A Different Culture

Dear all, how's it going?

Currently doing cardiopulmonary clinics in the medical discipline and this first week has been quite calm. Apparently, it is the "quiet" period, so no dramas at the moment(not that I want any). But there is still quite an array of cases, mainly in the respiratory area and patients with tonnes of co-morbidities.

As this is afterall the first week, my supervisor decided that mastery of a proper subjective and objective examination would be of utmost importance and then work up from there. So, she gave me a new patient, with a rather ordinary name and after reading his case notes(suspected bronchogenic right lung carcinoma with lymphadenopathy admitted for a lung biopsy), we went off to see him. So, we both stepped into the room and looked around expecting a Caucasian patient(the name was misleading), and lo and behold, we saw an Aboriginal sitting on the bed.

So, I just went about formally doing the subjective assessment. I mean, what can be different about this subjective assessment to others right? Well. It was different. Half of the time I was trying to interpret what he was saying(very strong accent), and the questions posed wasn't being answered the way I wanted it to be. Had to keep using different terms, analogies and very simple examples to ask and explain. Think the hardest was asking him chronological questions ie. "Do you know how long ago you started coughing up blood?" and he would name a whole list of places(Derby, Kimberlies, Karratha etc.) he went and where he got it. Not when he got it. He looked absolutely uninterested in answering the questions. He didn't know his doctor's name, what medication he took and his medical history. But he did get a little choked up on talking about his current condition as the doctors suspected that he has right lung cancer.

Anyway, I managed to pry enough information out with the help of my supervisor. 40 minutes!

After objective Ax, we got back into the doctors' room and my supervisor told me to sit down and explained to me that it takes a different approach to do a subjective on Aboriginals.

So here's what she told me:

1) Sit down or bring yourself down to their eye level while talking to them. I was standing up when talking to him. They feel intimidated by that.

2) If they don't make or avoid eye contact with you, it's ok. It just means they respect you as a healthcare professional, or they are just really shy people. So don't think they are uninterested in your questions.

3) If they can't give you a timeline in terms of exact dates, its because they don't know the time we know. My patient doesn't wear a watch and on asking, he says he doesn't need to. Their time is determined by how long they stay in a place. Ie. When I was in Derby I started coughing up blood and about 3 months I went to the Kimberlies I got short-winded etc. So best is you just let them tell their story and ask less questions.

4) Use extremely simple terms with them and give examples they can relate to. If its a body part, just point to it(unless its really obscene.).

5) Don't be suprised if their family members are scattered everywhere in the small townships. They live a nomadic lifestyle. Most live on their own in very small communities with few services.

6) Smile.

Really an experience for me. Hope this helps and if you have anything to share. Please do.
Oh yes, the towns he names were all North. They like the weather hot.