Best health outcomes for Maori - Medical Council of New Zealand

are asked in a consistent manner, with full explanations, and
the patient is given enough time to answer, it is unlikely that
anyone will find a question about ethnicity inappropriate or
offensive. Quite the reverse, you may find that your patients
welcome the opportunity to share with you how they see
their cultural heritage and their health interacting. For
example, if a patient were to say, “Oh, my family’s Italian
(or Tongan or Samoan or Mäori), and food is such a
central part of family life, there’s no way I will ever not be
overweight. There’s nothing I can do about it”, you could
take the opportunity to offer nutritional advice that is still
culturally sensitive or propose an exercise regimen that
could counteract dietary indiscretions. See Cases One and
Five below for Mäori examples of how knowing about a
patient’s culture can help you in improving their health.
The central place of effective
communications
The greatest value of cultural competence is to enhance
communication between you and your patient: to ensure
that the consultation is of value for both of you; that the
information needed is shared between you and the patient
(and perhaps their whänau); and that the desired outcome
(the best possible health for the patient) is achieved.
Be aware that many Mäori have a natural desire to seek a
consensus – to avoid disagreements about small matters.
They may defer to the authority of those in the practice team
who are, after all, experts in health care, but that does not
necessarily mean they agree with what you are saying. The
Best health outcomes for Mäori: Practice implications
values of harmony and respect may be more important
than expressing disagreement. Unfortunately, this desire
for consensus in no way means that, once they are out of
your presence, they will proceed with the treatment plan,
and so it is very important to ensure that “yes” means “We
have agreed upon this plan and I will do my part as we have
discussed”, and not “I totally disagree and have no intention
of doing what you have outlined, but I will not insult you by
saying so to your face.”
Along these same lines, it is best not to take the silence of
Mäori patients as agreement with what is happening. In fact,
silence by Mäori may indicate complete disagreement with
what is being proposed. In some this is stoic acceptance
of treatment they perceive to be inappropriate, while
others may not want to challenge the authority of the
provider. A better approach is to check that patients have
understood by the use of open questions. For example,
you could say, “I want to be sure that I have given you all the
information you need. Please tell me what you understand
will happen to you, from what I have said.”
In addition, remember that each of us, regardless of
background, has a personal preference for receiving
information. You may need to deliver healthcare information
in a number of ways to be certain that the patient has a
sufficient understanding of the topic. This is a time when
whänau members may be helpful in assisting you to ensure
that sufficient information has been received by the patient,
and also in checking on understanding and disagreements.
The role of the patient is to receive treatment, while the role