Cultural Awareness for Clinicians

PLEASE NOTE:  This transcript was mostly AI-generated and may contain errors.

00:02.08
irinavarlan
Hello and welcome.

00:02.45
Farheen
Thank

00:03.93
irinavarlan
I'm Irina, and today we're going to speak about cultural competence in healthcare. What is it?

00:09.34
Dr Margaret Abbott
Thanks.

00:09.80
irinavarlan
Why is it important to be culturally aware in healthcare? And why now? Why the increased interest in this lately? And is there anything we can do about it? But first, I'd like to welcome my guests for today, Dr.

00:22.25
Farheen
you.

00:22.65
irinavarlan
Margaret Abbott and Farine Jesser, and thank them for accepting my invitation to help me navigate this topic today. Hello, before we start our conversation, could you please introduce yourself?

00:34.98
Dr Margaret Abbott
Hello, I'm Dr Margaret Abbott. I'm a GP. I've been working in for over 30 years in a deprived area of Nottingham City. And I'm also so the Health Inequalities GP lead for the Nottingham City Place-Based Partnership. And I've got special interest in health inequalities relating to people with mental health problems, learning disability, and in particular asylum seekers and refugees.

00:58.89
irinavarlan
Thank you.

01:00.34
Farheen
Hello, my name is Farini Jester and I have had, um if I'm a pharmacist and I've had experience working on mental health wards. um I'm also um a Muslim and I've, oh, I think we're gonna knock i okay that Okay, that's it. but

01:20.63
irinavarlan
you You can, you can start again. You can, you can add more. There's no problem at all.

01:25.78
Farheen
The only thing is, is that, I mean, I want to, I don't want to say I am a pharmacist because I've retired because of ill health. So I don't want to say that. So that's why I was trying to make it. So I've had experience of working as a pharmacist on mental health wards.

01:39.72
irinavarlan
I see.

01:42.59
Farheen
That's what I will say.

01:43.52
Dr Margaret Abbott
Hmm, that's okay.

01:43.54
irinavarlan
That's, that's absolutely fine.

01:44.50
Farheen
Okay. Yes.

01:45.62
irinavarlan
Yeah, that's absolutely fine.

01:46.58
Farheen
Okay.

01:47.49
irinavarlan
Um, do you, yeah, go ahead.

01:47.76
Farheen
My name, my name is Farine Jesser. and And I have had experience of working as a pharmacist on mental health wards.

01:58.59
irinavarlan
Do you want to add a bit about you being Muslim and also being a patient taking medicines? Because initially you said you'd like to share that.

02:03.78
Farheen
Yes, well, I might mention that and when I'm doing my experience.

02:07.11
irinavarlan
Okay. That's absolutely fine. Thank you both. So what is cultural awareness and what is cultural competence in healthcare?

02:19.95
Dr Margaret Abbott
um Perhaps if I can come in there. um So all of us have got a culture, whether we might be of different coloured skins or different faiths or ah ah coming from a working class background or other backgrounds from another country or ah in this country have been brought up in this country. um And sometimes we're not always aware of our own culture. So the cultural awareness is being aware of our own culture first and foremost and how that might influence our ah interaction with people um and then the cultural awareness of other people um and ah that is how I would describe that cultural awareness really being aware of of your own and other people's culture and how that might affect interactions in health care and cultural competence really is

02:51.07
irinavarlan
Thank you.

03:19.18
Dr Margaret Abbott
tailoring your interactions with other people and your messages in a way that aligns with the other person's culture. um So that is acceptable to to the other person. So if you um approach um messages in a very um dominant way or um with authority, some people will react against that depending on what their background has been, what their experience of health care in the past, um and ah interaction with other people of your own race or background. So we need to be understanding of what other people are thinking, what their backgrounds might be, and ah develop our messages to be personalized to that person. So

04:07.71
Dr Margaret Abbott
somebody from a certain um country, ah particularly I'm thinking of asylum seekers, those are so those people coming from another country, they may be um university professors or surgeons.

04:21.88
Farheen
Okay.

04:23.27
Dr Margaret Abbott
They may be somebody who doesn't speak ah doesn't read and write to their own language and who has come from ah a rural background. The message, even though it's the same country that the person's coming from and same same ethnic group, you would approach those two sets of people in a completely different way. And so everyone is personal as to what their background is, their faith, their beliefs, their health beliefs. So it's important to personalize it to the to the person in front of you and be curious, ah sensitively curious about how your messages might be received and why they might not accept your advice and explore that and be open.

05:04.09
Dr Margaret Abbott
and that's That's the main things really, so that people will trust you and then they will follow your advice or you can tailor your advice to whatever their opinions might be or their background. um So those are the things I think I wanted to emphasize really in terms of cultural awareness and cultural competence.

