2. Communicating with your patient

An interesting study was done in UK hospitals in 2019. They looked at what makes a good ward, and they found that there's a big gap between what health professionals and patients think is important. The most important thing to patients was good communication and staff attitudes, but according to the health professional, hand hygiene and infection control was top of the list. I'm not saying communication is more important than hygiene, it's just interesting to be reminded that patients prioritise different things to you, the health professional. [Music] Ask the specialist, a podcast where doctors from Royal Darwin Hospital ask a team of specialists to answer the questions they have about working with Aboriginal patients. My name is Bill O'Rourley. Bill O'Rourley means the red tumbler cock too. I'm an elder of the larynquian nation. My name is Brawau Engie, or in Tarnamiri, a Teewee elder. And my name is Rathjoy Melanie Hirdman, and I am from Irelandland. The specialists are Larakia, Teewee and Yulngun leaders, who have all had personal experiences in hospital in the Northern Territory of Australia. [Music] I'm Vicki Carrigan. Some people call communication a soft science. It's the touchy fugly stuff. The suggestion is that communication is easy, but you know it's not. Not being able to communicate is really stressful for you, and really stressful for the patient. In fact, poor communication is one of the way patients experience racism. But the good news is there are so many things you can do to improve communication. I've been thinking about that question. It's a very good question. There are opportunities to make communication better here in a Royal Dao hospital, and all health centers for indigenous people in different ways. Bachi Menengua Darndara. Good morning is Bachi Menengua. Good afternoon is Bachi Guddlingua. So that's good morning in Larakia, and the Larakia people are the traditionalised Darwin, but Larakia is not really a spoken language. It's not a spoken language because of the impact of colonisation, because of the stuff that my ancestors did to your mob. Yeah, yeah, so yeah, they were introducing it again, trying to revive it. Bachi Menengua in Larakia. What's good morning in your mob? I don't know. We don't really have a word for good morning. Yes, I know. Yo, Namari. It's good morning. We appreciate it anyway, so we don't have word for it. That's Stuart McGarrer. He produced the podcast with me. Stuart's an Aboriginal health practitioner in the Northern territory of Australia, and he's studying to be a nurse. Throughout the series, we chat about what the specialists say. You'll also hear my mate Richard Margleton's voice a lot. He's recorded all of the doctor's questions, so the doctors remain anonymous. How best can we communicate? I don't know their language. I've maybe learnt one or two words. What is the best way that we can communicate? Is it through interpreters? Well, interpreters can help, but they may not be available on occasions. So, you know, there's no reason why, like they do at CDU, for example, a your own language or something language can be taught to these practitioners for them to learn in the hospital. In the hospital. Speak slowly. Don't use big words or acronyms. Tone, volume, yeah, and a lot of our people have a tightest media, but still clearly, simply use pictures. Online, Google, medical books, skeletons and heart models, and all of those things to use, because the other thing is we are visual people. So, if you can draw pictures, then that's going to make your job easier. Knowing one or two words is good, you know, a greeting, a goodbye. First thing to learn about Lairke Landridge is my mark. See you later. I mean, if a person walks in and you say hello to them in their language, they're going to be like, "Oh!" And the next time I go see the doctor, it'd be like, "I like you, because you learned a little bit of my language." I mean, like it's not like we as every patients expect you to learn the whole language. God knows. You know, because that's that notion with some health professionals, like, "Oh God, I've got to learn a whole different language." So, no, I just say a few words. That's it. It puts the clinical environment at ease. And I can tell you a story. This doctor was, he had a problem with communication with the parent. And the mum came in with the child. The child had a burnt foot. They'd stepped on hot coals. He would not let the doctor touch his foot, even observe or talk to him. He would, he was looking down. I think it was four or five years old. Anyway, the doctor somehow remembered words that I had taught him for fire, foot and water. So, he used those words and the five-year-old cracked up and told him he was wrong. But if he didn't use that, he wouldn't have built that trust and, you know, put himself at that little boy's level to say, "I'm learning too. I need your help so I can look after your foot." So that's kind of nice that idea of making the patient the teacher. And it gives the patient power, doesn't it? Yeah, I mean, it gets you something to be proud of, you know. I taught this doctor one word. When did you learn to speak English? 14. So until 14, you spoke only. You were all. You were all jumping off? Yeah, pretty much. What made you learn English at the age of 14? Well, I guess I wanted to get a job. Yeah, but, you know, I just watched a lot of movies and stuff. But I had no idea what was going on. So I would just fast forward it to action part, you know, where there's fighting scenes and stuff. I had no idea what the storyline was. But I then I realised, you know, I knew to understand what was going on here. So I learnt the English. That's great. So you will often hear people say, "You're", which is in a green, or saying, "Yes". Sometimes people like hear it when they say it, they think they're saying, "No". But they're saying, "You". And Ma is another one. So Ma is, if you give them a direction or you're telling them, "You're going to go into theatre at this time. You're going to have your operation and you'll wake up. At this time, and there'll be people there waiting for you." And they say, "Ma". That's in a green. So they are agreeing that they've received that story. And they are saying, "Yes, okay. That's clear. I'm going to, you know, I'm ready." Or, "Yes, I agree." So you, Ma, Yaka, now, Manmak, okay, or good. Your heart, "Totork". So that's with a "hardy", "Totork", "Buruć", which is "lums", "Buruć", and "dinting", "dinting", which is "kidneys". Ask your patients, whatever illness they have, or if they've got a broken knee and call, whatever it is, ask them what the Yolongu name is. They know what it is. But