Designing culturally sensitive care
Between 1995 and 2003, Dr. Michael Green was a physician and Chief of Staff at a small hospital in Moose Factory, Ontario. The issues and challenges he encountered working in the remote First Nations community cultivated an interest in research and broader health-system issues. That interest eventually led Green to Johns Hopkins University, where he earned his Masters in Health Policy and Management.
In 2004, Green landed at Queen’s, where today he’s an active physician with a 600-patient roster and an associate professor in the Departments of Family Medicine and also Community Health and Epidemiology. He’s also Director of the Queen’s Centre of Health Resources and Policy Research. As part of the latter role he’s currently involved with two major research projects that hearken back to his previous work in northern Ontario.
The first is called Educating for Equity, an international five-year initiative that includes research partners in Canada, Australia and New Zealand. The project’s Canadian arm is funded by $1.25 million from the Canadian Institutes of health Research (CIHR) and includes researchers from the University of Calgary, the Northern Ontario School of Medicine and the University of British Columbia (UBC). Their collective purpose is to learn how medical education can improve the ability of practicing doctors to care for Aboriginal patients with chronic diseases, particularly Type II diabetes.
The study isn’t about the medical aspects of care, such as which drugs to prescribe. Instead, it’s more concerned with identifying culturally sensitive approaches to care that might help Aboriginal patients feel safer in a health care setting. The issue is critical: diabetes is rampant on native reserves across Canada, and to deal effectively with the disease patients need more than just a few trips to the doctor’s office. They must participate in their own care by watching their diet, exercising, and monitoring their blood sugar, for example.
The trouble is, most physicians on reserve are non-native and come from a dramatically different cultural background than their Aboriginal patients. As a result, they may unwittingly dispense unrealistic or impractical advice – for instance, recommend a diet of fresh fruit and vegetables that is either unavailable or unaffordable in a northern community – or convey it in a manner that causes some patients to consciously or unconsciously recall previous experiences with racism or discrimination. Exacerbating the problem is that few non-native physicians remain for a long time in reserve hospitals, which makes it hard for them to build trust with their patients.
"Time to develop trust is important," says Green, who is the project’s principal investigator. "If it’s not there, Aboriginal patients may feel like it’s not safe to open up."
In the first year, the Educating for Equity researchers have reviewed the literature on effective chronic-disease treatment for Aboriginal people, and interviewed Aboriginal patients, individually and in focus groups, about their experiences with physicians. Through the Indigenous Physicians Association of Canada, they’ve also reached out to Aboriginal doctors to ask them what they think other doctors should know or be thinking about when they provide diabetes care to Aboriginal patients.
Ultimately, the goal is to develop an educational program that can be delivered to practicing physicians across Canada that will help them deal with Aboriginal patients in a more culturally appropriate manner. The next step will be to create a similar program for medical students and residents.
Green’s other research project, also funded by CIHR and in partnership with UBC, the University of Northern British Columbia, the Manitoba Centre for Health Policy and the Institute for Clinical Evaluative Sciences (ICES), is investigating the approaches used on and off First Nation reserves to deal with the 2009 H1N1 flu pandemic in Ontario, Manitoba and British Columbia. Did the virus have a greater impact on reserves than off, a scenario that was often portrayed as fact in media reports? Was the impact the same in all provinces? how did the approaches to treat the problem differ, and which approaches worked best?
"We’d like to learn how the policy environment may have influenced the actual outcomes in terms of hospitalizations related to pandemic influenza in each of the provinces," says Green. "In future pandemics, knowing the most successful approaches will help us develop consistent guidelines on how to manage and treat a new strain of influenza."
Profile by Alec Ross