05:28.76
irinavarlan
Thank you do you. Do you want to add anything else Farina?

05:31.95
Farheen
I was just going to agree with and Dr Abbott about how it's a patient-centered approach and patient-centered communication um and um understanding that

05:32.97
irinavarlan
Do you want just to move on? yeah

05:51.81
Farheen
um the perception of each person's cultural beliefs and um actually realizing if two people are the same um culture and religion they may not and believe in the same things exactly so that's why I mean it's it's all patient-centered so you have to try and ah not treat all Muslims the same not treat

06:24.20
Farheen
or like Dr Abbott said, and with asylum sleep seekers, they won't all be the same. um So it is a patient-centered approach and understanding, but primarily is is understanding and different cultures, especially within the environment that you're serving, the area that you're serving.

06:34.40
irinavarlan
Mm

06:34.68
Dr Margaret Abbott
Mm hmm.

06:41.88
irinavarlan
hmm.

06:48.20
Farheen
So Dr Abbott, um um is and serves like and does mental health and asylum seekers. So you're probably you are aware of all of those the cultures and the things that might affect their overall health. So, I mean, if that's that's the primarily the ah important thing, I think, is making it the cultural competence patient centered with a holistic sort of and

07:12.26
irinavarlan
Okay.

07:19.83
Farheen
treatment.

07:21.43
irinavarlan
Okay. So thank you for that. But can we discuss a bit more maybe about why is it important and why is it important now? I mean, this isn't a new thing that people in search for a better life or for a career opportunity, they change country, even continents, and that we see this influx or even rotation of cultures, possibly more so in the big cities than in the rural areas and in remote areas. But this isn't new. This has been happening since the beginning of the world. um Why do we care about it now? Has it become a problem? That's when we normally tend to want to do things something about ah things, right? and When it becomes a problem or an error happens or we notice some sort of ah a trend. Why now basically is my question.

08:12.32
Dr Margaret Abbott
I think that some one of the big drivers in this has been ah the covid COVID pandemic and the um collection of data around that um and who and the um a revelation that a certain ethnic groups have ah suffered more badly from COVID and then people looking into that as to why. And one of the um big things that has come out is is people's trust in the vaccine and their health beliefs about vaccines.

08:37.62
Farheen
Thank you.

08:47.46
Dr Margaret Abbott
um And so I've worked in the ah local ICB alongside the data analysts and ah managers

08:53.63
irinavarlan
me.

08:58.08
Dr Margaret Abbott
looking at that kind of thing and we've In the COVID pandemic, we were developing um approaches to COVID vaccinations for those ethnic groups that have ah had the lowest uptake. And it wasn't ah out of that came the understanding from community leaders and from surveys of people from different ethnic groups, how much um We were normally not um making our services um culturally aware. We we weren't um giving the right messages. We weren't addressing the health beliefs of those particular groups. um We weren't understanding that if community leaders endorsed something, um then they were more likely to um take it on board. um And if ah people,

09:57.06
Dr Margaret Abbott
were of the same race or ethnic group as themselves, they were much more likely, in the terms of health professionals, delivering the vaccine, they were much more likely to believe what they said and were reassured that they their message was that the vaccine was safe. So we developed and with um the majority black-led church community leaders we and mosque leaders, we we developed um

10:13.19
Farheen
are.

10:23.95
Dr Margaret Abbott
ah clinics, COVID vaccination clinics, especially for that group, and they were very successful. And likewise, the Romanian community, we had um community leaders from the Romanian community actually um being filmed having their their own vaccine, and that made an uptake of that particular group.

10:44.41
Farheen
Thanks.

10:44.73
Dr Margaret Abbott
so um so That that has um what is one of the main things in terms of the the poor outcomes from COVID, from particular groups, but also there's also been um a lot of um messages recently and research about the increased maternal mortality, for instance, in Black and Asian and

11:12.42
Dr Margaret Abbott
women um and that has led to our local hospitals um engaging with ah community connectors who can then connect with both teach both health professionals but also um help the community to engage better with health so that they actually get better maternity outcomes and have ah safer pregnancies. So um those are the two things at the moment I ah can think of that ah have really brought it to the fore um and we've understood it's not just ah The health inequalities in in these different groups aren't just because of the actual ah bodily makeup or the medical conditions underlying and the actual um people who are not coming forward or who are suffering from

11:59.04
Dr Margaret Abbott
maternity mortality or COVID and deaths. But it's also the fact that they feel reluctant to access health care, they feel reluctant to ah and just ah ah believe what the health professionals are are telling them because of distrust. And so building trust and um personalised approaches and has been the way that we've needed to to go forward with this and actually be successful.

12:29.02
irinavarlan
I see. Thank you. um Do you want to add a bit about teaching um and your two speakers from Nigeria and Muslim women's work or do you want to save that for a different point?

