Annual health check for Aboriginal and Torres Strait Islander – podcast – Ngiare Brown part 1

This is the first part of a 2-part podcast hosted by Mayrah Sonter and featuring Dr Ngiare Brown talking about the benefits of a regular 715 health check.

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Announcer

You’re listening to a 2-part podcast hosted by Mayrah Sonter and featuring Dr Ngiare Brown talking about the benefits of a regular 715 health check.

Mayrah Sonter

Well, thank you very much for joining us here in this podcast. My name is Mayrah Sonter, and I will be hosting today but also share some of my experience of having recently undertaken my first 715 Health Check. I can't believe I didn't know about it before. Now I'm 35, how come I didn't know about it? It's interesting to go through it and to find out that my sister actually has a 715 every year. Even within our own family, we weren't kind of all across it, but what we're here to talk about today is, the 715 from the perspective of a patient as well as a doctor. I'd like to introduce Dr. Ngiare Brown, who is one of the first identified Aboriginal medical graduates from New South Wales and one of the first Aboriginal doctors in Australia. Hi, Dr. Brown, how are you?

Ngiare Brown

Morning, thanks for thinking of me.

Mayrah Sonter

Of course, it was a no brainer and I said, 'Look, we'd really like you to go and have a chat with a doctor.' Obviously you're not my personal doctor, so as I tell my story today and share my patient experience, going to get my test and talking to various other people around this project. It won't be the relationship that we had in the room, but you'll be able to tell from your many years of conducting health checks for their mob.

Ngiare Brown

And speaking of many years, if it makes you feel any better. I've recently turned 50 and I thought as part of my birthday celebration to me, this year and for every subsequent year that I too, would then go and have my comprehensive health check done, which is good and timely for variety of reasons. But it's never too early and it's never too late to get into the habit.

Mayrah Sonter

And it's really nice that you position it like that in the way that taking care of yourself as a gift, and it's one of the things. It's not just let's go out and check a party, but the best thing I can do to honour myself on a special day like a birthday and every year just to go in and check in with a doctor and see how your health is going.

Ngiare Brown

Absolutely.

Mayrah Sonter

Now I'd like you to introduce yourself, if you don't mind. Just a bit of your background and where your mob's from and what inspired you to become a doctor.

Ngiare Brown

Oh, so very short answers is what you are after there's-

Mayrah Sonter

You can give us some more.

Ngiare Brown

I'm UN nation woman, so my father and my grandmother's country is around the Shorehaven and I grew up here in the Illawarra. I've been a wife for so many years but was drawn back here for a variety of reasons. And we were just discussing how beautiful a place this is. Yep, I'm adopted by trade, I have a background in a number of disciplines. My first love was emergency medicine before I moved to specifically into primary care and into Aboriginal and Torres Strait Islander health, which of course I adore, and it's what I'm completely connected to. I work with Aboriginal and Torres Strait and the children and adolescents. Specifically now, I run a small, not for profit called Ngaoara and we deal particularly with children affected by trauma and with complex needs and we do outreach to a number of communities. But also as you know, I do a bit of work in policy and other areas. But a complete privilege to work in Aboriginal health.

Mayrah Sonter

We're very lucky to some of your time today, so thanks for sharing. What was it that made you want to become a doctor?

Ngiare Brown

You see, that's a good question. And I decided very early on so I probably obnoxious/precocious in that sense. I used to think that it was because I really liked Mash that was one of my favourite shows ever. I thought it was also because I loved science, I'm a tad on the nerd side and wanted something that ... I loved science but I also love the notion of being able to work with people every day and to connect, and to have relationships and to hear their stories because they give each and every time. But I happened to be out in community one time and I've heard this story a number of times in different contexts, but at similar kind of theme.

I was out with another Aboriginal doctor who shall remain nameless, but it will probably become evident who it is. We were at in a remote community we're doing so work together. And one of the elders, the senior women, she kind of points at us, but she called us over. She points at him in particular and says, "Are you one of them, Aboriginal doctors?" And he goes, "Yes, aunt I am." And she waves her finger and she said, "You know that you didn't choose to be a doctor." And he's kind of a little perplexed but I told her and she says, "We chose you."

