Monday, February 20, 2012

AMS Doctor - making sense of my work

Last week the Prime Minister, Julia Gillard, released the Closing the Gap report. She and Tony Abbott spoke to it in parliament. Everyone knows that there is large gap in health outcomes between Aboriginal and Torres Strait Islander people and non-indigenous Australians and this report sets out the progress against the goals in remedying this. In other (related) news, constitutional recognition of Aboriginal and Torres Strait Islander people is on the agenda, and there are good reasons why this will contribute to improved health outcomes for Aboriginal Australians. And, in a sign that this issue is important and hurting people right now, we have fresh in the memory a fairly peaceful protest reported as a riot on Australia day. Fortunately, most people agree that something needs to be done about this indigenous disadvantage. And this is where my fancy gets tickled! There is quite a lot of information out there about what works well (and what doesn’t) and quite a lot of opinion and policy. There are even places which collate much of this information in one place (see the award winning AustralianIndigenous Health Infonet which does a brilliant job of collating all the knowledge that’s worth knowing in this field.) But how do we make use of all this information so it can actually make things better for Aboriginal people across the country. I’m going to try to be a guide around all this knowledge. It’s not that I’m an expert, it’s just that I try to make sense of this to improve my own practice, and publishing this will help me do this. I will try to be the sort of guide that I enjoy most – knowledgeable, opinionated and occasionally entertaining. I hope. I shall try to distinguish between evidence and my opinions formed on the basis of that evidence. And I’m happy for contributions and discussion – none of us have all the answers, and so I will learn more than anyone. However, none of us will learn from abuse or personal attacks for opinions we disagree with, except that the attacker has just lost the argument. None of that here please.
My views are heavily influenced by the fact that I spend my primary job seeing patients. I think of this as an advantage (but then I would, wouldn’t I!) as too often people think they know what doctors are doing behind those closed doors, and get the policies wrong. I’ll reflect on my clinical work in an Aboriginal Community Controlled Health Service and the importance of Community Control. I’ll highlight research and reports that are published and comment on how it helps me improve what I do. And I’ll comment on the impact of policy on my patients and my consultations.
Because I’m a GP (not “just a GP” but a proud member of that specialty!) I’ll also highlight old and new GP philosophy and research that impact on my care – mainly because I can’t help myself!
A word of warning however. As a non-indigenous Australian, I will be fervently trying to avoid the mistake we non-indigenous Australians keep on making. We still have a tendency to put on a big red cape and wear our underpants outside our tights as we descend, briefly, on to an Aboriginal community with “The Answers.” The problem with this is that it just makes us look silly. Not just because that’s not where you should wear underpants, but because we’ve tried this as a solution, and it doesn’t work. It hasn’t worked for over 200 years now.
The only way these problems will be solved is to work with Aboriginal people and communities. Let me rephrase that. The only way these problems will be solved is to work with Aboriginal people and communities. So, one of the main reasons for writing this blog is that I’m a doctor, and I work in this field. That means people end up listening to what I have to say. And this is what I have to say, in essence: “You’re listening to the wrong person! Yes, I have some opinions, but you need to go and listen – not speak to, but listen, understand – to some people in your local Aboriginal community.” And that is essentially the central message of this blog. I’m optimistic that the gap will be closed, and excited by the nation that we can become. After all, get this right, and we will all be changed for the better.
Enough introductions now. Let’s see what shape this thing becomes...

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