12:42.12
Dr Margaret Abbott
No, that's all right. Yeah, sure. So. um Yeah, so. um So more recently, I've and like ah delivered some training for health primary care health professionals to ah in our area regarding um cultural competency, and I was joined by the ah somebody from the Muslims Women's Network and also a GP from Nigeria who were able to share some of the um insights that they had from working with those communities and they were really helpful insights into what beliefs some people might have um and also particularly in the Muslims that Women's Network it was very much to do with um whether ah

13:21.77
irinavarlan
in.

13:33.34
Dr Margaret Abbott
the way somebody is greeted, it's not appropriate for instance for a male doctor to try and shake the hands of ah a female um Muslim um in some circumstances, um the the need to understand the family makeup of of people that you're seeing that actually they might

13:44.09
Farheen
you

13:51.53
Dr Margaret Abbott
want to take decisions ah away and talk to people of more authority within their family, which is a bit different to what white British people might do. um For the African um ah GP, he was saying that people come to him and mention um how certain things um just don't gel with their culture. So um they've had beliefs in some some areas of Africa, not everywhere, but some beliefs about cervical smears actually damaging you and ah causing fertility ah fertility problems or that um that ah natural

14:34.12
Dr Margaret Abbott
um the the traditional healers that they might turn to in their own countries, um the herbs and the other things that they might suggest were more efficacious than the Western medicine. So they gave pointers of things that we might just explore so kind of like if somebody's not coming for a cervical smear for instance and they're from an African background or any other background for that matter to just explore why they're not and try to understand have they got beliefs about it do they think that's going to harm them you know actually explore it rather than just say okay that's fair enough you don't want it actually explore it and and understand and the same with medicines i suppose the same why why

15:18.63
Dr Margaret Abbott
Why are you a bit hesitant about taking this medicine? What are the reasons behind it? and You know, have you got any other alternatives that you think of just to try to understand that person really and where they're coming from? And you never know what might come come forth out of that.

15:36.15
Farheen
It's

15:37.62
irinavarlan
Thank you. um I see. So there is increased evidence then that cultural beliefs and behaviors along with the language barriers directly influence the health outcomes of people.

15:40.60
Farheen
cool.

15:49.77
irinavarlan
but Can we maybe, and you've also, you' you've given us some examples of your of your own training sessions and and and attempts to engage with with patients in different communities. um can Can you think of of um any situations far you know from from your pharmacy experience? um on how this cultural beliefs and health beliefs can affect medicines and um treatment compliance um and how can it impact and affect the therapeutic success.

16:26.88
Farheen
So and my experience is from secondary care in hospital. um and it would be on um ah mental health wards. So for example, um ah I found that in some cases, ah um people with mental health conditions, prior to them becoming ill, they would just drop all of their religious activities. So going to the mosque or praying,

16:59.92
Farheen
But then there were other cases where people would increase it and they wanted to, and they did want to fast. They did want to carry on. good They went to mosque more, they prayed more because they got some solace from that. and So the other problem was that if they did want to fast, then we would have to try and and explain to them first the risks of them fasting. So they'd be would they be at high risk or and learn you know what was their risk? What would happen if they did fast? And if they were adamant to fast, then we would try and organize a way that they could, which was very difficult if they were on three times at TDS. Daily was um hard enough because the whole timing changed.

17:53.50
Farheen
because you have to pass from and ah sunrise to sunset. So the timings of the nurses giving the medication is set on the drug chart. and And it'd be very difficult for them to change that and make everyone aware of it. And so we'd have to check that. other Are they complying? Have they read the notes? This is the health pressure. Have they read the notes to say that this person and is taking the meds o'clock in the morning for example and not at eight o'clock so they weren't giving it either missing it or given twice because that was a problem and also the food they're still they needed to save their food um the and from what they and what they chose in the morning and then they would be should be given that food later on

18:31.05
irinavarlan
Hmm. Hmm.

18:47.56
Farheen
I mean, the other thing was that there was a lot of, and if they were fasting, they were given that food, but there would be relatives who'd bring food for them. Obviously, they wouldn't bring it at those um ah visiting times. They can come in, they'd come in at a late much later time or much earlier time. So that's ah One of the areas and the other areas was the person like for personal personalizing the patient's medication was the only person that they would really trust was um that was an increased. And so um I had to get some evidence of I had i got a letter written from an imam

19:41.28
Farheen
say um in the Quran which um chapters say that you do not have to pass you can give more to charity you can read more of the Quran and it's fine because you are have a chronic illness so um but what I found is that it's trying to make all of the health professionals aware of this so so they can still carry on with their treatment. And you would have thought it was easier in hospital because the patient's there and the nursing staff are there and the medication's there and that's what they have to do to make them compliant is to give them the medication. But because they're used to giving it at eight, 10, 12, like four, six, 10, for those strict times, then sometimes it would get missed

20:41.70
Farheen
And sometimes as well, there was and chances of getting a double dose of that education.