That's still goosebumps for me, the notion that in fact, I always try to acknowledge that we stand on the shoulders of giants. All of the ancestors, my family members that went before me, that paved the way such that we would have choice and opportunity. And then to also know that our senior people, our ancestor's spirits, whatever. I don't know if I believe in fatal destiny in that sense, but I do believe that there are certain pathways created for us if we're open to the experience to know where we're needed. I think for me, that's probably the nicest story.

Mayrah Sonter

Certainly it is, it's got tears in my eyes, just hearing it and it's nice to know the kind of our cultural upbringing and beliefs have crossed over there in that story with medicine and choosing you. It's knowing you as a person, it's no doubt that you were always meant to be a doctor, a very caring person. Why is it important to have Aboriginal and Torres and the doctors?

Ngiare Brown

Well, I think because we have such extraordinary potential and talent in communities. And if they were kids, young people, adults who were privileged as I was with the same sorts of opportunities, you would see us flourish. I think that we have extraordinary insight, I think that our cultural connections actually then helped to enrich the medical profession, in terms of what we can offer and bring. Medical schools, the health profit, they're not doing us a favour in that sense, if you know what I mean. Because if we are provided with the right kinds of environments, and mentors and support, then what we can do in turn for the environments and the teams within which we work can be extraordinary.

And we can actually lift the health game and we can lift the profile of the entire population, not just Aboriginal and Torres Strait on the peoples. I think it's also really important that we provide, and I'm not saying I do, but I would like to, I hope. But the notion we should be role models, and we should provide something that our children can aspire to, in terms of achievement, and success and we don't just have to work in certain areas that are dictated to us. We can choose, and we can be great in whatever we desire to do, and I think that's important. Change our social norms and raise our expectations, and the platforms by which we experience being Aboriginal and Torres Straight on the peoples.

Mayrah Sonter

And as an Aboriginal and Torres Strait on a patient I'm sure you've come across over the years on that part, just in the same way that the story you've told us about the anty who said, "We chose you to be a doctor." How do you think it makes patients feel to have an Aboriginal and Torres Strait Islander doctor?

Ngiare Brown

I have been lucky enough that more than a couple of occasions, I've actually had my patients say to me, "Don't you worry about what other people say." 'Cause of course, there's always going to be the haters, right and you can't be black because you're educated, or you can't be black, because you have a roof over your head or, you're earning a good income. I said, "Don't you worry about that because we're very proud of you and what you've done for us. And for every thousand negative comments you get it just takes that one to really just feel your heart again and make it all worthwhile."

Can I tell another story, and I hope he doesn't mind me dubbing him here but Kelvin [Kong 00:08:07] another fabulous young man great family. When he was a very young doctor just graduated, I think. And he was seeing a lady in clinic. And had just started sort of the interaction with her and his sort would get really emotional and weeping he goes, "Oh my God, what have I done? I've made my first patient cry." And he goes, "What's wrong?" And she said, "You know what, I'm so proud I didn't think I would live long enough to be treated by an Aboriginal doctor." They are the stories that we hang on to.

Mayrah Sonter

Another beautiful one. I'm going to have to pull it together here. Yeah just certainly does make you proud, and not just because you're an Aboriginal Torres Strait on the person but because you're fabulous doctors as well and have all of the right skills to be just as good as carers as anyone else. And when you walk into a room probably more probably because of our culture and having culturally appropriate environments in care and expectations when patients come in. Can you tell us a little bit about the importance of culturally appropriate care when patients come to a clinic?

Ngiare Brown

I think there are lots of strains and perspectives to that. And I'll try and capture a couple of those. Our notion it's sort of traditionally, culturally, we are an inclusive people. We are a collective, so the notion that we know not just to deal with an individual, but all of the other factors, relationships, people, environments and their life, that's extraordinarily important. I think perhaps because a lot of Aboriginal Torres Strait on the mob have experienced barriers, discrimination and exclusion in their lifetimes and their lifetimes of their families, parents, carers, grandparents, whatever. Then we sort of we know what to expect but we also know that they are not the things that we should be engaging in, and so we know to do our jobs better in that sense.

