Become better at working with Aboriginal and Torres Strait Islander patients GPs can make a big difference to health outcomes for Indigenous Australians. How can you help both individual patients who walk through your door, and the wider Indigenous community? There are many ways to build trust with and help improve the health of Aboriginal and Torres Strait Islander people based on the 3Rs: ‘relationships’, ‘rapport’ and ‘respect’. We have adapted our advice from the RACGP Introduction to Aboriginal and Torres Strait Islander health protocols and perspectives guide. We encourage you to read this guide to help grasp many of the issues involved in Indigenous healthcare. Aboriginal and Torres Strait Islander people are diverse, so be cautious when applying these tips in broad brush strokes. However this is a good starting point to get you thinking about treating Indigenous patients. 1. Show respect for Indigenous culture Aboriginal and Torres Strait Islander people usually have a great amount of pride and respect for their culture. This includes their languages, lifestyles and customary laws. Community often plays a big role in Indigenous culture. This encompasses blood relatives, extended family members, kinship ties and hierarchies. As a doctor, it helps to understand your patient’s values and beliefs. Take the time to research, listen and absorb Indigenous culture and the relationships within it. 2. Involve the Indigenous community Engaging Indigenous people in their treatment and really listening to their needs is paramount to success. Take the time to talk with Indigenous stakeholders, such as community groups. Be an active listener, genuinely seeking guidance on how to best reach and treat Indigenous patients. The RACGP guide outlines the process for consulting and communicating with Indigenous communities. It’s also important to obtain consent if you are going to use information gleaned from your discussions, particularly if it relates to Indigenous history, community and families. The people you consult with should have a say in how this information is represented. This process will help you build trust with your Indigenous patients. 3. Understand the wider impact of treating one patient Indigenous health is unique and at times, complicated. There are many factors to consider from a cultural and historical perspective. This process takes time. But according to the RACGP guide, if you keep a desire to learn and listen at the very core of your care, any mistakes you make along the way will likely be tolerated, accepted and even forgiven. The RACGP advises doctors to consider the social, emotional, and environmental impact of their practice. This means understanding issues and values important to or impacting many Indigenous Australians, such as connection to the land, spirituality and ancestry; inter-generational traumas resulting from removal from family, substance misuse and family breakdown; and disadvantage resulting from racism and discrimination. These issues need to be considered when working to improve health outcomes. Also recognise the role an individual plays within a community. No one is separate; we are all connected in some way. If the community suffers, the individual suffers and vice versa. Understanding this cultural view is very helpful when dealing with individuals. 4. Acknowledge positions in the community It is a mark of respect to properly acknowledge a person’s position in the world when talking to, or about, them. Aboriginal and Torres Strait Islander people prefer you acknowledge both their occupation and position in their community. For example, someone who speaks on behalf of a group may be referred to as a community spokesperson. Aboriginal and Torres Strait Islander peoples should also be called by their title (perhaps ask if they should be called Elder for instance to reflect their position in society). The RACGP guide also states you should be wary of the correct spellings of titles and language groups as a mark of respect. If in doubt, always seek advice from the appropriate member or members of the local community. 5. Learn about customs related to dying and death Death is a very sensitive issue in the Indigenous community. If you’re visiting a community to provide healthcare, it’s best to check how they do things before you go. In general, the RACGP suggests you: In remote settings, avoid naming deceased people Understand that this practice is drawn from a traditional context If appropriate, find out the time periods applicable for avoidance In a traditional context, this applies to the use of names and images also Find out what kind of ‘sorry business’ the community members observe. ‘Sorry business’ refers to the customs and rituals traditionally performed when someone dies. For a GP, this means it can be particularly tricky speaking to family members after a patient dies. A further complication can occur when the whole community shuts itself away, especially if an important member passes on. In all of these cases, it’s vital you speak to the appropriate community members and/or the local Aboriginal council or health service to find out about their particular death customs or protocols. Note: not all Indigenous peoples practice ‘sorry business’ customs, just those in more traditional contexts. 6. Be aware of ‘avoidance’ behaviour Indigenous people may avoid certain topics or people based on their cultural beliefs. The most common one is the segregation of issues into ‘women’s business’ and ‘men’s business’. Often this will apply to sensitive medical topics such as reproductive health. If you find a person is not willing to talk to you or simply ignores you, this could be the reason. There are often strong social hierarchies in Indigenous culture. You need to consider this in your consultations. If you aren’t getting anywhere with a line of questioning, step back and consider who you are speaking to and their place in the community. Sometimes local people will clue you in, sometimes not. Being aware of these protocols is the first step in understanding and then administering appropriate health treatment. Building trust is key too. Once you have that, the patient feels comfortable to communicate these types of cultural practices that impact at a local level. 7. Keep learning This article has only skimmed the surface of the principles and protocols involved in Indigenous health. There are numerous further guidelines to consider. For instance, the language you use when treating patients and the language they use amongst themselves. Understanding the difference between terms such as ‘mob’ and ‘clan’ is vital to gaining trust and acceptance. The RACGP guide contains a comprehensive section on verbal and non-verbal communication plus a great breakdown of Indigenous history.