20:44.66
Dr Margaret Abbott
Thank

20:48.61
irinavarlan
Let me see.

20:50.38
Dr Margaret Abbott
you.

20:51.85
irinavarlan
Well, that's quite interesting. um You're right. I think I was more when I asked the question, I was thinking more about how do you get patients to be compliant at home ah when you haven't got the support.

21:03.31
Farheen
so

21:04.62
irinavarlan
and And then when you shared all this, what happens on the ward where you you've got the nurses on and old the clock and people ready to inter intervene at all times. And it's still difficult.

21:14.34
Farheen
Well, OK.

21:14.67
irinavarlan
um How do you cross the other barrier? So if people want to fast and you you tell them in a consultation, oh, but you're allowed you're allowed to take medicines, even though you're you know it's Ramadan because you're really poorly and you need to take the medicine.

21:23.40
Dr Margaret Abbott
yeah

21:28.33
irinavarlan
um it's It's not always ah received as we'd hoped so, is it?

21:33.58
Farheen
But that's what I mean. So I mean, if you know, say, say in them if I was a pharmacist working in a GP surgery,

21:40.68
Dr Margaret Abbott
I

21:43.20
Farheen
and And you've got diabetics, for example. And what I would do is with six to eight weeks beforehand, um you identify the people who may be fasting and bring it up in your consultation that, oh, fasting Ramadan is going to be starting soon.

21:48.08
Dr Margaret Abbott
don't know.

22:08.98
Farheen
I mean, everybody is probably aware of Ramadan. in that Asian area because all of the supermarkets and things have the sales on for the rice and all of the food and things like that. And so Ramadan is going to be starting soon. And do you intend to fast? Do you want to fast? So ask them about it so they know that they can talk to you about it. And you'll explain the risks to them.

22:43.17
Farheen
i would I would explain the risks of if you do fast and if they still want to fast, then you have got time to speak to the diabetic nurse, for example, ah speak to the GP um as a pharmacist, speak to the team who's it who can be involved and look at the guidelines.

22:44.94
irinavarlan
Mm hmm.

23:03.94
Farheen
There are guidelines. I think that there's a British Islamic medicine Medical Association that is it

23:11.30
Dr Margaret Abbott
Yeah.

23:12.74
Farheen
and it's Yes, that they they will give, and they will have some guidelines or you can ask them, which um I think is important, but I think it's important to do that before fasting actually start.

23:12.97
Dr Margaret Abbott
Yes.

23:27.88
Farheen
So like next year, it'd be probably the whole of March that's fasting. So about January time, maybe and you could um start sort of looking at

23:36.63
irinavarlan
Mm

23:43.21
Farheen
who could be affected.

23:46.61
Farheen
And even getting in contact with ah your local imam, which area you're in.

23:46.78
Dr Margaret Abbott
Yeah.

23:52.53
Farheen
There may be a mosque nearby, or like Dr. Abbott said, with the Muslim Women's Center, is it? um Network that they will know of some somebody, or the imam, or even themselves, and who could come and speak to, if they're ladies, that there's probably

23:59.92
Dr Margaret Abbott
Network.

24:02.87
irinavarlan
-hmm.

24:12.14
Farheen
and that ah male patients would probably not um trust ah a female person as much as they would a male person. and foot

24:22.79
irinavarlan
Oh, okay.

24:23.89
Farheen
yeah

24:24.11
irinavarlan
So this is a different level of of health belief, I suppose, no?

24:25.61
Farheen
That's what I found in hospital as well.

24:28.75
Dr Margaret Abbott
Thank you.

24:30.56
irinavarlan
Okay.

24:33.14
Farheen
And because I was um young, ah female, and of speaking to them about it, but I'd always tell them as well that I am a Muslim,

24:43.96
irinavarlan
Okay.

24:44.47
Farheen
I am a Muslim, so I know that you want to fast and how it does, sometimes it does help them. It does help them. I think there was a study done in perinatal psychiatry, mental health, to say that praying actually reduced their anxiety of of women, especially um on the perinatal wards, psychiatric perinatal wards.

25:04.69
irinavarlan
Okay. Okay.

25:13.69
Dr Margaret Abbott
Yeah.

25:14.10
Farheen
worked in.

25:14.23
irinavarlan
Okay. Thank you. That sounds interesting.

