Listening to native patients. Changes in physicians' understanding and behaviour.
OBJECTIVE
To discover how physicians develop an understanding of Native patients and communities that enables them to communicate better with these patients.


METHODS
Qualitative method of in-depth interviews.


METHODS
Native communities across Canada.


METHODS
Ten non-Native physicians providing primary care to Native patients and communities.


METHODS
In-depth, semistructured interviews explored communication strategies developed by primary care physicians working with Native patients. The audiotaped and transcribed interviews were analyzed by the investigators using the phenomenologic approach of immersion and crystallization.


RESULTS
Three main themes emerged. First was elements of communication: during patient-physician communication, physicians speak less, take more time with patients, and become comfortable with silence. Second was community context: patients' illnesses are not distinct from their community context; patient care and community relations, culture, and values are often inseparable. Third was the process of change in physicians: over time, participants increased understanding of Native culture, ways of communicating, and behaviour. Change comes about through long service, listening well, and participating in community events.


CONCLUSIONS
Developing cross-cultural communication was difficult and took years, if not forever. Understanding Native communities changed physicians. They described a journey of self-examination, development of personal relationships, and rewards and frustrations.
Kelly
Len
L
McMaster University, Hamilton, Ont. pogmor@voyageur.ca
Brown
Judith Belle
JB
D000328:Adult; D002170:Canada; D003144:Communication Barriers; D003466:Cultural Characteristics; D006801:Humans; D007198:Indians, North American; D007407:Interviews as Topic; D010817:Physician-Patient Relations