I think it's also fabulous when we have sort of the community controlled services, but also non community control and mainstream services that want to be relevant to Aboriginal people, to have Aboriginal and Torres Strait on the staff, not just doctors that are part of the service, so really friendly, beautiful coloured faces at the front desk, Aboriginal nursing staff and allied health professionals and receptionist, have areas that may have, gift for the kids to play with, have artwork on the walls, have printed material or other media running in the background whereby people feel that they are acknowledged and they are relevant, and that they are valued, and that they have the same kinds of or perhaps additional concerns, than other patients do, but they can still be part of this service, which of course, they're entirely entitled to.

Mayrah Sonter

I think if you pull that all together really nicely for us there. 'Cause that's a really important part of getting a health check feeling comfortable in where you're going. It can be quite, and get a bit nervous about going you never know what the doctor is going to find out or it's always nervous in the waiting room, I find kind of looking at people and do I have the right doctor whom I'm going to say today how long is going to take. There's all these questions that you get nervous about kind of sitting in that kind of space. Having a welcoming, friendly space where it's easy to come in and check in at the front before you even get into the doctors really important I find. Now, can you tell us what an actual 715 Health Check is?

Ngiare Brown

A 715 it's a health check that Aboriginal and Torres Strait on the people's can have done on an annual timetable. But it should be comprehensive in nature, and offer you not just the usual, hi, how are you? What's your name? Where do you live? But take full consideration of your social background and social histories, ask you about your family history. Is there anything important not just in your own personal medical background, but that of your family, so we can take that into consideration? We know that we have many families with long backgrounds of chronic disease, for example, diabetes, cardiovascular risk, and they're super important we're considering how we tailor our history, our examination, our investigations, and then a treatment plan for you.

It goes through the steps of that history and they'll ask you questions about, you got a job at the moment, where are you working? What are you exposed to? What are your interest? Do you play sport? Are you involved in any other sort of social activities, cultural activities, for example, which I think is really important. They'll then make determinations around the kinds of examination if they need to tailor that at all, depending upon your age, and where you live and your access to services and what your history brought up, for example, male, female, young or old. And then the investigations and X-ray, for example, or some bloods taken, and referrals as appropriate.

For allied health professionals, pediatrists, nutritionists, diabetes educators, but also perhaps you might need to see a cardiologist or a diabetes and endocrinologist as a specialist. And then we wrap that all up in a specific and individualised kind of plan for you, that we discuss and we negotiate and we try to educate so that you then are able to play a part in your own health and take responsibility for some of those aspects. But also you then get to choose what you share with family and the other providers. It's supposed to be a relationship and partnership for your health, that you understand, that you agree to and then together, you can move forward on how to be healthy and stay healthy.

Mayrah Sonter

That's a great snapshot, and I'm going to share kind of my experience and going to the doctor and the test shortly. But then another thing to note is the 715 is the Medicare code at which doctors name to claim, so that's why it's called a 715. Sometimes it is an Aboriginal health check or go to them and get your health check. Different communities call it different names, but that's what we're talking about. It's for Aboriginal Torres Strait on the people every year to go along and be proactive about their health. And let's not wait until there's a problem coming up or that you're sick. In some communities that we visited and talk about this, have that is there a policy not to see any patient who is coming with the rolled ankle after 40. Because that's not the purpose of the visit, we want you to come in and do the full checkup that is required for a 715. Why is it important for our mob to get a 715 Health Check?

Ngiare Brown

Multiple reasons. I think for me, just from my perspective, sort of professionally, I suppose. I think it's an opportunity to try and get ahead off any issues that you may already have, or any issues that you may be at risk of developing, for example, does that make sense? But I think it's about changing how we think about health and well being. We always talk about prevention, but we don't do much in that space. If you have an opportunity to have a comprehensive health check done at 715 that's both build, it won't cost you anything except your time. But to then give you a snapshot of where you're at, what you're doing really well and what we need to support you to do better, for example.

