Working well 3: Challenges of working at an Aboriginal Community Controlled Health Service

This resource is part of a series of online 'Working Well' resources designed to assist GP Registrars and other health professionals working in Aboriginal Community Controlled Health Services (ACCHSs).

You will hear stories and perspectives from a range of people with experience of working in Aboriginal Health in one way or another. We hope this will help you in finding your feet as you contemplate working in ACCHSs in the future.

The resource can be used on your own, in a small group or with a Supervisor. Find out more information about how to use this resource or just click the 'Start' button to begin.

See the full list of Working Well resources.

This project has been funded by Northern Territory General Practice Education (NTGPE) with assistance from AMSANT and the Danila Dilba Health Service (DDHS). Many thanks to all the contributors.

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Working well 3: Challenges of working at an Aboriginal Community Controlled Health Service
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TOPIC A: Finding your place within the team
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Working Well 1: Differences
Back TOPIC A: Community control
Back TOPIC B: Holistic approach
Back TOPIC C: Cultural safety
Back QUIZ: Check your knowledge
Back SUMMARY: Print or download resources
Working Well 2: The ATSIHP
Back TOPIC A: The role of the ATSIHP
Back TOPIC B: ATSIHP training
Back TOPIC C: Knowledge of community
Back QUIZ: Check your knowledge
Back SUMMARY: Print or download resources
Working Well 3: Challenges
Back TOPIC A: Finding your place within the team
Back TOPIC B: The cross-cultural environment
Back TOPIC C: Addressing complex patient needs
Back TOPIC D: Managing your own expectations
Back QUIZ: Check your knowledge
Back SUMMARY: Print or download resources
Working Well 4: Misunderstandings
Back TOPIC A: Lack of respect
Back TOPIC B: Different levels of knowledge
Back TOPIC C: Resolving misunderstandings
Back QUIZ: Check your knowledge
Back SUMMARY: Print or download resources
Working Well 5: Advice
Back TOPIC A: Get to know the community
Back TOPIC B: Work closely with the team
Back TOPIC C: Manage your own expectations
Back SUMMARY: Print or download resources
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Think about the focus question below and click on each of the staff members to listen to what they have to say about this topic.
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How might you approach the challenge of finding your place within an ACCHS team?
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KEY POINTS AND ADVICE
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Finding your place within the team

Get used to not being treated in quite as such a sort of a special way as you can be as a doctor in some other settings. And it doesn’t mean you’re not respected, actually you are often very respected, particularly once you've been around a while and people have decided that they like you and trust you. But there will also be people who have a chip on their shoulder about authority figures who will be quite possibly rude or, you know, kind of trying you out to see what happens if they’re not polite and if you arc up and try and pull you’re status card that doesn’t go so well.

Other things about the environment including a completely different approach to bookings and waiting rooms and all that kind of stuff ... I ... this is variable, I’m not saying all community-controlled services are the same ... but I think it might be true to say they often do have a slightly more casual feel than you might be used to and it can feel not in control and a bit chaotic if you’re not used to that.

Another thing I think people struggle with is responsibility for follow-up and for results and that kind of thing - because that can be often actually very well done in the community controlled service where there's people specifically allocated to doing that kind of work, but as a new doctor in the service, particularly a more junior doctor, you are used to feeling like 'right, well I ordered that test and I must be in charge of what happens with it', and it’s hard to do that.

I mean, very often you wouldn’t be able to get hold of patients by the phone, so there need to be other ways for them to get results and be followed up and, yeah, learning to trust, or if you don’t trust, learning to see, well, what is the system in place and finding out about it, I think that’s a tricky thing.

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Finding your place within the team

One challenge definitely I guess is trying to figure out exactly what the role is of an Aboriginal Health Practitioner and how much that they can do and I think I’ve found this to be very variable based on the experience of an Aboriginal Health Practitioner in terms ultimately their training I think goes as far as being able to use the CARPA manual fully and independently make decisions and initiate treatment and management plans based on that, but I think it’s always challenging for Health Practitioner when they’re in clinics where – and depending on how things have been organised - when there’s doctors there as to how much decision-making takes place.

Because, what I find is that there is a lot of doubling-up on work sometimes and you wonder how there can be better relationships between health workers and doctors so that there is a more efficient use of time and people aren’t necessarily taking histories twice or doing examinations twice and whether sometimes things can be sorted out with the health practitioner and that patient may not even need to see the doctor.

So that’s definitely one improvement and that’s for any sort of health service, that’s an improvement that can be made.

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Finding your place within the team

Working more in a team I found quite hard. I was used to it being just me and the patient, but now the patient was seeing an AHP before they saw me, and they might also be being managed by one of the care co-ordinators or the mobile team or something. And I think there is a temptation to sort of just kind of put your blinkers on and keep working just you and the patient, because that’s what you’re used to. And maybe you don’t see the benefits of working as a team at first. But I think that’s a big mistake.

Having said that. I’m at the end of my term now and I still haven’t worked out how to best work together with an AHP. Sometimes I feel like the interaction could be better. For example, you can let it become so that the patient sees the AHP and they write the history and do a brief exam in the notes, then you pick up the patient and read the notes on the computer, but the AHP is already seeing someone else, so there isn’t much of a chance to have interaction there. Then you kind of do repeat the history and exam, and sometimes if there is something you think you could use the AHPs help with again at that stage, you might not want to interrupt them, or maybe you’re just busy yourself.

Anyway, so you can end up not really working together. And I think that’s a shame, because that’s not how it’s supposed to work. And the patient’s missing out, and you and the AHP are missing out from learning from each other. So that’s a challenge.

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Natasha Pavlin
GP
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Iyngaranathan Selvaratnam
GP Registrar
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Caitlin Tunnicliffe
GP Registrar
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