Providing culturally safe care to Indigenous patients is an expected competency of all registrants. Cases continue to emerge, such as the one below, showing that Indigenous stereotypes can result in harm.
A panel of the Inquiry Committee recently concluded a case where a registrant did not fully meet the expectations in the Indigenous Cultural Safety, Cultural Humility, and Anti-racism practice standard, highlighting the expectation of creating safe health care experiences.
Case study
An Indigenous woman chose to terminate her pregnancy and contacted a reproductive health clinic to understand her options. In this process, she identified herself as Indigenous and, given her previously negative experiences in accessing publicly funded care, she requested to have a support person with her. The clinic denied her request, citing a policy which does not allow support people to be present and told her they would not treat her differently just because she is Indigenous.
Prior to the procedure, the patient requested to pray, which was abruptly dismissed by the treating physician. The nursing staff stopped the procedure to allow her to pray, however, the treatment by the physician left the patient feeling rushed and disrespected.
Post procedure, the patient requested to keep the remains for ceremony. While the staff provided the remains, they made comments which made the patient feel there was disregard for her culture.
Following the procedure, the patient experienced unexpected severe pain due to retained tissue and subsequent hemorrhage, leading to an emergency second procedure, which she believed was the result of the physician rushing. This was another experience of trauma for the patient.
Overall, she felt this experience affirmed her pre-existing concerns that medical care would not be culturally safe, nor offered with cultural humility.
In response to the complaint, the physician involved in her care recognized the seriousness of Indigenous-specific racism and its impact on patient health. The clinic did try to communicate their protocols for support persons and demonstrate their understanding regarding the return of biological tissue; however, this is not how the patient perceived the situation.
The physician in their response also noted that typical post-procedure care does not include any direct follow-up, unless there is a concern from the patient, and that all patients receive written and verbal post-procedure care instructions.
Inquiry Committee recommendations
Following an investigation, the Inquiry Committee concluded the case with recommendations related to several aspects of the physician’s involvement. The Inquiry Committee was specifically critical about the statements made about the specimen, the restriction of support persons and an overall lack of clear and culturally safe communication with the patient.
As per the Indigenous Cultural Safety, Cultural Humility, and Anti-racism practice standard, physicians must facilitate the involvement of the patient’s family and others upon request. This could mean allowing for a separate space for support, such as the waiting room or a private area. It is important to ask the patient who they would like to support them and examine how that support can be incorporated into the appointment.
Physicians must also acknowledge and incorporate Indigenous cultural rights, values, and practices into the plan of care. In this situation, providing more time for both prayer and to meet cultural needs may have gone a long way in demonstrating cultural humility and facilitating a culturally safe experience for the patient. There was also a lack of cultural safety in the return of biological tissue, which is significant in ceremony for Indigenous patients. Physicians are expected to honour the patient’s decision in returning tissue and to do so with respect.
Recognizing the effects that a patient’s past experiences may have on their ability to process information is also critical. While it may not be typical to include a post-operative phone call for follow-up, there may be instances where it is best for patient care. A patient may be hesitant to seek care if there is a problem, or a patient may not know what to expect. In this case, scheduling a follow-up call may have helped the patient feel more supported and improved her overall experience with the process and the broader health system.
College resources
Providing culturally safe care is a CPSBC requirement. The Indigenous Cultural Safety, Cultural Humility and Anti-Racism practice standard sets out clear expectations for registrants and can be used as a tool for ensuring a culturally safe medical practice.
In addition to the standard, CPSBC has a list of learning resources, from papers to full courses, which can aid physicians in their journey towards cultural safety.
CPSBC’s most recent episodes of its new podcast, Connecting the Dots, highlight practical suggestions for breaking down systemic barriers and providing Indigenous patients with culturally safe care.