In reply: We thank Hickey and West for their comments. Indigenous researchers, elders and community members collaborated in developing and delivering the Ways of Thinking and Ways of Doing (WoTWoD) tool.1,2 The cultural quotient is a validated culture‐agnostic measure of an individual's generic ability to deal with cultural diversity. Specific considerations included the following:
- Our focus was on general practitioners in metropolitan Australia who provide care to culturally diverse population groups, a small proportion being Indigenous Australians. The model of care underpinning WoTWoD is proportionate universalism — described as integrated universal cover plus targeted services commensurate with needs.
- As a partnership approach, the core WoTWoD values are reciprocity, mutual respect, mutual trust and patient‐centredness.
- As a group, GPs are also culturally diverse.
- Successful cross‐cultural relationships require the actors (eg, GP staff and patients) to be comfortable with their own cultural identities.3
- As generalists, GPs naturally recognise more similarities (lumpers) than differences (splitters) in their clinical practice and interpersonal interactions.4 In managing cross‐cultural differences they often say they “treat everyone the same”, suggesting that race and ethnicity may not be considered an important health determinant or, like lumpers in anthropology, believe race is not a real entity.5
These factors determined the choice of the cultural quotient to measure the cognition, metacognition, motivation and behaviour of general practice staff in managing culturally diverse interactions and relationships.2,3 These measures were complemented by interviews with practice staff and Indigenous patients recruited through the practices. The mentors and researchers also had regular discussions and kept notes of interactions to further understand Indigenous health within the multicultural diversity of general practice.
The equity challenge being addressed by WoTWoD is the general practice dimension of the Closing the Gap conundrum. This is best described by Oliver Wendel‐Holmes (1850), dean of Harvard Medical School, while reflecting on resistance to the admission of African Americans to Harvard, when he said, “the greatest inequality is the equal treatment of unequal peoples”.
We share the vision for an Australian health system that is free of racism and inequality, recognising that Indigenous health research requires a common conceptual framework and terminology, including shared data and tools, that are strategically aligned with general practice and integrated primary health care.
- 1. Liaw S, Hasan I, Wade V, et al. Improving cultural respect to improve Aboriginal health in general practice: a multi‐methods and multi‐perspective pragmatic study. Aust Fam Physician 2015; 44: 387–392.
- 2. Liaw ST, Wade V, Furler JS, et al. Cultural Respect in general practice: a cluster randomised controlled trial. Med J Aust 2019; 210: 263–268. https://www.mja.com.au/journal/2019/210/6/cultural-respect-general-practice-cluster-randomised-controlled-trial
- 3. Ang S, Van Dyne L. Handbook of cultural intelligence. Theory, measurement and applications. New York: ME Sharpe, 2008.
- 4. McKusick VA. On lumpers and splitters, or the nosology of genetic disease. Perspect Biol Med 1969; 12: 298–312.
- 5. Hochchild JL. Lumpers and splitters, individuals and structures: comments on racialized politics. In: Sears DO, Sidanius J, Bobo L; editors. Racialized politics: the debate about racism in America. Chicago, IL: University of Chicago Press, 2000; pp 324–343.
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