Sharing the true stories: improving communication between Aboriginal patients and healthcare workers

Alan Cass, Anne Lowell, Michael Christie, Paul L Snelling, Melinda Flack, Betty Marrnganyin and Isaac Brown
Med J Aust 2002; 176 (10): 466-470.


Objectives: To identify factors limiting the effectiveness of communication between Aboriginal patients with end-stage renal disease and healthcare workers, and to identify strategies for improving communication.

Design: Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in-depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication.

Setting: A satellite dialysis unit in suburban Darwin, Northern Territory. The interactions occurred between March and July 2001.

Participants: Aboriginal patients from the Yolngu language group of north-east Arnhem Land and their medical, nursing and allied professional carers.

Main outcome measures: Factors influencing the quality of communication.

Results: A shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters.

Conclusions: Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.

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  • Alan Cass1
  • Anne Lowell2
  • Michael Christie3
  • Paul L Snelling4
  • Melinda Flack5
  • Betty Marrnganyin6
  • Isaac Brown7

  • Cooperative Research Centre for Aboriginal and Tropical Health, NT.



Our study was supported by a grant from the Cooperative Research Centre for Aboriginal and Tropical Health. We would like to thank Dr Peter Arnold for his critical reading of the manuscript.

Competing interests:

None declared.

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