1 December 2020

How to address racism in everyday practice

GP20 Indigenous health Political RACGP

GPs can fight conscious and unconscious racism in the health setting and help make it safer for indigenous patients to seek care, experts say.

At the recent GP20 conference, Indigenous GPs Dr Tanya Schramm and Professor Peter O’Mara and GP registrar Dr Josephine Guyer spoke about the enduring impact of colonisation and racism on the health of Aboriginal and Torres Strait Islander peoples.

Professor O’Mara, a Wiradjuri man and chair of RACGP Aboriginal and Torres Strait Islander Health, said systemic racism was exemplified in the high levels of cardiovascular disease and renal disease among Indigenous Australians.

Despite Indigenous Australians encountering these diseases far more frequently than non-indigenous Australians, they are also less likely to be offered treatments such as revascularisation and renal transplant therapy.

Professor O’Mara said he was also deeply concerned about rates of Indigenous and Torres Strait Islander patients who discharge against medical advice (DAMA).

“A particular case comes to mind of a man who was in his mid-40s who looked like he was having an infarct, so we sent him to the hospital, and this man was happy to get treatment because he knew the risks,” he said.

“He went into emergency and had an IV bag and ECG monitors on him, when at some point, he started to pull the ECG leads off and said; ‘I’m leaving.’

“The hospital in this situation got him to sign forms to acknowledge he understood what leaving meant … so in some ways, the hospital washed their hands of him.”

Professor O’Mara said in these situations, the hospital staff should have really been asking themselves: “What was so toxic about this environment that would have this man rather walk out the door and risk dying, than stay for the treatment he was initially willing to receive?”

Dr Schramm, a Palawa woman and senior lecturer in Aboriginal and Torres Strait Islander health education at the University of Tasmania, said giving a patient an unsafe cultural experience could cause a ripple effect for that individual and their community.

“When it comes to DAMA, that individual is likely to go back into the community and tell loved ones about their bad treatment, and then you have more people who may hesitate to go and get treatment at that hospital,” she said.

But there are things GPs can do to try and create a more culturally safe experience for their Indigenous and Torres Strait Islander patients.

Dr Guyer, a Wiradjuri woman and registrar medical educator at GP Synergy, said it was important to take the time to get to know the person in front of you and their health priorities.

“You can also learn about the Indigenous land you live on and learn some of the language to use in your consultation with patients, I find it’s usually really well received,” she said.

But doctors also needed to reflect on their own life experiences and the views they’d been bought up with, Dr Schramm said.

“When seeing a patient as a GP, it’s up to you to be quite consciously aware that you might have an issue in your experiences that could affect your view of this patient. You have to take that into account when you are consulting that patient,” she said.

“It comes down to trying to form really good rapport with that patient, so you can have a good open conversation where you’re paying some respect to that person because you’ve taken into account what your bias might be, before you walk into the room.”

Doctors can also ask their Indigenous patients whether they are doing a good job, and be less hesitant to take on criticisms, Dr Schramm said.

“Do something constructive about the (feedback) to make a change, because that’s how we are going to make a change in the Aboriginal health statistics,” she said.

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shyamala hiriyanna
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shyamala hiriyanna
4 months 6 days ago

No racism will not go. Who said white is best and Black is bad. Why is it so hard to understand diversity ? The Trauma the original people of Australia takes a long time to heal. The racism and sexism i have faced in Australia, has made me less confident, and has destroyed some part of my life. So Let us try and be nice to each other. Let us respect each other. Then only any thing will get better

max.kamien@uwa.edu.au
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max.kamien@uwa.edu.au
4 months 14 days ago
In 1977, in Perth, one of my Aboriginal patients had a massive myocardial infarction. She was admitted to the coronary care unit at the major teaching hospital where I also worked. The following day I went to see her but she had discharged herself from the hospital. I manage to find her but she would not return to the hospital. The reason for discharging herself was that she was menstruating and the nursing staff would not allow her to have a quick shower. I went back to the hospital and gathered all the nurses and junior doctors for a tutorial… Read more »
Michael Berger
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Michael Berger
4 months 14 days ago
“The hospital in this situation got him to sign forms to acknowledge he understood what leaving meant … so in some ways, the hospital washed their hands of him.” I think this is a little disingenuous on Prof O’Mara’s part.As he would be well aware it is a legal necessity and bears no relationship to the actual care given. All patients,irrespective of ethnicity,are required to go through the same process in these circumstances. I also feel that Prof O’Mara’s language,when he refers to “toxic environment” is more than a little inflammatory. No one can know what transpired in that situation… Read more »
Dr. I Rivlin
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Dr. I Rivlin
4 months 14 days ago

I’m disgusted at the vilification ujustly imposed on everyday decent Australians.
How dare you accuse ordinary, hard-working and honest people of “unconscious racism”? You both denigrate decent citizens and devalue *actual* bigotry.
Shame on you for this outrageous and uncalled for calumny.
Your moral posturing will do nothing other than engender racial division and create social disharmony.

Katie Williamson
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Katie Williamson
4 months 8 days ago

Dr Rivlin, there are countless studies on the impact of Racism on health outcomes, including extensive research on the impact on Aboriginal and Torres Strait Islander health. Prof Tracy Westerman’s work https://indigenouspsychservices.com.au/about/dr-tracy-westerman/ is a great place to start learning about the prevalence of racism in Australia and its healthcare system.
If you deny the existence of unconscious racism then you’re a major part of the problem.

daman langguth
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daman langguth
4 months 15 days ago

It is a fallacy that different life expectancy and differences in disease outcomes are due to healthcare delivery ; it is due to socio economic factors. I agree of course there are many ways we can improve our delivery but unless underlying soci0-econmic factors are addressed nothing will change. This the WHO position and eveyr bit of healthcare research supports it.

max.kamien@uwa.edu.au
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max.kamien@uwa.edu.au
4 months 14 days ago
I have had a relationship with Aboriginal people in the far west of New South Wales for 50 years. There have been many changes for the better and a few such as drug addiction, boils and dental caries that remain. In 1975, I wrote:” There is a large economic shadow overlying the whole basis of social and medical intervention. I was not able, nor has any other agency yet been able to improve the economic opportunities for Aborigines in the far west of New South Wales. Without, such opportunity I have the uneasy feeling that community development is akin to… Read more »
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