Effective Communication: Aboriginal And Torres Strait Islander Patients

Introduction
Successful communication is a vital aspect of a doctor patient relationship because it helps to improve the patient's health outcomes, their adherence to treatment and therefore the delivery of health care.1 However, delivering effective health care to elderly Aboriginal and Torres patients can be especially challenging, because messages exchanged between the doctor and the patient can be interpreted differently due to cultural heterogeneity.3 Aboriginal and Torres Strait Islanders also have more holistic approach towards health compared to western culture. Therefore it is essential for doctors to address the physical, social, spiritual and emotional factors that affect the patient and their whole community.3 This essay discusses two communication skills, active listening and appropriate language usage, which doctors can use to adopt a holistic and patient centred approach for
effective health care delivery.

Active Listening
Active listening is an important communication technique that assists the doctor in eliciting the patient's agenda for an accurate diagnosis and a tailored treatment plan.2 It is defined as a skill, which requires the health professional to carefully listen to the patient and interpret their message for an appropriate response.2 Doctors should predominantly use targeted non-verbal communication skills to facilitate the process of active listening, since elderly Aboriginal and Torres Strait Islander patients are particularly sensitive to the body language of doctors.2,3 Therefore, is important to adopt a professional yet relaxed posture since a paternalistic or dominating attitude can provoke a fear of racism or disempowerment in the patients due to historical factors or past mistreatments.3Tonal changes should be applied throughout the consultation, where the doctor can begin with a polite and respectful tone and then gradually adopt a casual or serious tone depending on the patient and their circumstances.2,3 Doctors should physically position themselves in front of the patient and lean in to illustrate their interest.2 However, patients still need an appropriate allocation of personal space to prevent violation of their sense of security and trust in the doctor.1,2 Moreover, long gaps of silence should also be integrated into the conversation since Aboriginal patients use this time to contemplate the conversation or seek family input to make an informed decision.2 Hence, continual interruptions should not be made, since they can be indicative of apathy or disinterest and discourage patients from revealing their stories, containing key information, required for diagnoses. Moreover, the degree of eye contact with Aboriginal and Torres Strait Islander patients needs to be kept minimal because excessive eye contact with Aboriginal patients can be misinterpreted as discourteous or rude.1,2 Similarly, Torres Strait Islander patients can associate direct eye contact as an expression of interest, especially if the doctor is of opposing gender.2 As a result, indirect eye contact is required to be professional and respectful towards the patient's status as elders within their community. Hence, active listening requires the employment of a combination of non-verbal communication strategies that assist the patient in opening up to the doctor and thus facilitate a good doctor-patient relationship.

Usage of appropriate language
It is vital for the doctor to understand the language differences of Aboriginal and Torres Strait Islander patients since their population do not possess lingual homogeneity.3,4 Firstly, health professionals should be aware of the specific dialect used by the elderly patients in the remote community of their practice. Doctors can become social involved in community events to identify and understand the community slang as well as research about the social, cultural and spiritual aspect of the ethnic group.1,4 This allows doctors to incorporate and comprehend slang words within the consultation, for example, colloquial terms such as 'bung' to describe exhaustion, "little/big pain" to convey the degree of pain or "ngangkari" to refer to traditional healers.5

Information regarding diagnosis, further tests or available treatment options should be delivered in simple language that is free of medical jargon.4 The use of videos and graphics can be highly beneficial for the patient, especially when videos are presented in the patient's native language.4,5 This allows the patients to clearly understand their condition and therefore make informed decisions about their treatment. Health professionals can also seek aid from an Aboriginal liaison officer or an Aboriginal health care worker from the community to assist in the explanation of complex medical information relating to the diagnosis, treatment and health care advice.5 Doctors can also gain a better understand the patient's symptoms, medical and personal history as well as their responsibilities as elders from the health care worker.1,5 In this way, any misunderstandings can be mitigated within doctor-patient interactions, which can promote self-management in the patient and increase likelihood of follow up appointments to maintain continuity of care.1 Therefore, it is important to identify lingual differences of Aboriginal and Torres Strait Islander patients to deliver culturally responsive and effective care.

Conclusion
In conclusion, communication is dynamic processes that can be tailored by health professionals build a holistic and culturally appropriate relationship with elderly Aboriginal and Torres Strait Islander patients.1,2,3 The two specific communication skills discussed in this essay employ specific strategies tailored to Aboriginal and Torres Strait Islander patients, which allow health professionals to provide culturally responsive care.
While actively listening the patient, doctors need to particularly conscious of maintaining a minimal degree of direct eye contact, allowing long gaps of silence as well as applying appropriate tonal changes.2,3 Similarly, doctors can overcome language barriers by seeking help from an Aboriginal liaisons officer or an Aboriginal health care worker and the use of graphic material.4 In this way, a patient has a better understanding of their condition and therefore can develop self-management strategies.1 Therefore, doctors should adopt a patient-centred approach to collaborate their ideas with the patient agenda for effective health care
delivery.1