PCP 2 Reflection 1:

Title:
How to manage cultural differences around the death or family members whilst eliciting a
thorough history on initial consultation.
Reflective Focus:
A Chiropractors first role with a new presenting patient is to elicit a thorough and in-depth
history, which can guide the conversation into further pathologies that the patient may have
forgotten to write down on their intake form. This can in turn guide the Chiropractor towards
a short list of differentials. Once the short list of differentials has been established then
testing clusters can be performed to either rule in or rule out pathologies, this will finally end
with a working diagnosis which can either have further external evidence gathered (such as
radiological imaging or blood test performed), referral out to the most appropriate clinician if
outside of the scope of practice for a Chiropractor, and finally treatment from the
Chiropractor if appropriate and the first two options have been checked off.
How do you ask for family history when the patient who presents to you cannot speak about
people who have passed on?
Familial history is important in such conditions as cancer, heart failure, and diabetes type 1
(Souza, n.d.).
The culturally sensitive Chiropractor will have a broad knowledge of cultural differences and
how best to work with the patient presenting to them to overcome a communication barrier
which may affect their health. And if they do not have that knowledge, are open to gaining it
regardless of personal opinions or believes towards the culture which is different to their
own. This shows a high degree of professionalism, particularly in a diverse country like
Australia.
Deeper underlying Issue:
Within Australia our Indigenous peoples are Aboriginals and Torres Straight Islanders.
Within these cultures when someone passes-on they are said to be dreaming. If the persons
name who has passed-on is said out loud, these cultures believe that it may interrupt or
recall the person from their dream-state (2020).
This apprehension of saying the name of someone who has passed-on into the dreaming
could impact how the Chiropractor learns about the family history of disease.
Information or Skillset:
There is plenty of information for health professionals to use as research centres if they are
unsure how to approach cultural communication barriers with Aboriginal or Torres Straight
Island peoples. It must also be recognised that the Aboriginal people are made up of many
tribes spread out across Australia, and while they all have the same core beliefs there will
also be slight differences between a tribe in Queensland to a tribe in Western Australia such
as dialects, ceremonies, outlook on health care in general and potentially resistance to
Caucasian clinicians. (Vindigni et al., 2017) concludes that Chiropractors practising within
Australia need to undergo cultural proficiency training to engage respectfully with Indigenous
patients.
Team Approach:
Going into clinical observations next year, I am interested to see how many Indigenous
Australians are treated during my time with various practices and how the graduated
Chiropractors handle the situations. I would like to ask them if they have had any further
training through continuing education seminars etc. or if they have just learned through
experience in the industry, overcoming the cultural barriers.
Asking some of our lecturers from Northern Queensland (Mackay) would also be a good
idea, as the population of Indigenous peoples are greater in numbers.
Plan of Action to address Reflective Focus:
The plan of action during an initial consultation with an Indigenous Australian will be to refer
to the patients deceased family members in a round about way e.g. “are you aware of any
health issues within the heart or cardiovascular structures that the person who gave birth to
you or who gave birth to them may have experienced?” this question will be relative to
asking about the Indigenous persons mother and grandmother.
Application of Plan and the Outcomes:
The application will be from research, gaining experience in these situations personally and
through mentorship in this area to be culturally sensitive. The correct application of this
strategy will benefit any patients who present to myself for Chiropractic care, diagnosis
begins with the history.
References:
Nslhd.health.nsw.gov.au. (2020). Retrieved 30 August 2020, from
https://www.nslhd.health.nsw.gov.au/Services/Directory/Documents/Death%20and%20Dyin
g%20in%20Aboriginal%20and%20Torres%20Strait%20Islander%20Culture_Sorry%20Busin
ess.pdf.
Souza, T. Differential diagnosis and management for the chiropractor (5th ed.).
Vindigni, D., Polus, B., Cleary, S., & Doyle, A. (2017). Chiropractors` experience and
readiness to work in Indigenous Australian Communities: a preliminary cross-sectional
survey to explore preparedness, perceived barriers and facilitators for chiropractors
practising cross-culturally. Chiropractic & Manual Therapies, 25(1).
https://doi.org/10.1186/s12998-017-0144-0