4. Patient centred care

The phrase "patient-centered care" is used a lot. It's not an easy thing to do. You know that to deliver patient-centered care, the patient needs to have some power. And that's also quite tricky, because as a highly trained professional, you have a lot of power, and we want you to have that power, so that you can make us better. That said, the research shows that when patients feel empowered, it results in better health outcomes. If patients feel empowered, they're more likely to stay in hospital and engage with their treatment. My name's Vicki Carrigan, and in this podcast, our specialists will share their thoughts on how to empower patients, and also why patients leave hospital even when they're still sick. 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 Warile. Bill Warile means the red tumbler, Cooke 2. I'm an elder of the Larrakean nation. My name is Brawaeingi, Puranthana Mary, and a Teewee elder. And my name is Radjoy Melanie Hirdman, and I am from Aumland. The specialists are Larrakea, Teewee, and Yulngun leaders, who have all had personal experiences in hospital in the Northern Territory of Australia. In these podcasts, doctors ask the questions, but you won't hear their voices. That's done by my mate, Richard Margleton. How can we empower people to feel like they're allowed to ask questions? Because I know that I ask, have you got any questions? And sometimes I wonder whether, in fact, there is a. I don't want to ask a stupid question. And I'm a firm believer. No questions are stupid question, because it tells me that I'm not doing my job if you haven't understood something. Keep them time to talk. You know, keep them the opportunity to say what they want to say. And often, many times, doctors will come and say, "Oh, you've got this and this and this." It doesn't give them the opportunity to talk. And that's how you do the power shift to let them know that they're in charge, Eric. That's right. You see, a lot of these people are controlled freaks. So they've got to change their way of thinking. Yeah. So even just entering the healthcare environment, when a health professional is talking to a real person, they automatically feel inferior. Should I like your comment where you really let them know that this is your body and that you are the boss? Yeah. For that, I will support your decision. You've got to reassure them that if they ask questions, that's okay. How do we make patients feel empowered in the clinical scenario? Do we give up our power? Like you try with body language, but how do we do that? I guess my verbal language probably isn't that good in doing that. I'm just uncertain with it sometimes if I've got my little badge and I'm in my scrubs, whether that whole symbolism thing gets in the way of that message that I'm trying to convey. If I've got my little badge and I'm in my scrubs, yeah, that would be off-putting. I know one doctor who seems to have this great rapport because he actually wears a nadok shirt or a football currency with Aboriginal print on it. He always wears like, you know, Indigenous print shirt when he's actually consoling, not a suit. That's actually smart. And then you think, is he Aboriginal? Is he not? The Aboriginal patient is going to be like, oh wow, this guy is quite relaxed. He's not all medicaled out with a green gown on and stuff. But not only that, he is comfortable enough to walk around in public with Aboriginal artwork on his body. Yeah. Now, if you're a racist or a bigot, you will not put on an Aboriginal print shirt. And if you're a female doctor, you know the big trend at the moment to wear the waven earrings. Few more than waven earrings, you'd be like, oh, yeah. It just opens up this cheek. I'm Vicki, here with my co-host Stuart. Stuart's an Aboriginal health practitioner, so he works with patients all the time. We're talking about giving patients power, which is important so they can actually engage with their care. Yep, definitely. Just make some think again, you know, that they have lost all their rights or authority in the consult. And this idea, it prompted T.E. Elder Peter Waiing, who don't have to marry to share with us this concept that he came up with. You know, I've made up this thing myself. I've called up the five people's wealth. AEI, are you all right? A stands for Ericant, E for Ego, I for Ignorance. And if you've got those one, two, three, you've got the O, it's for open opportunity and then you, it's for understanding. So if you've got the first three, you can have this, you can change, by having these last two hours new. In every organization, CEOs, managers, and top position, I've seen those displayed, Ericant, Ego and Ignorance. It's very hard for those people that have been trained to come down to be humble, but it can be done. If you are going to work with indigenous people, patients, get off from the high halls and come down, talk to normal people as a normal person. So, and it's an important thing. I felt like I was sitting at the feet of Buddha, or whoever you think is wise. I'm talking about the sacred knowledge. Why do people leave without telling the nurse or doctor, or why do people get up and go and sometimes come back and sometimes not? What are they thinking in that moment? I know there's different priorities, but why don't patients tell us more about why they're leaving? Well, there could be heaps of reasons. Do they realize that they have to tell somebody that they're walking out of this building? A real life example, and all men got a call to say that his grandson had been killed, and he had to go and do ceremony, and he got up and walked out because he thought if he told anyone, he would be prevented, and it was his role to do ceremony. So, he had to get up and leave. Often there are family and cultural obligations around why they must go, fully understanding that they need to come back. Obviously, there are many reasons. The communication may not be good between the patient and the doctor, where the patient sometimes being kept in our cells, accommodation. There could be a problem there. It could be also with patients and their own family. Could be cultural. There are cultural reasons as well. Yeah, all sorts of cultural reasons, including avoidance. To conflict. To conflict with that other family group. That's why they run away. They won't tell anybody because it's not their business to know. We don't know what's going on, and we sort of hear people who've taken their own leave, but