Providing Anti-Oppressive Health Care

Introduction

Anti-oppressive health care is a crucial aspect of medical practice in Canada's diverse society. This guide will help you prepare for the MCCQE1 exam by exploring key concepts, Canadian guidelines, and practical applications of anti-oppressive care within the Canadian healthcare system.

Key Concepts in Anti-Oppressive Health Care

Understanding Oppression in Healthcare

Oppression in healthcare can manifest in various forms:

1. Systemic discrimination
2. Cultural insensitivity
3. Language barriers
4. Implicit bias
5. Lack of representation in healthcare providers

The ADDRESSING Framework

The ADDRESSING framework helps identify various aspects of diversity and potential sources of oppression:

Canadian Context and Guidelines

Truth and Reconciliation Commission (TRC) Calls to Action

The TRC's Calls to Action specifically address healthcare disparities for Indigenous peoples in Canada:

Canadian Human Rights Act

The Canadian Human Rights Act prohibits discrimination based on:

• Race
• National or ethnic origin
• Colour
• Religion
• Age
• Sex
• Sexual orientation
• Gender identity or expression
• Marital status
• Family status
• Genetic characteristics
• Disability
• Conviction for which a pardon has been granted or record suspended

Implementing Anti-Oppressive Care in Clinical Practice

Canadian Healthcare Disparities

Understanding healthcare disparities is crucial for providing anti-oppressive care in Canada:

CanMEDS Framework and Anti-Oppressive Care

The CanMEDS framework, developed by the Royal College of Physicians and Surgeons of Canada, incorporates principles of anti-oppressive care:

1. Medical Expert: Integrate cultural safety into clinical decision-making
2. Communicator: Use patient-centered communication that respects diversity
3. Collaborator: Work effectively with diverse healthcare teams and community resources
4. Leader: Advocate for systemic changes to reduce healthcare disparities
5. Health Advocate: Address social determinants of health in patient care
6. Scholar: Engage in continuous learning about diverse populations and health inequities
7. Professional: Demonstrate commitment to ethical, culturally safe practice

Key Points to Remember for MCCQE1

• Understand the ADDRESSING framework for identifying potential sources of oppression
• Know the TRC Calls to Action related to healthcare for Indigenous peoples
• Be familiar with the Canadian Human Rights Act and protected grounds against discrimination
• Recognize common healthcare disparities in Canada, particularly for Indigenous, LGBTQ2S+, immigrant, rural, and low-income populations
• Apply principles of cultural safety, trauma-informed care, and language access in clinical scenarios
• Understand how the CanMEDS framework incorporates anti-oppressive care principles

Sample Question

A 45-year-old Indigenous woman presents to your clinic with chronic lower back pain. She expresses hesitation about taking prescribed pain medications and mentions her preference for traditional healing practices. Which one of the following approaches is most appropriate in providing anti-oppressive care for this patient?

• A. Insist on the prescribed pain medication as the only effective treatment option
• B. Dismiss her concerns and traditional practices as unscientific
• C. Refer her to a non-Indigenous pain specialist without discussing alternatives
• D. Explore her traditional healing practices and discuss how to integrate them with conventional treatment
• E. Suggest she choose between either traditional practices or prescribed medication

Explanation

The correct answer is:

• D. Explore her traditional healing practices and discuss how to integrate them with conventional treatment

This approach aligns with anti-oppressive care principles and the TRC Call to Action 22, which recognizes the value of Aboriginal healing practices. By exploring the patient's traditional practices and discussing integration with conventional treatment, the healthcare provider demonstrates respect for the patient's cultural beliefs and preferences while ensuring comprehensive care.

Options A, B, and C dismiss or ignore the patient's cultural preferences, potentially perpetuating systemic discrimination. Option E creates a false dichotomy between traditional and conventional medicine, rather than seeking an integrated approach.

Canadian Guidelines

The First Nations Health Authority in British Columbia provides guidelines for cultural safety and humility in healthcare:

1. Create a culturally safe environment
2. Practice self-reflection and recognize personal biases
3. Build relationships based on respect and trust
4. Incorporate traditional healing practices when appropriate
5. Collaborate with Indigenous communities and Elders

References

1. Truth and Reconciliation Commission of Canada. (2015). Honouring the Truth, Reconciling for the Future: Summary of the Final Report of the Truth and Reconciliation Commission of Canada.
2. Canadian Human Rights Act (R.S.C., 1985, c. H-6)
3. Royal College of Physicians and Surgeons of Canada. (2015). CanMEDS 2015 Physician Competency Framework.
4. First Nations Health Authority. (2016). Creating a Climate for Change: Cultural Safety and Humility in Health Services Delivery for First Nations and Aboriginal Peoples in British Columbia.
5. Public Health Agency of Canada. (2018). Key Health Inequalities in Canada: A National Portrait.