You may hear the terms 'cultural awareness', 'cultural safety', 'cultural respect' and 'cultural competence' used in Australia, especially in the healthcare system. The following definitions will help you to understand what they mean. Practical knowledge of these issues will aid safe, effective, and appropriate clinical communication:
- Cultural awareness is sensitivity to the similarities and differences that exist between two different cultures and the use of this sensitivity in effective communication with members of another cultural group.
- Cultural safety involves actions that recognise, respect and nurture the unique cultural identity of a person and safely meet their needs, expectations and rights. It means working from the cultural perspective of the other person, not from your own perspective.
- Cultural respect can be defined as the recognition, protection and continued advancement of the inherent rights, cultures and traditions of a particular culture.
- Cultural competence means becoming aware of the cultural differences that exist, appreciating and having an understanding of those differences and accepting them. It also means being prepared to guard against accepting your own behaviours, beliefs and actions as the norm.
- Personal cultural competence is the actions we personally take to expand our knowledge of other cultures and how we use that to shape service to those people. This is especially important in effective doctor-patient relationships.
It is difficult to explain all of the complexities of the Australian culture and the expectations of the 'average' Australian patient. There are however some recognised characteristics that may help you to understand why your patient behaves in the way that they do and what they may expect of you.
How to show politeness
Maintaining communication with others in your healthcare team in Australia is vital. Team members will be your greatest teachers. 'Please' and 'thank you' are important words in our culture and will help you maintain effective relationships with all of your team.
If you do not use appropriate language, your simple questions and requests may unintentionally have a negative effect on the person you are speaking to. The following are some suggested questions:
Would you mind if... ('I came on grand rounds tomorrow?')
Would it be possible… ('for you to take this patient down to X-Ray as soon as you can manage it?')
May I... ('examine you?')
Do you mind... ('explaining the procedure for …?)
Could you please... (unbutton the top few buttons of your shirt for me?)
Admitting you don't know and asking for clarification
In Australia it is acceptable to tell a patient or a colleague that you do not know or understand something.
You don’t need to 'save face' in the Australian culture and pretend that you do know. Patients and colleagues alike value honesty, so if you don't know; say 'I am sorry but I don't know that but I will find out and get back to you'. Similarly, you may admit to your consultant that you haven't done a task if you have been too busy. Importantly, it also means that you are less likely to make mistakes and will cause less harm to your patients.
Ask for clarification of what you do not understand. For example, if your patient says 'Doc I am feeling a bit wobbly on my pins today', you will need to clarify what they mean. Rephrasing or clarifying parts of the consultation will help your communication.
If you do make a mistake, admit your error by saying: 'I am sorry' then find out where you went wrong and learn from the experience. You will then have the opportunity to learn something new and move on. This will enable you to make the most of all your learning opportunities and ensure a safe and effective healthcare environment.
Displaying an appropriate attitude
A doctor's authority with regard to knowing what is best for their patients is generally respected. In return, it is expected that patients will also be given respect and not treated in an authoritarian manner by doctors and healthcare workers.
If you would like to examine a patient, ask permission first, explain what you are doing, why you are doing it and then thank them afterwards. Offer them the same respect that you would expect in their position.
In the workplace you will work in multidisciplinary teams where every person has equal value and respect. Every team member has an important role to play. In hospitals everyone from the switchboard operator and ward assistant to the most senior administrator plays an important part. In some medical management teams the patient and patient's family are also members of the team.
In Australian culture, it is generally expected that each team member will carry out their own roles and responsibilities to 'pull their own weight' and not leave tasks to other team members.
Watch the response of your patient, their families and your colleagues when you are speaking to check misunderstandings. People often express non-comprehension by frowning, for example. You will learn a lot from how people respond to you about how to say something or if you have said something that is inappropriate or not correct.
Slowing down your rate of speaking
If you usually speak fast and you have an accent some people will not understand you, especially on the phone or in a noisy ward. If you find that people misunderstand or do not respond to what you are saying, try to slow down.
Australians often use slang, or colloquialisms, when they speak to each other.
This may seem complicated, but don't worry. Australians are generally a friendly lot and if you don't understand, you can ask people to explain what they mean. Slang words are often just shortened versions of longer words, with 'o' or 'ie' added at the end, for example barbeque becomes 'barbie', afternoon becomes 'arvo', OK becomes 'Okie Dokie'.
Teenagers, as in all countries, have their own ever-changing slang words which are often influenced by popular international culture.
Swearing is also quite common – sometimes it is meant to be offensive and sometimes it isn't. How something is said can change the meaning of what is said.
The DoctorConnect Online Education Program is an online orientation for IMGs and other overseas trained health professionals to the culture and language of Australian society. It introduces some of the knowledge, skills and attitudes required by health professionals to familiarise themselves with a range of language, cultural and medical issues relevant to the delivery of healthcare in Australia.