approval was granted by the WA Human Research and the WA Aboriginal Health Ethics Committees.ResultsAboriginal patients comprised 4.3% of the cohort of 37,304 IHD patients and 23% of the 224 DAMAs. Emergency admission (OR=5.9, 95% CI 2.9-12.2), alcohol admission history (alcohol-related OR=2.9, 95% CI 2.0-4.2) and Aboriginality (OR 2.3, 95% CI 1.5-3.5) were the strongest predictors of DAMA in the multivariate model. Patients living in rural areas while attending non-metropolitan hospitals had a 50% higher risk of DAMA than those living and hospitalised in metropolitan areas. There was consistency in the ORs for Aboriginality in the different multivariate models using restricted sub-cohorts and different Aboriginal identifiers. Sex, IHD diagnosis type and co-morbidity scores imparted different risks in Aboriginal versus non-Aboriginal patients.ConclusionsUnderstanding the risks and reasons for DAMA is important for health system policy and proactive management of those at risk of DAMA. Improving care to prevent DAMA should target unplanned admissions, rural hospitals and young men, Aboriginal people and those with alcohol and mental health comorbidities.

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“…Caring for Aboriginal patients requires communication skills that accommodate different styles of interaction and different understandings of and responses to illness 10,12 . Cass and colleagues' seminal study showed that miscommunication between doctors and remote Aboriginal patients with renal disease was common and often went unrecognised, with a shared understanding of key concepts rarely achieved 13 .…”

Section: Reflection and Conclusionmentioning

confidence: 99%

Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication

Durey

Thompson

Wood³

2012

Internal Medicine Journal

111

109

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Improvements in Aboriginal health have been slow. Research demonstrates ongoing discrimination towards Aboriginal Australians based on race, including in health services, leads to poor health outcomes. Using an eclectic methodology based on observations and discussions with health practitioners experienced in working with Aboriginal patients, this paper identifies how cross‐cultural misunderstandings undermine the quality of care to Aboriginal patients in hospital and offers suggestions for improving practice. It also explores the concept of institutional racism and challenges doctors to reflect on their role in perpetuating power imbalances. We argue that physicians and healthcare providers need to do more than just deliver evidence‐based interventions, by critically reflecting on their own attitudes to and practices with Aboriginal Australians and work collectively to effect systemic change which creates a more inclusive and safe environment for all people accessing healthcare.

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Overseas‐trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains

Cited by 25 publications

References 20 publications

A qualitative study of staff perspectives of patient non-attendance in a regional primary healthcare setting

A qualitative study of staff perspectives of patient non-attendance in a regional primary healthcare setting

Voting with their feet - predictors of discharge against medical advice in Aboriginal and non-Aboriginal ischaemic heart disease inpatients in Western Australia: an analytic study using data linkage

Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication

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