Listening to native patients. Changes in physicians' understanding and behaviour.

OBJECTIVE To discover how physicians develop an understanding of Native patients and communities that enables them to communicate better with these patients.

DESIGN Qualitative method of in-depth interviews.

SETTING Native communities across Canada.

PARTICIPANTS Ten non-Native physicians providing primary care to Native patients and communities.

METHOD In-depth, semistructured interviews explored communication strategies developed by primary care physicians working with Native patients. The audiotaped and transcribed interviews were analyzed by the investigators using the phenomenologic approach of immersion and crystallization.

MAIN FINDINGS Three main themes emerged. First was elements of communication: during patient-physician communication, physicians speak less, take more time with patients, and become comfortable with silence. Second was community context: patients' illnesses are not distinct from their community context; patient care and community relations, culture, and values are often inseparable. Third was the process of change in physicians: over time, participants increased understanding of Native culture, ways of communicating, and behaviour. Change comes about through long service, listening well, and participating in community events.

CONCLUSION Developing cross-cultural communication was difficult and took years, if not forever. Understanding Native communities changed physicians. They described a journey of self-examination, development of personal relationships, and rewards and frustrations.