And then for you to be able to share that experience and those stories with your family members, and those in your sphere of influence. Because historically, I think we've had very poor or negative interactions with the health system. We tend to wait until we are quite unwell, and wait until we already have a handful of complex conditions that we need to deal with, which means we are unwell, it means we're not at our peak to be able to maintain ourselves. And then the people that we care about and love, raise our children, care for our elderly, do our jobs.

Why wait? As you said, we need to get ahead of that, change our expectations and our social norms about well being. And it's an interesting, I think kind of ... It's not a contradiction, per say, but Aboriginal and Torres Strait on the mob and peoples everywhere, always talk about well being. In fact, we're at the forefront of those conversations about being socially, culturally as well as personally well and yet we don't tend to do that. We have an opportunity now to be able to access items and activities and services within the system to help us get well and to stay well. But also then, to role model those sorts of positive health behaviours for those around us, and particularly our kids.

Mayrah Sonter

And some people might have the perception that, "Oh there's a lot of bad health in my family and I'm going to get it anyway, so what's the point in going to the doctor?" A kind of defeatist attitude almost, which I hate to generalise, but a lot of the young men in particular, toughen and feel like they don't need to go along and get a health check. What would you say to those kind of people out there who are thinking that they're that person about why they should go and get a health check?

Ngiare Brown

As a public health check, I would say absolutely, there is a significant proportion of our health issues are preventable.

Mayrah Sonter

Absolutely.

Ngiare Brown

Whether we're talking about issues of physical activity, and BMI and weight, and your blood sugars and heart disease again, risk factor profile. In our teens and early 20s, the most non Aboriginal people don't see until they're in their 50s, we can do so much about that. And so the notion then we can get ahead of that. And just make it a routine, when you're young, maybe every two years, have a regular checkup. And make sure you have that stuff checked, but also, then it makes you think about healthier choices, better options on a day to day basis.

And particularly for our young men, I know it's really difficult to be a bloke, to be an Australian bloke, because it's just expected that, "Yeah, I'm sporty, and I drink beer and that's fine. I don't talk about emotions and I certainly don't talk about things like having regular health checks." You then layer on top of that all the social and cultural complexities to be an Aboriginal and Torres Strait Islander male, then it really becomes a really crowded space for them, but we want to break out of that. And in fact, reengage our young men to be leaders in this space, and to have them be the role models.

And to say, "Look, you know what ... " And I think there's a number of organisations now that are very much focused on the fitness aspects of not only physical well being, but mental health, and how we teach our kids, we teach our families, and then we become entire communities that are role models, but reengaging, I mean, I think it is important. Because for a bunch of historical and contemporary reasons, I think they've had a lot of their power base removed. Getting them back into a place where they're comfortable and feel powerful, again, I think will be important.

Mayrah Sonter

Absolutely, some really good advice there. It's interesting about that kind of layering on when you point it out it's out like, "Yep, it's obvious." I'm sure we can all encourage each other. I know I have girlfriends, whenever I go to doctors and get something done, I privately text them, and say have got that done, have you had yours done lately? Just to make to sure that we're all checking in, looking after each other, probably could be a little bit more open about it. Because you never know who's going to say that in terms of role modelling and letting people know about it. In fact my sister is coming for a 715 and we never talked about. I could have been on earlier, that's why it's so important too. And the first one was always I think in life generally. The first one is always the hardest. Once you've been, you've done it, you've gotten through that first one, you know what it's all about, then you can kind of know what to expect next time and invite some of the other family members along to go and get theirs done too.

