Unsure about delivering culturally safe care?
Distrust of Western culture
Distrust of Western culture and medicine is understandably present for many marginalized groups, noted Dr. Joseph. She gives the example of a patient in the Territories who refused treatment for diabetes. After gentle probing, she found out it was because the patient’s brother had died after taking diabetes medication.
“It’s really important to understand the patient who is in front of you and respect their idea of wellness and treatment. In this case, as a physician, it is my due diligence to explain the options, help her understand the broader picture of diabetes and health, and say, ‘If you want to give it a try, I will work with you. Come to me when you are ready if this is something you would like to consider.’”
Dr. Young, who graduated from medical school in 2019, believes real-world experience needs to be at the forefront, too, balancing out the academic.
“As an Indigenous person, I didn't necessarily feel the need to have additional training in cultural safety, because I'm very well aware of the effects of colonialism in our country, having been a generational survivor of residential school and the Sixties Scoop and all of that,” he said. “But there was a lot of mentorship that happened, with some of the physicians who were already practicing in Sipekne'katik, for many years, who were able to guide me along. I could see if you went into another clinic environment where you didn't have colleagues who were experienced, or who were working under different models, like fee-for-service, they would not have been able to provide that level of support.”
First and foremost, he said, early-career physicians need to seek out opportunities for additional training and gaining new knowledge, whether it's through reading or asking questions, and getting to know the community. “There are many ways that you can do that. We had a powwow just this past weekend here in Dartmouth in the urban context through the Mi'kmaw Native Friendship Centre. I think it’s very important to have comfort just going to those things and getting to know people and the beautiful side of our culture and ways of being—not seeing us just as a traumatized community that has issues, is step number one.”
Trauma-informed care
From there, physicians also need that foundational knowledge that will directly inform their practice, he said. “That typically involves trauma-informed care. There are whole courses on this, and, the best one that I've seen is from Alberta Health Services, and it's an online module, and it’s free.”
Dr. Young said that the most crucial component of trauma-informed care is recognizing that trauma is pervasive in our society, and there is a potential that the patients physicians see will be retraumatized by the healthcare system, or have been retraumatized by the healthcare system.
“So we need a compassionate approach, taking time to develop relationships, taking time to understand and contextualize the reasons people behave in the way that they do. So when patients, for instance, maybe have emotional dysregulation or are angry with you, understand that that actually probably has a background context that is rooted in their previous experience with physicians and healthcare providers who have treated them poorly.”
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