Culturally safe, trauma-informed care for Indigenous patients is a core expectation for all registrants, as outlined in CPSBC’s Indigenous Cultural Safety, Cultural Humility and Anti-Racism practice standard. When this practice standard is not upheld, it can erode trust and reinforce barriers to equitable health care. A panel of the Inquiry Committee recently reviewed a case involving a registrant who did not meet these expectations.
Case study
An Indigenous woman presented to an ambulatory clinic for her first gynecological assessment, seeking care for long-standing symptoms. She disclosed a history of sexual assault, which increased the potential for re-traumatization during sensitive medical encounters. Several elements of the visit contributed to her growing distress. During check-in, she was asked to explain the reason for her visit in an area with limited privacy. She was then required to change into a gown and walk through the waiting area, which left her feeling exposed and unsafe. Throughout the process, she was asked multiple times to repeat her story, requiring her to recount deeply personal experiences.
By the time she saw the physician, the patient was emotional. The open-ended questions he asked felt impersonal and retraumatizing. The patient did not perceive an effort to build rapport or establish a culturally safe environment. She also experienced the encounter as marked by a power imbalance, particularly being a female Indigenous patient in a sensitive situation with a male physician.
As trust eroded and communication broke down, the physician ultimately ended the appointment, citing safety concerns due to the patient’s response, and an inability to proceed.
Case resolution
The Inquiry Committee noted that although open-ended questions are generally effective, the physician did not appear to recognize their impact on the patient or adjust his approach in response to her visible distress. This was a missed opportunity to pause and consider de-escalation strategies. While ending the examination was appropriate for safety reasons, earlier efforts to build rapport may have changed the outcome. The Inquiry Committee acknowledged complex power dynamics, including gender and the nature of the exam. A more reflective, patient-centered approach could have validated the patient’s experience and supported a more respectful conclusion to the visit.
Key takeaways
This case illustrates how applying principles from the Indigenous Cultural Safety, Cultural Humility and Anti-racism practice standard could have improved the patient’s experience.
- Reflect on power and privilege: Power imbalances were evident throughout the interaction. The patient expressed feeling a lack of control. Greater awareness of how power dynamics affect Indigenous patients could have prompted the physician to adjust his approach and spend more time building rapport, potentially avoiding a breakdown in the therapeutic relationship.
- Provide clear, anticipatory information: Although some details were communicated in advance, the appointment unfolded differently than expected. The patient felt unprepared. Given her trauma history, more detailed information about the process, consistent staff interactions, and clear expectations may have helped reduce anxiety.
- Recognize and respond to trauma: The clinic was aware of the patient’s trauma history, yet a trauma-informed approach was not consistently applied. For example, the patient had to repeat her story multiple times, despite relevant details being available in the chart. Trauma-informed care may require adapting usual practices, such as pacing the appointment or prioritizing relationship-building. Acknowledging distress and adjusting expectations can help to build patient trust.
CPSBC resources
Providing culturally safe care is a CPSBC requirement. The Indigenous Cultural Safety, Cultural Humility and Anti-Racism practice standard sets out clear expectations for registrants and serves as a practical tool for ensuring a culturally safe medical practice.
As a reminder, CPSBC has resources available to enhance learning about cultural safety and humility.