Ngiare Brown

No, I agree. Absolutely. And I think because as I mentioned, a lot of our being the royal, our experiences have been quite negative in the past, but to then to change it to something that is actually a positive. Oh, my blood pressure was perfect today. Thumbs up, and then you go okay, well, it's like we do the community weight loss challenges and things like that. You're turning something that is a health risk into a health positive, because you're celebrating the successes. And actually, like you said, after you've done the first one and said, "Well, that actually wasn't so bad was it?" What I'm going to do is I'm going to ... If we challenge ourselves, I want to improve on that, I want to maintain my weight, I don't want to prove my blood pressure, or I want to get myself off my diabetic medications, because I can do that through diet and exercise. Things that are as simple as that you can actually access the appropriate supports to make that happen with something as simple as a 715.

Mayrah Sonter

Now, perfect timing 'cause I'd like to just chat through the process from where to go for anyone who may not have hear a 715 or know what it's about. Hopefully, you're listening to this podcast, you already learned fair a bit about it already. Right now, we would just like talk through some of the logistical steps. The first thing, a question that comes up is why should you identify as an Aboriginal and Torres Strait on the patient at your local clinic doctor?

Ngiare Brown

Well, apart from the fact that, we should all be extraordinarily proud of that. It's important from a very nerdy, boring perspective around statistics, but also access for services and for staff and for patients to Aboriginal specific health entitlements, which is important as well. And so that way, they should be notified that you can be bulk billed for certain services that you are then entitled to, perhaps a cluster of referrals to certain other allied and specialist medical services, because you're an Aboriginal and Torres Strait on the person. And also, I think, it gets the services to think more about you as an individual, about you as a cultural person, and also what they can be doing better. They're just some of the little snapshots that are important to me to know that patients are Aboriginal and Torres Strait Islander. But also if there are issues, and they might be social issues, as well as health issues, then we also know that we can access additional services and supports for them, irrespective of what they might be.

Mayrah Sonter

Can you tell us a little bit about bulk billing for those people out there, I'm not quite sure what it is. I wasn't sure what bulk billing was, what does that actually mean?

Ngiare Brown

Well the bottom line, it just means that you will not pay out of pocket or should not have to pay out of pocket. And even for some of the services that claim against that item, when you have your consultation, or if there are any other service fees, then you are entitled to a full refund of that amount, so you will not be out of pocket.

Mayrah Sonter

To get your 715, you can go to your local AMS or bulk billing doctor. And there are some doctors out there that don't bulk bill, which means they will charge you. You can still go there and have the test, but it will be at a charged rate. If you're thinking of going getting 715, it's best to go to your local doctor that already kind of knows you. But if you call up and just say do you bulk bill? And if they say yes, then that's the right doctor to go to for your 715. And then you won't have to pay out of the pocket to have that test.

Ngiare Brown

Now that's absolutely right and on that, so once we know that we have a good network of community controlled services, Aboriginal medical services, there are a vast number of primary care providers and group GP practises. What's super important? Yes, the financial considerations, absolutely. Irrespective though, you should be able to climb against the 715. But having a provider that you can build a relationship with is very important, because then you're more likely to go in a timely manner. You're more likely to trust them with very sensitive information, and you're more likely then to refer others Aboriginal Torres Strait on the people's there.

Mayrah Sonter

And on that note, I previously went to the same doctor as my parents. The doctor already knew the family history, he knew probably more about their history than I knew, because that's my parents doctor. But then I moved, then I went and found a new doctor, because people are busy. I don't have time to drive across town to go to that particular doctor anymore, I want to go to the one kind of closer to me. There are lots of reasons why people go to different doctors our mob move around a lot. Travelling, visiting family, around different parts of the country. Can you give us some advice around why it's important to build that relationship and go to the most frequent doctor every time.

Ngiare Brown

I think you've already sort of mentioned issues of trust relationship and them being familiar with you and your story and the story of your family, which is always a gift. It means then, for example, just in terms I mean to be blunt convenience and timeliness. If there's something that you need, you might want to repeat a script for a medication that you're on, or you just need something very quickly, then you can pop in, you don't need to repeat yourself. They know who you are, they have your full clinical records, and they can do it in a timely manner, and you'll be out and on your way.

