What was your experience with studying medicine like?
“I look back on those years really fondly. I did it through UNSW, so it was a six year degree, and I came straight out of high school. My first couple of years were in Sydney, which was a big shock coming from the little town of Wauchope.”
“The way UNSW works is you get to do your rural placement for your final years when you really spend most of the time in hospital. So I got to do my final years of training back up in Port Macquarie (half an hour from Wauchope) which I much preferred to Sydney.”
What helped you through medical school?
“Through uni, I was pretty lucky. I had a scholarship (Balnaves scholarship) which helped to pay for accommodation and other stuff you usually pay for when you’re at uni. The rural placement was really good, it was quite small – there were only 12 people at the hospital in my cohort – but that’s taken off now.
“I had the opportunity to do a study tutorial mentoring program, which is available for the Aboriginal and Torres Strait Islander medical students, called ITAS tutoring. I had a tutor through all my six years of uni – he was a couple of years ahead of me, so he’d already been through it and had seen how it’s done. He was pretty switched on and clever and we used to catch up for two hours each week and do exam prep. I lived at college for the first couple of years, which are the heavy science-y years, where you really get to grips on all of your science.”
“A couple of other Aboriginal Torres Strait Islander medical students living at college got together, and we studied together. We had the whiteboard in one of the study rooms, and we just nutted it all out before the exams. There were exams that my friends and I failed along the way and I’m not sure we would’ve gotten through some of those without that sort of stuff.”
Tell us about how you came into a leadership position supporting other Aboriginal and Torres Strait Islander doctors?
“I threw my hand up and said ‘Yep, I’m really interested’. I’ve been so happy with all the help that I’ve gotten, and I’d love to kind of do the same thing for people coming through.”
“The cool thing about IGPRN is that it’s a team: Rhys, the program manager, Olivia O’Donoghue, Darwin based medical educator for IGPRN, and myself. The three of us figure things out together and try and do our best. The first 12 months of my time as chair were hard because it was entirely affected by the lockdowns and pandemic, and some of the opportunities that I had as a registrar weren’t there for the 2020/21 cohort. So I’m really hoping some of the work that I’ll be able to do now will be more similar to the way that I envisioned it when I was a registrar.”
What kind of role does community and family play in improving the health of Indigenous patients?
“As a doctor looking after an individual patient, you have to think – what are the barriers that I have to take into account for this person? What are some of the things that are going to really be important to them? In your consultation, you might be thinking the most important thing is for them to get on top of their blood pressure, when actually the most important thing to that patient might be their sister who’s just been diagnosed with breast cancer and that’s the biggest worry on their mind.”
“You have to make things meet in the middle – there’s the role of the doctor, the agenda of the doctor and the agenda of the patient. It’s really important for doctors and healthcare workers to be in tune with what’s most important to the patient. And you’ve got to bring your own agenda into it, because there’s going to be certain things that you want to make sure you’re doing. Certain targets, screening, blood pressure and other things that you’ve got to get right.”
“Addressing what they’re telling you is important to them. Building rapport and trust means they’re so much more likely to be able to share that with you. That said, you don’t always get all that information out in one appointment; sometimes it takes a bit of time even to establish trust.”
What kind of barriers are there for Aboriginal and Torres Strait Islander patients in accessing medical care?
“Probably one of the bigger barriers at its core is, for lack of a better term, mistrust in some of the paternalistic, prescriptive languages that we occasionally use in healthcare or in health policy.
“It’s just about finding that balance between giving the information and making sure that you do so in a way that is clearly understood, making sure that whatever medical advice you’re recommending is genuinely understood.”
“It’s important to consider the list of barriers, but it’s probably almost more important to figure out how to extract that from the person. The communication styles that you’re going to use to try to pull that out, the way you go about helping them, how you overcome that is as important as being aware of what limitations there are.”
How should we incorporate what we know about the social determinants of health into practising medicine for Indigenous patients?
“In terms of the social determinants of health, if they’ve got multiple kids that they’re looking after, their partner works away, and they’re a fly-in fly-out worker, that’s going to change the way that you tailor care. If they’re having trouble affording five different prescriptions that you’ve got them on, that’s going to tailor your care.”
“As medical students, junior doctors and Fellows, knowing some of our statistics around the disparity for Aboriginal and Torres Strait Islander Australians versus non-indigenous Australians is important, but it’s about what you do next.”
“If you can be that person that is a trusted source of information, that could be a really powerful thing, especially for those moments where you get told something that wouldn’t be shared with anyone else, because you’re the one who has got to look after that person.”
Aboriginal Medical Services often focus on more holistic patient care, could you explain how that looks from your experience?
“I’ve experienced working in Aboriginal Medical Services, and I think a lot of the time the patients are really fortunate to have that as an accessible service. You’re often greeted by an Aboriginal and Torres Strait Islander receptionist, usually you’ve got Aboriginal and Torres Strait Islander health workers, sometimes Aboriginal and Torres Strait Islander nurses, and then sometimes you’ve got Aboriginal and Torres Strait Islander GPs as well.”
“Some of the patients used to say ‘to be looked after by mob was a really cool thing’, and that was why they chose to come. They felt really comfortable, they felt happy, and they felt like they had most services that they needed to have. So navigating the system was not difficult, because you didn’t have to go see the GP and then go over to another place for the pathology test and then go over to another place.”
“The other really important thing, which is often unsaid, is the fact that these places bulk bill. Money doesn’t change hands in an Aboriginal Community Controlled Health Service or Aboriginal Medical Service, which is massive because it means that there is no denied access.”
“They have a really strong ability to accommodate patients and provide a multi-disciplinary kind of care. Awabakal, as a Community Controlled Health Service, even incorporated daycare and NDIS packages with home care and lawn mowing – it is really comprehensive.”
What do you think medical students should know about being culturally aware and culturally sensitive?
“As a med student, you’re going to be all over Australia. If you get to know the country that you’re living in and working on, that’s really cool. It can be difficult to figure out and sometimes you might not know where to start, but it’s quite beneficial to know if there are any specific cultural points that are worth knowing for that country that is appropriate to looking after patients in those settings.
“A good place to start is just to try to talk to any of the local elders in the country and then ask around at the hospital – most hospitals have an Aboriginal Liaison Officer. Often they’ll be doing their own ward round in the hospital for the Aboriginal and Torres Strait Islander patients because their role is hugely multi-faceted, but it sometimes overlaps with your social work or other allied health roles. So that’s a realistic go-to for a medical student.”
“Once you’ve kind of got that awareness, it all flows from there – all it takes is the knowledge to be able to do it. It’s just finding a way to target those feelings and channeling them in a way that is really helpful and culturally appropriate.”
These articles, from our GPFirst magazine, are aimed at inspiring the next generation of GPs by sharing real stories of working in practice.