Improving Clinician–Patient Communication In Aboriginal Health Care By Having A Yarn
Storytelling is one of the oldest elements of human culture. Stories unite and sustain us throughout the millennia, building bridges to shared perspectives and nurturing understanding and empathy between peoples that span generations.
Unsurprisingly in our current turbulent social and political climate, stories are as important as ever. They offer mirrors and alternative gateways, together with insights to reimagine our reality while reinforcing our cultural heritage. Many believe what separates humans from other animals, is the moment in our evolution when we began to tell stories.
Is it any wonder we are re-discovering the transformational power of storytelling in a medicine?
Sound communication lies at the heart of effective clinical consultation. However, communication between Aboriginal patients and healthcare practitioners including doctors, nurses, and paramedics, continues to be problematic.
Indeed, many argue lapses in communication are arguably the biggest barrier to the delivery of successful health care to Aboriginal people. One of the techniques, promising to help close this communication gap is clinical yarning.
Clinical yarning is a patient-centric approach that melds communication preferences in Aboriginal culture with biomedical understandings of health and disease and comprises three interdependent methodologies:
- The Social Yarn: practitioner looks to find common ground and develop a relationship
- The Diagnostic Yarn: practitioner facilitates the patient’s health story while interpreting it through a biomedical or scientific lens
- The Management Yarn: uses stories and metaphors as tools to help patients understand their health issue paving the way for a collaborative management approach.
Conducted effectively, clinical yarning has the potential to improve outcomes for both patients and practitioners.
Mapping Clinical Communication Against Cultural Preferences
For Aboriginal people, ‘yarning’ is a culturally appropriate way to connect, exchange information and share stories between two or more people, both socially and more formally.
Yarning is a way to talk about things that are important and that connect the two participants. Information is embedded within the story or yarn being told, with the onus on the listener to hear and make meaning of the information being conveyed. It is a highly conversational and informal way of sharing news or imparting information that looks to de-stress a situation and create a shared understanding.
Recent field research has paved the way for an emergence of yarning-based approaches to communication as a culturally appropriate method in Aboriginal health research and in counselling and other therapies.
Nurturing Connections And Relationships
Like other patient-centric communication methodologies, clinical yarning is based on establishing a strong connection between practitioner and patient. Clinical yarning adopts a holistic perspective and looks to understand a health condition from the patient’s perspective.
One of the clinical yarn’s unique aspects is the emphasis it places on the social yarn as a means of creating a relationship, nurturing trust, and helping the healthcare practitioner to understand a patient’s story. The social yarn demonstrates to the patient that the practitioner is interested in them as an individual and helps both patient and practitioner to understand the other’s perspective.
A clinical yarning based approach encourages the exploration of a patient’s problem using their personal narrative. Attentive listening by healthcare practitioners to the patient’s story can improve the appropriateness and quality of the care the patient receives by encouraging empathy, engendering greater emotional engagement and allowing a more thorough understanding of illness within the patient’s own context.
Transforming Metaphors Into Clinical Tools
In clinical yarning, stories and metaphors are transformed into educational tools helping healthcare practitioners to explain often-complex health information in a way the patient finds non-threatening and easily understandable.
This approach also aligns seamlessly with Aboriginal cultural traditions in which storytelling is the way in which information is exchanged and social bonds reinforced.
Metaphors are proving to be a useful means of explaining health information to patients in a way that is meaningful to them and is more likely to assist the patient in recalling details. This is consistent with research that points to stories and metaphors as successful communication approaches in improving a basic understanding of health issues including chronic diseases, hypertension, diabetes and chronic pain and their connection to preventative or ameliorating behaviours.
One theory explaining the potential power of metaphors in improving patient understanding of health-related issues is their ability to stimulate an emotional response. Yarning activates areas of our cerebral cortex associated with memory, learning, and imagination.
Research increasingly supports the view that communication between Aboriginal patients and health practitioners can be improved by reframing clinical consultations as a less intimidating and more informal clinical yarn. Clinical yarning harnesses the power of social, diagnostic and management elements, whilst lowering the barriers to forming effective relationships between patients and healthcare professionals, paving the way for improved outcomes for both Aboriginal patients and practitioners.