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  • Aboriginal people are usually renamed with Christian names
  • Kirkton road - HIV service in Sydney; sex workers, IDUs

Notes

  • alcohol problems
  • don't tell the patient they're going to get in trouble - not paternalistic/authoritative
  • mistrust of the health profession and police; makes an obstacle to care
    • these aren't your issues - don't take it personally
  • problems with the law
  • gain trust (esp if going down hill)
    • "I'm actually here to help you"; any patient that is sent by legal aid doesn't want to be there
    • establish goodwill
  • initial engagement at the start of the consultation saves you time later in the consult; they're more readily forthcoming
  • if it's not working well, admit that I'm going about things the wrong way- be upfront
    • don't suck up to the patient, some of them will storm out; just realise that it's not your fault. Don't take it personally.
  • "Consultant is part of the system"
  • concentrate on the patient at the start of the consultation (not notes)
  • explain that you have to ask some set questions - so they know what you're writing
  • naming etc - don't use special names for people unless they've explained that you can
  • eye contact is individual (some like, some don't)
    • if you're constantly looking at someone all the time, that's intimidating (gut instinct)
    • traditional areas - listen to HCWs
  • aboriginal HCWs - used to bridge the gap (don't understand); use Aboriginal HCW to explain things they don't understand
    • should be male and female (Men's and Women's business)
  • first questions when you meet Aboriginal people - ask "who is your mob"; different mobs have different languages/cultures
  • Torres Strait Islanders are related to Fijian. Aboriginals are on mainland.
    • culture is vastly different
  • use normalisation
  • give them a choice of management
  • don't be paternalistic
  • include community services that are culturally appropriate
  • responsibilities to family --> poorer compliance in certain cases
    • burnt chop syndrome - everybody else in the family is more important than her. You have to deal with the whole family, because they prioritise children over themselves
  • GP house call in response --> can scare people because they're expecting this to only happen when there's an emergency; don't answer the door if you live alone; seeing someone not from your community makes you stand out (gossip)
  • might not know infected toe is connected to diabetes --> amputation
  • patients have very good reasons for not presenting earlier - don't have health as first priority
  • bring a female HCW if you're visiting a female's house
  • men's business - only seen by male doctors
  • women's business - only seen by female doctors
  • home visits - you can see how people live
    • people feel like they're being judged, and feel uncomfortable
    • may want to keep family life separate to professional life
  • Aboriginal HCWs can make up that they're visiting for a different reason than they really are (confidentiality)
  • In their home you can see why their chronic conditions aren't improving
  • people prefer if you call ahead, or if you send a nurse rather than the doctor themselves (intimidation)