It's often difficult to get that kind of comprehensive coverage when you're constantly having to go to a different provider. Now, that is also your prerogative but also if you're mobile for work or for other reasons, for example. I know a lot of our mob tend to move around to different communities and family members, and that's also okay. But I think there are options now, in terms of mobile medical records, or at least being able to keep a copy of your own medical records with you is helpful. Or having that A health or and some other areas electronic option available so that you're able to share your clinical history. And there's always stuff we forget, I forget stuff about my own medical history, for example. So it's nice to be reminded and make sure you don't forget some important stuff along the way.

Mayrah Sonter

Some really good tips there. And now going along to the doctor, first thing is make a booking, and that's different in different communities. I'm in the city, my local doctor provides an online app. You log on, put in your details yeah, where's that 15 minutes luck with that doctor book? I'm often away. That's kind of my experience of going through. Some other people might have to go to their local service and just rock up on the day. They may not take bookings or it may take a little bit longer. I'm just wondering about what you can expect when you go and book.

Ngiare Brown

Yeah, and that's true. Some services have online booking, it's convenient, and you usually get to pick who you want, if you can, on a day that suits you both. Others don't. I know some community controlled services are just first in best rest, and that's the nature of it. But it means that you might get bumped for an acute or an emergency situation. And other services will have a mix, they'll have appointments, and then they'll just have droppings. And normally the appointments of people that need perhaps longer consultations, which would be good for 715, for example, or just turn up because you've bumped your toe and you need someone to kiss you, boo-boo, and away you go.

It's a matter of just finding something that suits you that you're comfortable with and fits in with your schedule, when you want to book a 715, be very clear about that. Because they'll need to find a practitioner, who is across all of that, and that they can put aside the time because you know it will take at least 30 to 40 minutes. If it's your first visit, and it's uncomplicated, for example, or if there are multiple issues that you need to have addressed in that consultation, maybe an hour, for example, there's all of that. There's the timing that you need to consider, so what was the rest of the question?

Mayrah Sonter

No, that's good. Yeah, knowing, identifying cause EMI doctor only has 15 minutes left so I had to ... And online there wasn't a space for me to say, "I'm getting a 715, therefore I need about an hour time or whatever might be appropriate. Actually I had to pick up the phone and go, "Hi, I wanted to book online, but I noticed you've only got 15 minutes slots." I'm Aboriginal, I would like a 715, that takes a little bit longer, and then they were able to handle it over the phone. You really have to be proactive and stand up for yourself at that point when you're going to the doctor and really kind of be as clear with as much information as possible, so that you're kind of set up for success, before you even get in the room with the doctor.

Ngiare Brown

Now, that's absolutely right.

Mayrah Sonter

I suppose the next bit, so we've had talked a little bit about fees associated. It's best to go to a bulk billed service, if possible. If you don't go to a bulk billed service, what might people be up for?

Ngiare Brown

In the first instance, and particularly if you don't have health insurance, for example, that might cover some of the difference. On average, I think you'd be looking at about 150 bucks. In some areas, it may be somewhat least, but of course, it's usually based upon time and according to your MBS rebatable item or Medicare benefits scheme.

Your rebatable items are based on short, or long consultations, case conferencing, and then a mixture of ... And it's all usually time dependent, and also what kind of expectation you need to sort of input into that particular consultation. It really is then up to the individual service to make determinations about that, but they should, in fact, be upfront about the out of pocket costs. What you will be liable for in the first instance as a part of that visit, and they will be very clear or should be very clear as to whether it's yep, completely bulk billed so that should be zero.

Whether there will be a gap fee, so there will be for example, something that's bulk billed and then there'll be a small additional cash fee associated with that, or whether you will be charged for the full consultation. And then you make a decision about what's going to be most appropriate for you and your family.

Mayrah Sonter

Yep, so that's why it's important to hurry up and find out before you go because I'm sure you will get a bulk billed service nearby to wherever you are so that you run out of pocket for that.

Ngiare Brown

And you're not surprised when you get there.