25:19.17
Dr Margaret Abbott
And I think in primary care that that the practice nurses who are the main people who are dealing with people with diabetes in particular, which affects ah but the fasting affects the condition more so than others that so we have links and ah educational kind of activities to around that so that people are aware of that, particularly in the areas where there are a high number of Muslims or people who who might be undertaking fasting. um So um yes, it is quite a

25:52.87
Dr Margaret Abbott
a well-known thing, but obviously, and as you say, people don't always take the advice of females, don't always take the advice from a white British people um because they, you know, why should they believe somebody who's not of the Muslim faith and who isn't a person of authority? So there are um links to um um edicts or or kind of declarations from the ah from Muslim leaders ah that we can access as well that around that and around ah vaccinations as well. um So yes that in primary care it is known but it is remembering as you say too to talk to people particularly who are new diabetics because other people who've who maybe had the message lots of times over the years

26:46.01
Dr Margaret Abbott
ah you know may well be aware of things but actually new diabetics need to be ah ah particularly kind of um clarify that and and ah when you're first talking to somebody about um diabetes ah then take again a personalized view and understand where what faith they might have, what influence that might have on them, what family background might have. Yes, as you say, not all Muslims believe the same thing either, so um it's a personalised approach, but it is important to remember that when you've got somebody new and who might be ah fasting at some point in the year, you might not see them just before Ramadan, so it's important to remember that that but when you're first talking about things, perhaps, yeah. So

27:34.13
irinavarlan
Yeah. and what What you both just said now made me think of something, um and particularly what you said before that the joint work that was done during COVID to try and reach certain cultural groups.

27:46.80
Dr Margaret Abbott
if Yeah.

27:48.09
irinavarlan
that weren't necessarily engaging or weren't believing or weren't literally getting the message because maybe it wasn't in the right language or the right place shared.

27:51.83
Dr Margaret Abbott
Hmm.

27:56.11
Dr Margaret Abbott
Hmm.

27:57.03
irinavarlan
um I wonder if it could be looked at as a collaboration for the future. So rather than, you know, waiting for a pandemic or something severe to happen, um it could be like a joint work.

28:02.44
Dr Margaret Abbott
Hmm.

28:06.23
Farheen
Yeah.

28:08.16
irinavarlan
And ah every time when it's close to Ramadan, maybe

28:10.83
Farheen
Yeah.

28:11.87
irinavarlan
within their community. So actually think about your health as well, plan, try to approach your nurse or your GP, especially if you're in a certain medicine, ah explain to them that you want to fast and see what you can do together, because pressures are huge on the and NHS, and who's going to have time to filter and figure out which patient will and will not fast.

28:32.15
Dr Margaret Abbott
Yes.

28:33.09
irinavarlan
And that's only the Muslim community, but you've also got so many other ethnicities that we know so very little of.

28:37.09
Dr Margaret Abbott
Yes.

28:37.43
Farheen
Okay.

28:39.35
irinavarlan
ah Like you said, Farine, at least for Ramadan or for other celebrations, you see it in the supermarkets. But for some communities, you don't. You don't even know it's there or it's happening.

28:47.18
Dr Margaret Abbott
yeah

28:48.05
Farheen
Okay.

28:48.90
irinavarlan
You're just sat in front of them during the consultation. And I think those are maybe even more challenging because you know very, very little about them.

28:55.45
Farheen
yeah

28:57.94
irinavarlan
um One of the things that I had in mind when you mentioned this was medicines containing animal products. ah You mentioned briefly, um I think, about how in the old times the insulin was of porcine, but now we've got more newer formulations, so we've got more availability.

29:10.38
Dr Margaret Abbott
Thank

29:17.20
irinavarlan
But we could also fall into the other side, isn't it?

29:17.27
Farheen
Mm

29:19.66
Dr Margaret Abbott
you.

29:20.60
irinavarlan
We we know about we learn about the culture and and we see somebody who aesthetically identifies with the the thing we've we've built in our mind, the image, and we can come we can fall into the other side of assuming that they all do the same thing or they all believe into the same thing, isn't it?

29:36.21
Farheen
hmm.

29:41.70
irinavarlan
I don't know if one of you wants to talk about anything.

29:42.21
Dr Margaret Abbott
Yes, yes, so, um yes, and it's, it's, it is worth exploring that um particularly like gelatin capsules.

29:44.62
irinavarlan
but

29:52.75
Dr Margaret Abbott
um and vegans, for instance, that, so yes, that people from any background might be a vegan um and ah not want to take gelatin capsules.

29:53.81
Farheen
Yeah.

30:03.97
Dr Margaret Abbott
And it's worth trying to um be aware of what alternatives there might be. um Obviously, usually for GPs, we'd go to the area prescribing committee's guidance on this, which is usually ah Most areas have got an area prescribing committee and they they often can give us quite helpful advice or we can contact the medicines management pharmacists from the ICB to to say this is the situation because most people have come across this um ah and ah of what alternatives might be able to be suggested instead. so

30:41.81
Dr Margaret Abbott
instead of It's important to be aware, I suppose, that most people I suspect would actually ask about it if they had very strong opinions, but they may not do and they may not know their alternatives.

