Providing culturally safe care to Indigenous patients is an expected competency of all registrants. When care is not delivered through a culturally safe and trauma-informed lens, it can erode trust and further perpetuate barriers to equitable health care. A panel of the Inquiry Committee recently reviewed a case where a registrant did not meet expectations related to culturally safe care. The case also highlights key considerations of informed consent. It is being shared as a learning opportunity for registrants.
Case study
An Indigenous patient attended a specialist appointment for a routine but uncomfortable procedure. The patient reported concerns about unclear communication prior to the procedure, inadequate pain control during the procedure, and a general lack of cultural sensitivity.
During the procedure, it became apparent that preprocedural analgesia had not been administered. When the patient expressed pain and distress, the registrant continued with the procedure and made a comment that the patient perceived as dismissive. Although the registrant later recognized the oversight and apologized, the patient felt frightened, disempowered, and unsupported.
The patient left the appointment feeling that her pain had been minimized, her experience invalidated, and that the overall care provided to her lacked cultural safety.
Case resolution
The Inquiry Committee identified several concerns in its review of the case. First, the registrant relied on an informal process for a critical step (providing appropriate analgesia), which was missed and contributed to the patient’s discomfort. Second, when the patient expressed pain and physically withdrew during the procedure, the registrant did not treat this as a potential removal of consent. Instead of pausing to reassess the patient’s needs or re-establish consent, the procedure continued. Finally, the registrant’s communication during and after the procedure did not reflect cultural humility or an understanding of the patient’s lived experience.
Key takeaways
- Cultural safety and consent are closely connected: To obtain and maintain meaningful consent, registrants must communicate clearly, demonstrate cultural humility, and consider each patient’s unique background and context. When patients feel fear or mistrust—especially in the absence of culturally safe care—it can prevent them from providing genuine, informed consent. For Indigenous patients, these concerns may be heightened due to the lasting effects of historical and intergenerational trauma caused by healthcare experiences where consent was ignored or violated.
- Commit to cultural humility: Cultural humility means approaching every patient interaction with respect, curiosity, and a willingness to learn from their lived experiences. When missteps occur, what matters is how registrants reflect on the impact, take responsibility, and commit to ongoing learning and improvement.
- Consent is dynamic: Registrants must ensure that patients fully understand a procedure before it begins and remain attentive throughout. Even if a patient initially provides consent, questions or concerns may arise later. It is important to watch for verbal and non-verbal cues that may indicate discomfort or a withdrawal of consent. Past experiences or trauma can influence how a patient perceives information.
CPSBC resources
Providing culturally safe care is a CPSBC requirement. The Indigenous Cultural Safety, Cultural Humility and Anti-Racism standard sets out clear expectations for registrants and serves as practical tool for ensuring a culturally safe medical practice.
As a reminder, CPSBC has resources available to enhance learning about cultural safety and humility.
- Frequently asked questions
- Learning resources
- podcast episodes
In addition, the Consent to Treatment – Equity Considerations registrant resource and provide additional examples of obtaining informed consent.
Questions regarding this article can be directed to communications@cpsbc.ca.