Modules

Indigenous health

Introduction

The Communication and Cultural Competence program is based on case studies that give examples of everyday medical practice in Canada. These modules do not focus on diagnosis and treatment. Instead, they focus on communication between health professionals and patients. Please note that the modules are not intended to show the only way to deal with a situation. Instead, they are intended to provide guidance on how to approach and reflect on these different scenarios.
  • The topic of this case is that of health promotion, focusing on the broad determinants of health that are required for a full expression of an individual’s life. The World Health Organization (WHO) defines health as: “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” In the Jakarta Declaration on Health Promotion, the WHO further stated that health promotion is “the process of enabling people to increase control over and to improve their health.” (WHO, 1997) The individual physician’s role in this process is the focus of the case.

    The story explores some of the health issues of Canada’s Aboriginal peoples. Understanding these issues requires some knowledge of the history of the interaction between indigenous peoples and the Europeans who colonized this continent. Therefore, we will start with an outline of the 500 years of colonial occupation and its impact on the health of Aboriginal populations. As in the other cases, communication between physician and patient is an important theme and there are examples of conversations between physicians and Aboriginal patients.

    The second theme is the effect of socio-economic and socio-political determinants of health on an individual patient and his community. Type 2 diabetes is the biomedical process chosen to illustrate these themes since it has become an epidemic in indigenous and developing populations throughout the world.

    The third theme is that of patient counselling, specifically behaviour modification of both individuals and populations, and the responsibilities of physicians in promoting healthy lifestyles.

    We have included some brief stories and anecdotes told by Aboriginal people themselves. The use of narrative — stories in physician-patient communication — is an often neglected technique. As physicians, we should hear as much of any patient’s life story as we can. This is important when working with any patient, including Aboriginal patients, since beliefs and values are often communicated through the use of stories.

    The exercises in this case are designed to explore the interactions of population health, community health and the individual.

MCC role objectives

Communicator

  • When appropriate, facilitate collaboration among families and patients, while maintaining patient wishes as the priority, ensuring confidentiality, and respecting patient autonomy (1.5)
  • Identify the personal and cultural context of the patient, and the manner in which it may influence the patient’s choices (3.2)
  • Provide information using clear language appropriate to the patient’s understanding, checking for understanding, and clarifying if necessary (3.3)
  • Establish a common understanding and negotiate agreement concerning diagnosis, management, and follow-up (4.1)

 

Health advocate

  • Identify the important determinants of health, the risk factors for illness, the interaction between the population and their physical, biological and social environments, and personal attributes, including:
    • employment
    • income
    • social status
    • culture
    • social support systems
    • education
    • housing
    • diet and exercise
    • lifestyle issues
    • gender
    • genetics
      (1.0)
  • Assess and respond to the specific determinants of health relevant to the individual, the community, and/or the population (1.1)
  • Identify public policies and trends that affect health locally, nationally, and globally, and barriers to access for populations including persons with disabilities, the underserved, and the marginalized (2.0)

 

Professional

  • Practice the profession with due regard for basic human rights (the right to privacy, freedom from discrimination, autonomy) (3.6)
  • Be aware of the potential for unconscious bias influencing judgment (6.2.1)

 

Scholar

  • Use self-awareness in assessing competence, including reflection on personal practice (1.2)
  • Accept complexity, uncertainty, and ambiguity as part of medical practice (2.5)

Sentinel habits

  • Incorporates the patient’s experience and context into problem identification and management
  • Seeks out and responds appropriately to feedback

Entrustable professional activities

  • Assess, diagnose and manage patients with chronic diseases across multiple care settings (3)
  • Recognize and implement appropriate disease-prevention and health-promotion (4)
  • Lead and work within interprofessional health-care teams (8)
  • Collaborate with patients, families and members of the interdisciplinary team (9)

 

Critical competencies

  • Function effectively as an MRP and Internal Medicine consultant, integrating all of the CanMEDS roles to provide optimal, ethical, safe and patient-centered medical care (1)
  • Establishes and maintains proficiency in clinical knowledge, skills and attitudes appropriate to Internal Medicine (2)
  • Perform a complete and appropriate assessment of a patient, including a complete history, organized hypothesis-driven physical examination, and the ability to synthesize information to form an appropriate treatment plan and follow up including: (3)
    • a. Recognize, effectively assess unstable patients and initiate appropriate resuscitation
    • b. Be able to assess patients with one or more chronic conditions, develop a comprehensive plan of investigation and management
  • Uses preventive and therapeutic interventions proficiently (4)
  • Develops rapport, trust and ethical therapeutic relationships with patients and families (8)
  • Develops a common understanding on issues, problems and plans with patients, families and other professionals to develop a shared plan of care (12)
  • Facilitates the learning of patients, families and other health-care providers (18)

Objectives

By the end of this module participants should be able to:

  • Understand the historical reasons for the disagreements between Indigenous people and the Canadian government
  • Have a strategy for communicating with Indigenous patients
  • Know the theories proposed for the increased incidence of diabetes in Indigenous people throughout the world
  • Understand the approaches to behaviour modification
  • Understand the impact of socio-economic and cultural determinants of health on the individual patient

Self-assessment quiz

  1. How many Canadian First Nations are there?
  2. What interviewing strategies are helpful in communicating with Indigenous patients?
  3. What level of government is responsible for the health care of First Nations peoples?
  4. What percentage of First Nations people live in urban centres?
  5. What is the prevalence of type 2 diabetes in First Nations populations?
  6. Why are indigenous peoples throughout the world at increased risk of developing
    type 2 diabetes?
  7. What is the “thrifty gene” hypothesis?
  8. Are you familiar with and do you know where you can find the current guidelines for defining:
    • glucose impairment
    • glucose intolerance
  9. What are the major barriers to adherence to a “healthy lifestyle”?

Please read the following section “A short history of Indigineous health 1600-2015” before you begin.


 

Next: A short history of Indigenous health 1600-2015

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