Mayrah Sonter

Exactly, that's a definitely a good point. Now I'd like to talk through kind of in the room. You've gone through, you've identified that you're an Aboriginal Torres Strait on the patient, you've made your booking you've gone to your local doctor where appropriate, and you're not travelling for work or whatever else. You've asked about the fees so you know what the kind of looks like and you're in the waiting room. It's a comfortable environment, they've got acknowledgement of country on the wall, or some artwork and some very friendly staff, hopefully. And then you get to go in and you see the doctor.

There are some things that the doctor actually has do to make sure it's a 715 Health Check. Like check your blood pressure, your blood sugar levels, height and weight. You might collect blood and urine test, talk about your family history as you've mentioned before. You've done lots of these tests that you've given some examples. Can you just talk us through a little bit more about from a kind of soon as you walk in the room and you sit down, just to make sure that everyone's feeling really comfortable and what to expect.

Ngiare Brown

Yep, no worries. And of course, don't forget that as part of your first engagement and meeting with reception. There's always paperwork. And sometimes that's on a little tablet or an iPad, and you get to do it electronically, which is a bit exciting. But they'll ask you the same sorts of information about yourself and where you live and your employment, and your Aboriginal and Torres Islander identity and status. And they'll also seek consent from you to be able to record this information and if appropriate, they might need to share it. Now, they'll also discuss it with you so that by the time you go in to see the doc that should all be covered off. And they'll ask you questions about you, about personal stuff, I suppose.

But again, it will be about building rapport and relationship but they'll need to know information about your current health status and whether there is anything in particular that you've presented for or whether it's for a general checkup. Then they'll go through your past medical history, anything significant, any major illnesses, any major operations. They will ask your social history. Where do you live? Do you live with family? Are you in a relationship? Any Munchkins? How old are they? How's their childhood? How are they going? Because they want to know about that as well, and that's important. Yeah, like I said, any ops or major illnesses. Are you on any medications at the moment? What are they? How much? When do you take them?

Mayrah Sonter

And vitamins, we also have vitamins.

Ngiare Brown

Yeah, absolutely, because even if there's supplements or they're not prescribed medications, I always identify that I take a multivitamin, and then I will take stuff like Ginkgo, and Brahmi. Now, the other way, as well as just knowing that as part of your broader history, those medications can also interact with other prescribed medications. It's important to know, and some of them can actually prolonged bleeding, for example. If you were to have an operation, they'll ask you to stop your aspirin or don't take nurofen or don't take your fish oil and you Ginkgo within a week.

It's important to know those things even if they're not prescribed. They will ask you about allergies, they'll also ask you about things like cigarettes, and alcohol and it's not because they're judging you. Please don't ever think that. But it is important for us to know those things in the context of your overall health. Sometimes they're a reflection of how you're doing socially and emotionally as well so they said. They might also ask you if you use any other types of drugs or substances, and again, that's not because they're going to go running off to tell anybody, but it's really important in the context of your overall health and well being and your social environment.

They won't always do that, but as part of sort of a comprehensive relationship with your provider, because of course, we're bound by privacy and confidentiality laws, as well as our professional boundaries, if that makes sense.

Mayrah Sonter

Anything you tell the doctor, they aren't allowed to tell anyone else without your permission?

Ngiare Brown

Absolutely not. Unless it was going to be something that meant that you were a danger to yourself or others. And that's a whole other sort of conversation, but ordinarily, that's not the case. And then, of course, once they've got ... They'll ask you also about your employment history, because not only they're interested in what you do for living, for example. But there may have been certain environmental and occupational exposures like asbestos sort of smoke, or other things that might be in a dangerous that you're hearing. Also loud noises, heavy lifting those sorts of things are also important to consider.

Mayrah Sonter

Really interesting that you're able to flush those out. I wouldn't even thought of half of those the connecting questions and the reason behind. It does feel a bit judgy at times, and you have to be honest 'cause if you know, how many glasses of wine do you have? Or do you drink and you lie to the doctor, that's not helping anyone. It's not helping you and your health, it's to kind of give those signals to the doctor about how that would be affecting your health more broadly. It's important to be honest too as a patient.