sometimes people don't know how to spell it, because our languages are only written like 80 years ago. You might have heard Yolongu talk about the importance of walking in both worlds. The Yolongu world and the White Filler, or Balender world, as they say. Rachi Roy Malini-Herdman, she seems to have walked in both worlds sorted. At me watch health, she's a team leader and she's been called on to act in the CEO's job. She was elected the first young female chairperson of the Board of the Dimaru Rangers. Not long ago, she moved her family to Sydney for 12 months, so she could take up a job at Qantas. She's back home now in Arnhem Land, and chances are, you've come across Rachi Roy, or maybe you know her as Malini, if you've worked in health in the top end for a while. But the thing is, you have to know if that person is actually from that community, because there was a situation where some Yolongu mother words were used with women from Green Island, and they did not like that. So there are TV patients, there are people from men in Green, so men in Green it has a different length. language altogether, bright art language, grew Ireland is a different language, normalised a different language, and you're obviously the you're all in community have different dialects, but we use similar words in our language. - More than 60% of Aboriginal people in the Northern Territory speak an Aboriginal language as their first language at home. The hospital in Darwin sounds different to any other hospital in the world. In fact, Darwin sounds different to any other city in Australia. Next time you catch a bus or go for a walk, listen to the languages people are speaking. We live in a very unique part of the world. - It's really hard to explain because I've grown up in this environment, but it's a different body language for other yule more. And their facial expressions are different from your usual scoff and roll your eyes and those sort of not Western, but they're more like, I don't know, generic body language. I don't know. But we also have that different, like you know how we have sign language, there's Auslan and there's Yuleung or sign language, same for our body language. - Yeah. - So if the person's not looking at you, then again start with ice breakers and try and have a conversation if it doesn't work, then obviously get somehow or get a interpreter. - The other old thing is to if you're a young male and you're treating a young, an Aboriginal female, try and have somebody else in the room that can, because the gender issues are really important. You know, if you're a female and you've got a male, make sure that you have somebody with you that can count a bell at some male or a female depending. - Language should be modified to sit the patient's needs. Even just talking about these other expected side effects when you take this medication, come back in one week, let us know what you're feeling, 'cause some patients will just stop taking it. Like I'd destruct, right, but we'll stop taking hypertension medications 'cause the dosage was too high and it was giving him headaches, but he was deemed as non-compliant. And then I asked him in your long, "What's, why are you doing this? "Why are you not taking the medication?" 'Cause I drive trucks and every time I take this medication it's giving me headaches. So I had to talk to the doctor, then they dropped it from 60 milligrams to 30 and boom, he's coming every weekend, every Monday to get his medication. I wanted to ask somebody about this, I've seen some providers sort of take on a bit of a dialect where they say, "That one, big mop." I don't know if that's well received. I don't know what the right way is, we're not given guidance. They'll say like that big cancer mob is gonna as opposed to saying the cancer doctors are going to. And it's not that I haven't heard Aboriginal patients sometimes speak in that way, but not everybody I've heard does. I'm not sure if when a doctor sort of speaks in that way or any healthcare provider, how that's received, I've never seen anybody overtly take offense, but it does make me uncomfortable. I would personally be like, "Just be extended English." I actually know what they're saying, so. I sometimes get offended by that when I'm the patient. That's me personally. Yeah, I'd be offended. Because unless I knew the doctor had spent lots of time in community and has lots of Aboriginal friends, and we are brilliant at body language and picking up a sense of somebody's feeling. So if the doctor feels uncomfortable and that it falls, will you be thinking, "This bloke's, Gammond, he's bullshitting. You are the professional. You're in the white coat." "Be that professional, but be empathetic in the language that you use, your body language, and your behaviour." But Blackphilis will know you're trying to hide it, and you're like, "No, just relax, man." If they're genuine in trying to communicate, and they're using the Aboriginal word to try and get across better in a genuine way, it's about being genuine. There are heaps of things you can do to improve how you communicate. So let's go over what we've learnt. Let's do the podcast paper round on How to Improve Communication. (upbeat music) Familiarize yourself with the names of the local Aboriginal languages, and ask your patient to teach you a few words in their language. Speak slowly, avoid big words, and avoid acronyms. Break down the sentences. Use pictures, Google images, use models, skeletons to explain what's going on. Because the other thing is we are visual people. Be aware of gender issues and body language. And don't assume the patient is disengaged just because they don't communicate like you. And finally, as pirouing you suggested, be genuine. Next time on Ask the Specialist. When do you think a doctor should get an interpreter? Absolutely. The moment you realise that English is not their first language, absolutely critically important. How to communicate when you're working with an Aboriginal interpreter. Thank you to Auntie Balawera Lee, pirouing you for entitled Mary, Rachi Roy, Melanie Hauden, and Stuart Huwara McGraw for sharing their knowledge and personal experiences. I'm Vicki Kerrigan. We hope you've learnt some stuff you can try at work. But we also hope you've been inspired to think about who you are and how you work. Because while it's helpful and completely fascinating to learn about Aboriginal cultures, if we're sincere about wanting to improve health outcomes for everyone, we need to critically think about our culture and how we can change. Not just as individuals, but also take a look at the places where we work and the policies we've created to suit how we think the world should operate.