Power and Privilege

As noted, a culturally safe approach acknowledges the power dynamics at play in the HCP-patient relationship. In a Western approach to health care, HCPs are regarded as sole decision makers and recognized as the authority figures on what is best for the patient regarding health treatment (Tong, 2019).

For some patients, the tone of voice, physical demeanour and interaction of the health care practitioner can produce traumatic memories from experiences in residential school. Indigenous people may become resistant or apprehensive towards their health care practitioner if the interaction triggers past experiences (Wilkinson, 2021)

In one study, they found that Indigenous women living off reserve often experience having unmet needs from their HCP. In comparison with non-Indigenous women, there were a greater number of First Nation women who reported their unique health needs were not met by their health care practitioner. Similarly, they found Métis women also experienced unmet needs when accessing health care and longer wait times for appointments compared to non-Indigenous women. Inuit women had reduced access to a regular HCP and waited more than two weeks for an appointment (Surgo et al., 2023).

As a result of negative past experiences with HCPs, Indigenous women may become fearful, avoid   seeking treatment, and become reluctant to receive Western medical care to prevent mistreatment. The reluctancy amongst Indigenous women has been documented in previous literature. For example, Gomes, Hart and Downey (2023) found, “Those who had poor experiences in walk-in clinics or in an emergency department found that it resulted in delayed diagnosis or care, making them reluctant to seek out services again. (pg. 21).” As a result, Indigenous women do not feel safe and supported in these racial and discriminatory interactions with HCPs. Some of the women feel like a statistic or number and not a real patient to be heard and respected (Indigenous Mom & Baby, 2022). The anticipation of discrimination and mistrust of the system, results in their health conditions worsening and lowering their life expectancy (Askew et al., 2021).

In a culturally safe environment, the patient’s voice and needs are heard and respected by HCPs. Treatment plans and care decisions are directed by the patient and the HCP works with the patient (Wilkinson, 2021).

Relationship building is important to ensure the patient feels safe by establishing trust. Getting to know your patient personally and spending quality time during appointments could increase trust and strengthen the relationship. For example, practice active listening to personal stories, what is happening in their lives and not having the patient feel rushed in their appointment (you may miss important information and negatively impact the rapport) (Sovdi & Dickens, 2023). Instill the practice of being comfortable with sitting in silence, allowing space and time for the patient to open up and share willingly and unforced about what is impacting their wellbeing and health (Sovdi & Dickens, 2023).

You can listen to the optional Diabetes Canada Healthcare Huddle podcast episode, detailing more discussion and conversation around relationship building with Indigenous patients in the Cultural Competency Series- Cultural competency series – Indigenous communities with Rebecca Sovdi and Rachel Dickens.

As a health care practitioner who uses a culturally safe approach to care, your practice will encompass empathy, compassion and respect when interacting with your patients and treatment plan. This can be improved through reflective practice as a health care practitioner. Reflective practice allows one to reflect upon their own personal biases and perceptions to challenge stereotypes and discriminatory attitudes (Wilkinson, 2021).

To learn more about reflectivity and examples of how to properly engage in reflective thinking, please visit the following website La Trobe University, Reflective practice in health. Introduction – Reflective practice in health – Expert help guides at La Trobe University (libguides.com)