we don't know what the pressures were on that person and why they decided that they no longer needed to be in this building. Maybe we didn't listen, or maybe they were competing things. One is that isolation. They feel isolated. How would you like to be taken from your house, going hunting on your country, on your time, to sitting in a room with a TV fixed on one channel, not being able to speak in your language, choices, and then you can't go to centraling. Then they deem you as non-compliant, and then you're cut off from centraling. You have no income, and you can't call home to ask family for help. You're not allowed to take an escort with you because you're old enough to look after yourself, even though English is your 50th language. Sometimes they get up and go because it's cold, and they don't like the environment, and they go outside and time just overtakes them. I've had many an argument where the rule was that if you left your bed for so many hours, you were then deemed an absconder, and your bed was given away. And I think it's discriminatory. nation and that's wrong because people may want to go downstairs and sit and catch up with family and talk. But just get sick of just speaking in English and they want to go downstairs and yarn in language, you know. Some of these people who come to receive treatment and care in our hospital systems are sometimes the pillar of families. So they once they go, all hell breaks loose. The kids aren't being fed. They're not getting to school. The washing machines broke down. The power's gone out. Or the housing office is coming because the primary tenant has gone to hospital for six months and everyone's got to move out. And so sometimes they're the reasons why they want to go home. Sadly, one of the reasons Aboriginal patients leave hospital when they're still sick is to attend funerals. You told us that you'd like to know more about sorry business protocols because you'd like to understand cultural obligations a bit more so that maybe you can help to reduce self-discharge rates. I've certainly come across some people who are very agitated when they're being kept in hospital when there was some sorry business going on. The wards busy thinking they're trying to be non-compliant. We're at cross purposes that I don't think we have much of a handle on, law and culture. We don't understand that. It's wrapped up in their well-being and their health model and that they wouldn't necessarily tell us about it. But it may influence their health and their what we call compliance. I really hate that word compliance, you know. Oh, another tough one. So, I know they're big questions. Yeah, but that's good. Thank you for asking. And yes, funerals are a big part of our life. I know that some Western cultures and Western society, you don't go to funerals until your 20, 25 in your adulthood, whereas our life, we have a sense of, we have the need to go and pay our respects, whether it's through singing the songlines for our men or dancing for our women and being there and making sure because there's spiritual people as well in our culture. And by doing those activities or those dances or ceremonies, we help guide that person back to their country, with their spirit back to their country. So, that's why people often have that urge to go back. You've got to be in situ with the family, the extended family and the deceased person on country. You have to feel it on your feet like you're on the country and our land, our country is to church. Yeah. Real life story. I got a phone call in the middle of the night. Absolute distress by the nurse. Mr. Sonso from this remote community, elderly man, he'd had a brain tumor and he'd had a serious operation. And so he was in recovery, but it was pretty. He was getting out of bed, struggling to put his clothes on. He was leaving. In the light, no, you can't, you can't because your wound is, you know, you've got to have a little chit-n-e. He's going, I have to go. My grandson's been killed in an accident. We've got sorry business tomorrow. I have to conduct the ceremony. He was the ceremonial master. And she said, you know, but if he goes, he could die. And so what we negotiated was one of the male nurses would go with him on the plane back to country to be there just to keep an eye on him. He conducted the whole ritual and ceremony safely, got back on the plane and came back to the hospital and then finished his treatment. They make sure that somebody takes care of them until they get home. Most communities have a clinic. No, and understand most of them have telehealth. I don't see an issue. Other than people might complain about the expense, well, you know what, bad luck. What we've just talked about relates to that. Yeah, yeah. It's all about culture. Spirituality is part of our health as well. It's very deeply embedded in people. So if we miss funeral or something, that's not good to have. Spirituality. It's affecting the health of the spirituality. And a lot of non-indigenous people can't comprehend that. They will never comprehend that. Obligations, that's a big thing. Cultural for every indigenous people. They have obligations. Just do the paper round on empowering your patient. Give your patient time to talk about what's important to them and remember what Stuart said. When a health professional is talking to a real person, they automatically feel inferior. Consider wearing indigenous prints or indigenous design jewelry. Show you an ally. Remember pure weighing is five people's vows. A for arrogant, E for ego, I for ignorance, and then remember the two most important. O is for opportunity and openness and U is for understanding. Understand that your patient has family and cultural obligations and that ceremonies and funerals are incredibly important to the health and well-being of your patient. And if a patient needs to go home for sorry business, see if you can work with the local health clinic to make sure your patient's okay. Because you obviously don't want your patient readmitting through the emergency department. Next time on Ask the Specialist. The nurses came to me and brought the consent form for me to sign. But those boxes had already been ticked. So I got upset about it. We'll talk about consent and pure weighing is shares what happened to him at the hospital. Thank you to Auntie Balawara Lee, pure weighing, E for entitled Mary, Rachi Roy, Melanie Hordman, and Stuart Uart of 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.