30:48.13
irinavarlan
Bye.

30:56.50
Dr Margaret Abbott
So we did do some work with um um Urdu and Arabic speaking women, many of whom were ah from the muslim had the Muslim faith, and they were we were talking with them in focus groups about childhood immunisations, and they weren't aware that there were alternatives to the flu vaccination that didn't contain porcine products. um and ah that they could ask for those and so it was ah just a lack of knowledge so they just said no to them because they'd heard that that was what it contained but actually there were alternatives to to that so it's a question is them not

31:24.97
Farheen
I'm sorry, I'm sorry.

31:38.34
Dr Margaret Abbott
just presume them not presuming and just asking the question as well. And as as health professionals opening up that conversation and saying, is there a reason why you you don't think you should have that vaccine or your child should have that vaccine? um And might it be that you're worried about this aspect? There is an alternative. And then we made sure that all the GP practices and practice nurses all got in thee the vaccine that didn't have the um poor sign ingredients and then they were able to offer it then and and it made them all aware so we did some training with the practice nurses and health professionals in the in the practices so that that was all covered in you know 360 so that we encourage people to ask but also we encourage people to what the professionals to offer it

32:26.78
irinavarlan
I see. Yeah. do you ah Do you want to add anything for, you know, do you want us to move to the next question?

32:30.02
Farheen
you

32:33.74
Farheen
I think, yeah, I think I agree with um ah Dr Abbott in that, as I said before, that you can't treat every Muslim the same, every asylum the same. You have to look at them individually. um And that six to eight weeks beforehand as well with them, every because you might not even see them during fasting. during Ramadan because they're tired.

33:01.24
Dr Margaret Abbott
Yes.

33:02.65
Farheen
So if you're saying, well, it's not fasting, if you wait till March, say, for for example, when it's fasting, people's sleeping and waking cycles, that it changes. So um if they're not working, they'll probably be asleep most of the day. They'll miss

33:23.99
irinavarlan
Okay.

33:24.74
Farheen
There may be and more missed appointments during fasting. I don't know if anyone's done that. But that's why it's essential to do it before like ah six to eight weeks to try and and get the whole team involved before to catch everyone.

33:43.60
irinavarlan
Okay, um you've you both of you have mentioned a lot personalized care um and what what is it exactly? Is this the solution? um I remember from care homes um patients usually had um a file and at the beginning of the file you have

33:57.79
Farheen
Mm hmm.

34:03.49
irinavarlan
ah Document with about me and you ah have their information not only date of birth photo or allergies but relevant information for example about when the person takes their breakfast or what they like to have for breakfast or the fact that they prefer to sit and out ah watch outside the window for 10 15 minutes before they do something so you get a little bit of intro.

34:24.97
Dr Margaret Abbott
Bye.

34:25.89
irinavarlan
ah into that patient's life, a little window, but you don't necessarily get that in primary care, at least, um and potentially in secondary care too, right?

34:35.72
Farheen
Yes.

34:36.29
irinavarlan
You only get to find out more, the more you speak to them, the more, but then you don't have the luxury of time, do you? Especially in primary care, you have a 10 minute appointment slot. How do you do this? How do you cover this? How do you make your consultation culturally inclusive or appropriate? um Yeah, so I guess I want to explore this a little bit more and and what exactly personalized care is. it

35:04.69
Dr Margaret Abbott
Well, I suppose I in. In primary care, there are certain groups of people who we would um particularly um put ah messages on the front screen of the patient records so that you would be aware of. So people with learning disability, for instance, um then we we might list the reasonable adjustments that might be needed to um ah to help that person engage with us in terms of might need a ah late an early appointment or

35:35.55
Dr Margaret Abbott
to sit in the corridor instead of a crowded waiting room or they might not be able to read and write and so therefore um ah you know don't give them written and material for instance so there might be things like that and also for instance somebody who is a Jehovah's Witness who you know wouldn't be happy to have a ah blood transfusion we might put that on the front fronts screen and I think if there is a particular

35:58.38
Farheen
Thank

36:02.24
Dr Margaret Abbott
um set of beliefs that might um influence a lot of health care. We might well ah put that put that there on the front screen just to help us all. I know it's not easy now, um particularly with the pressures on primary care, but sometimes it's important to, the continuity of care is really important. so And the developing of the trust is what what I started off um this podcast about was the

36:27.40
Farheen
you.

36:31.74
Dr Margaret Abbott
um

36:34.17
Dr Margaret Abbott
people trusting you and getting to know you and to understand that you have their best interests at heart um might take you know several consultations, if not longer.

