The Cross Cultural Consultation

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The Cross Cultural Consultation
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My Background

• Son of a language teacher
• 12 yrs living and practicing in Waitara,
  rudimentary speaker of Te Reo
• 15 years working at Newtown Union Health Service
• Patients from many cultures Maori, Pacific, SE
  Asia, Africa, China, India,Europe

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The Ideal?

• Patient and Doctor are from the same culture
• Doctor learns to be fluent in patients culture
  language, customs,beliefs
• Is this achievable?????

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What is Culture?

• Attitudes and Behaviour of a particular social
  group
• The customs, arts, social institutions,of a
  particular nation,people or other social group

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Ethnicity? Culture?

• Are they the sameAlways, Sometimes, Never?
• Ethnicity a basis for assumptions about culture.

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Ethnicity Definitions

• The Ethnicity Protocols for the Health and
  Disability Sector define ethnicity as a social
  group whose members have one or more of the
  following characteristics
• they share a sense of common origins
• they claim a common and distinctive history and
  destiny
• they possess one or more dimensions of collective
  cultural individuality
• they feel a sense of unique collective solidarity

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The Census Ethnicity Question
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Other Cultures

• Religious belief
• Sexuality
• Western Medicine
• Age
• Parenthood
• Disability

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Principles of Good Cross Cultural Care

• Respect
• Somali Women and Genital mutilation

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Principles of Good Cross Cultural Care

• Know your own culture
• How does the body work/ homeopathy
• What stereotypes junkies

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Principles of Good Cross Cultural Care

• Be non-judgemental
• Rectal bleeding
• How to ask the Naïve question
• beware non-compliance

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Principles of Good Cross Cultural Care

• Beware of Assumptions
• Sexually active?
• Physical symptoms physical illness?

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Principles of Good Cross Cultural Care

• Do a Well Health Check
• Pronounce Names
• Patient Centred Medicine
• Learning about the cultures of your patients
• Supervision
• Community Centred Care

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The Use of Interpreters

• Language line

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Policy Framework

• Health Practitioners Competence Assurance Act
  118(i)
• (i) to set standards of clinical competence,
  cultural competence, and ethical conduct to be
  observed by health practitioners of the
  profession

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How did we reach this point

• equal care irrespective of race
• The Treaty of Waitangi
• Health Disparities
• Increasing Ethnic Diversity of patients and
  Health practitioners.

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Definition (Medical Council NZ)

• Cultural Competence requires an awareness of
  cultural diversity and the ability to function
  effectively and respectfully when working with
  and treating people of different cultural
  backgrounds. Cultural competence means a doctor
  has the attitudes skills and knowledge to achieve
  this

Department of Primary Health Care and General
Practice University of Otago Wellington
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Definition cont.

• A culturally competent doctor will acknowledge
  that
• New Zealand has a culturally diverse population.
• A doctors culture and belief systems influence
  his or her interactions with patients and accepts
  that this may impact on the doctor patient
  relationship.
• A positive patient outcome is achieved when a
  doctor and patient have mutual respect and
  understanding.

Department of Primary Health Care and General
Practice University of Otago Wellington
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Statement on Best Practice When Providing care to
Maori patients and their Whanau
Department of Primary Health Care and General
Practice University of Otago Wellington
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Code of Patients Rights

• Right 5 states
• Right to Effective Communication
• 1) Every consumer has the right to effective
  communication in a form, language,
• and manner that enables the consumer to
  understand the information provided.
• Where necessary and reasonably practicable,
  this includes the right to a
• competent interpreter.

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Code of Patients Rights

• The only right with the Where necessary and
  reasonably practicable, qualification within the
  right
• All other rights are qualified in this way at the
  end (and that is not on the poster)

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Cultural Safety

• Concept developed by Irihapeti Ramsden for
  nursing.
• Contrast with Transcultural Nursing
• The nursing council separates out Treaty issues
  from Cultural Safety
• Nurses will be asked to show they both apply the
  principles of the Treaty of Waitangi to their
  practice and nurse in a manner the client
  determines is culturally safe.

Department of Primary Health Care and General
Practice University of Otago Wellington
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Cultural Competence RNZCGP

• No mention of use of interpreters
• ? Because starting point was improving care for
  Maori.

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Cornerstone

• Needs revision looking through the lens of a
  person who needs an interpreter.
• E.g. Mandatory demographic fields should include
  preferred language and whether an interpreter is
  needed.
• Referral letters should identify patients that
  need an interpreter
• Consultation notes should record who interpreted

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Other Countries?

• Sweden Govt funded 3000 hrs a day in over 100
  languages
• Australia GPs have access to funded telephone
  interpreting
• Criterion 1.2.3 Interpreter services
• Indicators
• our GP(s) and staff who provide clinical care
  can describe how they communicate with patients
  who do not speak the primary language of our
  practice's GPs (interview)
• our practice has a list of contact numbers for
  interpreter services (document review).

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My Recommendations on Policy

• It is not reasonable to expect GPs to know the
  cultural practice of all their patients.
• Because of the Treaty of Waitangi and Maori
  indigenous status, we should all have a knowledge
  of Maori Cultural practice and some language.
• Cultural competence should be taught and assessed
  on general intercultural criteria as in the
  NZMC Cultural Competence document