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"Unwell while Aboriginal": iatrogenesis in Australian medical education and clinical case management

Authors Ewen S, Hollinsworth D

Received 27 February 2016

Accepted for publication 8 April 2016

Published 27 May 2016 Volume 2016:7 Pages 311—315

DOI https://doi.org/10.2147/AMEP.S107334

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Maria Olenick

Peer reviewer comments 2

Editor who approved publication: Dr Anwarul Azim Majumder


Shaun C Ewen,1 David Hollinsworth2

1
Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, 2Indigenous Studies, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sippy Downs, QLD, Australia

Introduction:
Attention to Aboriginal health has become mandatory in Australian medical education. In parallel, clinical management has increasingly used Aboriginality as an identifier in both decision making and reporting of morbidity and mortality. This focus is applauded in light of the gross inequalities in health outcomes between indigenous people and other Australians.
Methods:
A purposive survey of relevant Australian and international literature was conducted to map the current state of play and identify concerns with efforts to teach cultural competence with Aboriginal people in medical schools and to provide “culturally appropriate” clinical care. The authors critically analyzed this literature in light of their experiences in teaching Aboriginal studies over six decades in many universities to generate examples of iatrogenic effects and possible responses.
Results and discussion:
Understanding how to most effectively embed Aboriginal content and perspectives in curriculum and how to best teach and assess these remains contested. This review canvasses these debates, arguing that well-intentioned efforts in medical education and clinical management can have iatrogenic impacts. Given the long history of racialization of Aboriginal people in Australian medicine and the relatively low levels of routine contact with Aboriginal people among students and clinicians, the review urges caution in compounding these iatrogenic effects and proposes strategies to combat or reduce them.
Conclusion:
Long overdue efforts to recognize gaps and inadequacies in medical education about Aboriginal people and their health and to provide equitable health services and improved health outcomes are needed and welcome. Such efforts need to be critically examined and rigorously evaluated to avoid the reproduction of pathologizing stereotypes and reductionist explanations for persistent poor outcomes for Aboriginal people.

Keywords:
indigenous health, minority health, implicit bias, equity

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