36:41.36
Farheen
Thank

36:45.28
Dr Margaret Abbott
and If you can have the same person seeing them, the same pharmacist or the same GP or the same nurse, then that greatly helps it because you get to know that person and you are able to kind of think, oh yes, they've told me before about this aspect of things and I've overcome it like that, or let's revisit that again and explore it a bit more.

37:10.36
Farheen
you.

37:10.47
Dr Margaret Abbott
It is much harder if you don't have continuity of care and I do hope in the long run and that we will ah move into more of that. But if there are particularly complex cases, then it is really worth trying to work within primary care at least to kind of say, let's see if we can't arrange it at the front desk. that There's something on the front of the notes that says to see doctor or nurse X whenever possible, because then that will help that asset aspect of things.

37:36.92
Farheen
Yes.

37:42.24
Dr Margaret Abbott
But then, um We see so many people just as a one-off or once every few years. So I think in terms of personalized care, it's up to us health professionals to learn a bit more about this so that we are more confident about asking those kind of questions about, what what have you got any family traditions or health beliefs that might affect you taking this medicine? um working out how to say those things in a sensitive way um and also trying to expand your knowledge, a lot of films or and know training.

38:13.48
Farheen
Yeah.

38:22.92
Dr Margaret Abbott
You can pick up things like we've talked about today about Ramadan and pork products and so forth, um things that we might not be aware of. attending that kind of training, expanding our own minds as health professionals to what the other person might be thinking. But more all than anything, having those conversations and actually opening up to say, I don't know about your background, you tell me, you know, let's be humble and and ask them really to try to help

38:57.37
Dr Margaret Abbott
give them trust in us that we are interested. We do want to tailor our ah health advice to to their personal circumstances because we want them to be healthier. um

39:10.41
Farheen
But ultimately, I think we need we need to have the ability to help the patients transition um in and out of Ramadan safely.

39:10.61
irinavarlan
Thank you.

39:25.48
Farheen
um And to do that, they ah the healthcare team ah needs to be aware, be culturally competent to be able to do that.

39:36.99
Dr Margaret Abbott
No.

39:38.17
Farheen
I think that's important. And to do that as well, they that there needs to be that improved patient health care professional um communication. And like Dr Abbott said, I agree with Dr Abbott saying that when about the trust, they have to have that trust there and which will give them the patient satisfaction as well.

40:03.92
Dr Margaret Abbott
Yes, and it affects all sorts of aspects of health care in terms of end of life care.

40:06.21
Farheen
and

40:08.63
Farheen
yeah

40:08.67
Dr Margaret Abbott
ah People have different expectations at that time, family expectations, faith expectations, and at at childbirth as well, and and in relation to a lot of different conditions. So ah yes, we have to be open to to ask and be more able to to relate to people where they are really.

40:22.93
irinavarlan
Mm

40:26.28
Farheen
Yes.

40:27.29
irinavarlan
hmm.

40:31.07
Farheen
Yes.

40:31.90
Dr Margaret Abbott
and And likewise, if I as a white British woman goes to a health professional who's not white British, again, I'm hoping that they will take into account my culture and my beliefs as well as and and be non-judgmental about what I might say.

40:46.88
Farheen
Yeah.

40:50.82
Dr Margaret Abbott
So I think that's the important thing that we need to all be aware of our own culture and how how the other person might perceive us um ah as well.

40:58.82
Farheen
yeah I think the more patients are more likely to follow um ah treat their treatment plan, they have that um but if they feel they have that respect, their cultural beliefs,

41:01.73
irinavarlan
I see.

41:13.81
Dr Margaret Abbott
Yeah.

41:16.17
Farheen
from whoever they're dealing with, whether it's the GP, ah even receptionist, and nursing staff, whoever it is, if they feel that they have some sort of respect and and they understand what their culture is, they're more likely to um adhere to the treatment plan.

41:37.82
irinavarlan
um Thank you. So we've looked at what cultural awareness is and why is it important. um How can can staff get trained? ah you you You can read articles, you can listen to the podcast, for example, we we touch on a few subjects here, but is there official training for for NHS staff or for for people generally working in a patient facing environment, um to get better at this, to to raise awareness, to to help you become more open, I suppose.