Ngiare Brown

No, absolutely but also trust that information stays with that medical provider, because that's their responsibility. And they need to know just in terms of your health and well being and also those around you, so yeah. And so once I've gone through that history, we'll get into the examination part of it.

Mayrah Sonter

And I'm feeling comfortable talking to you right now, because we're both women. If we're going to have a conversation about girly bits all things that girls have to do, I would absolutely feel more comfortable with a female doctor. And so when I make a booking I specifically ask for that. Some people might be different, but that's actually an option when you go to a local doctor so you can say I want a male doctor. If I'm a boy or a female, or whatever your preference might be, that's correct, isn't it?

Ngiare Brown

Now, that's an excellent point. Oh, yeah, of course, you may want to talk about issues that are about sexual and reproductive health. Or you just may feel more comfortable with a provider, that's male or female, and it gives you that additional sense of safety around the environment, and the relationship to be able to discuss things. And then I found with a younger, the younger kids and the adolescents that I work with, they really like having a male professional or a male counsellor, because ordinarily, we don't think that young people need to see health professionals, because they're supposed to be young, fit and healthy. But there are lots of emotional and social issues going on and all the sports medicine stuff cause but the notion that they can have those professionals available to them to talk about things that they feel are specific to being a bloke or specific to being a woman or to being female. And it's important that you feel able to discuss them and particularly then if it comes to issues of examination and testing, and then what you do with that information.

Mayrah Sonter

Now, that's a really important point. You might want to take somebody with you, that could be an older sister, or a sibling, someone for support, it might be someone. If English isn't your first language, you might want some support to help translate what the doctor is saying, potentially, or just someone there for support, more generally. So that's a personal option and you're able to do that.

Ngiare Brown

Oh, absolutely, you are, and I think that's a fantastic point. You are always entitled to have a support person with you, particularly if you're young, but it could be at any stage of your life whereby you would feel more comfortable having somebody there to support you. And they may just sit in the background and not say a word. But you are entitled to have them there and of course, it's also part of their responsibility of services. And I know a lot of services that are in very, what would they they call it? Culturally and linguistically diverse environments, that they make that available either by phone or in person for interpreters and other support people. It might be people with disabilities, for example. Both physical and intellectual, to make sure that there is the right sharing of information that the communication is appropriate and comprehensive, and that people are actually understanding what they're saying to one another. Because you can't underestimate the sense that a lot of patients have around a power imbalance with a medical profession that we need to level that playing field as much as possible.

Mayrah Sonter

Very important point there, too. And that comes down to the doctors manner really, doesn't it? Just how well they can explain to you what the issue is in clear language, you're always able to say, "I'm sorry, I'm not quite sure what that means. I heard what you said, but I don't actually know what that means and what does that ... And why do I suffer from that? Or what can I do to fix it?" Feel free to ask as many questions as you want in there so that you as a patient feel comfortable walking out there that you know whatever the issues are or what you need to do to make sure that you're maintaining your health.

Ngiare Brown:  

Absolutely. And if you feel intimidated by a health professional, then you're not going to feel confident enough to be able to have those conversations, or to ask the questions, and then everything ends up being only ever half done and that's not in your best interest.

Mayrah Sonter

That's true.

[add closer]

Mayrah Sonter

There's no more better advice than that. I don't think from all that experience as a doctor, as a health professional from all the research that you've done. Thank you so much, Dr. Ngiare Brown for sharing your expertise, and your story and your experience of being a doctor in community right around the country of many, many years. Congratulations on all that and thank you for sharing your tips and encouraging our mob to get out there and have their 715 check every year. If you'd like to find out more head to health.gov.au where there's more information about health check that can help you in your local community. And let's get out there and get our families and communities healthier, stronger by getting a 715 health check. Thank you, Dr. Brown.

Ngiare Brown

My pleasure.

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