42:01.83
Dr Margaret Abbott
but

42:13.87
Dr Margaret Abbott
Yes, I think there's been a big gap recently because people have kept on saying there must be ah you know, we all need to be trained on cultural awareness and competency, but then there hasn't been any training. But now there is. So the Royal College of Midwives are particularly concerned about the disparity in outcomes and maternal mortality in certain ethnic groups. They've actually put together a e-learning for health um ah training modules on this and um I went on to them recently and they they're excellent, so really helpful. So they're three modules um which are ah introduction to culture and then cultural competency intersectionality

42:58.25
Dr Margaret Abbott
um which is how layers of deprivation and language and difficulty accessing healthcare care and health beliefs and culture all add together all the to make ah somebody and experience even worse health inequalities. So that's the second one. And then the third one is in particular relation to maternal um services. But actually when I read, listened to that as well, I thought that brought out quite a few other points as well and some good examples. So I would really recommend any of your listeners to um think about going on to the e-learning for health, um cultural ah awareness and competency ah modules. um There's also, and there's a, um the government website on migrant health is quite helpful as well. That's quite a good one to go to too. um And

43:56.94
Dr Margaret Abbott
There's BMJ kind of guidance, a British medical journal guidance on Ramadan, ah for instance, which is quite helpful too, as well as the Diabetes UK website for that particular aspect of things.

43:57.33
irinavarlan
Thank you.

44:10.59
Dr Margaret Abbott
um There's also ah for GP practices, there's a safer surgeries. um um toolkit and accreditation which is produced by the Doctors of the World UK organisation and that's something that helps practices look at all the aspects of the practices, the welcome that they give at reception, the notices in the waiting room, as well as interpersonal contact and registration at the desks.

44:42.06
Dr Margaret Abbott
at the front desk. So um the there is quite a lot out there if you look for it, but particularly on cultural competency, I'm really pleased to see that quite recently there's been one put up there on ah from e-learning for health.

44:55.95
irinavarlan
Thank you for that. We can we can link all the websites and the the modules you've mentioned in the podcast notes to share with everyone who's interested.

45:02.92
Farheen
Yeah.

45:06.63
irinavarlan
So thank you.

45:08.69
Farheen
The one that and person that you could get involved is the priest.

45:09.87
irinavarlan
Yep.

45:16.94
Farheen
in

45:17.18
Dr Margaret Abbott
Hmm.

45:18.38
Farheen
um ah When you know, discussing the Ramadan, if you can't the local one, if you've got a good relationship with them, I think they would be quite useful. And the pharmacist, whoever you have for medicines management, and they would know and where to look or um guidelines on what, if they want to change their medication, what's the best way to do it if they did want to change according to the half lives and things like that.

45:45.44
irinavarlan
Mm hmm. Mm hmm. Mm hmm.

45:54.26
Farheen
and And also I mentioned before the and British International, what was it, the Beamer, So that one and there was, so the pharmacist can look at um alternatives for those who don't want um to have um animal products in their medication.

46:04.09
Dr Margaret Abbott
Yeah.

46:22.23
Farheen
So I think it's ah ah it's not all, and so it's not all um ah based on, and you know, all the work just for the GP, because that is just, ah you know, in 10 minutes, ah but it will be, I think, a team effort from everybody in the practice and to try and um help to do this.

46:40.95
irinavarlan
Mm-hm. Mm-hm.

46:48.51
Farheen
So, because for the GP, it's going to be just too much with the 10 minutes, like you said earlier, 10 minutes, isn't enough time. And to start, all of this before Ramadan starts.

47:02.06
Dr Margaret Abbott
Hmm. Hmm.

47:03.34
Farheen
It's really important.

47:03.90
Dr Margaret Abbott
Hmm.

47:05.76
irinavarlan
Thank you both. um I think we've we've nearly come to an end. Before we go and before we say goodbye, do you have any key messages that you want listeners to take home with them? anything Even if it's one or three things, what's the most important thing that people should remember from today?

47:30.87
Dr Margaret Abbott
I would say that the um being culturally aware of your own culture and and being ready to inquire into somebody else's culture in a sensitive way um and upskilling yourself by learning more or and being open to um learning more about other cultures, am being friendly and and ah approachable and ah willing to ah learn from our patients as well as um those being able to help help and advise them.

48:06.60
Dr Margaret Abbott
So those would be my main points, I think.

48:07.69
irinavarlan
Thank you. Thank you.

48:10.80
Farheen
I think mine would be to respect and understand um the cultures of the ah patients in your area. um So then you can better help them to comply with their treatment plans. So better communication so you can get better trust. um So that but would be my main thing.

48:41.40
irinavarlan
Thank you both.

48:42.23
Farheen
like

48:42.51
irinavarlan
um Today's been really interesting. I've learned a lot and I've heard about a lot of interesting things. I'm definitely going to try that module you've mentioned, Dr. Abbott, because I haven't seen it before. um Thank you both. Thank you for for taking the time to come today and for for talking about um such a complex topic. I think we've we've left aside quite a few ideas that we were planning to touch on. But who knows, maybe we can do this another time. Thank you again.

49:09.80
Farheen
Thank you.

49:10.62
Dr Margaret Abbott
Thank you.