1. Diversity in practice Working with diverse groups of patients

2. This afternoon Presentation - Asian patients Refugees and asylum seekers Gay and lesbian patients When language is an issue DVD on consultations with patients with different language backgrounds Tea Case discussions

3. From last week - dont forget Cultural competence = cultural knowledge plus open-mindedness Everyones culture is a bit mixed-up Culture is dynamic and changes over time Consultation involves interaction between your culture and the patients

4. A few generalisations about Asian culture Respect for elders Families more important than individuals Importance of marriage Distinct roles for men and women Importance of mother in law within the home Big families, desire for sons Mental illness carries more stigma than general population Taboo subjects e g termination of pregnancy, STDs, domestic abuse British-born generation are very different Cultural conflict for second generation

5. Refugees and asylum seekers Very diverse group Small welcoming gestures are worth a lot Dont make assumptions May have complex health needs Often have different health beliefs/expectations of health care system May be separated from family Post traumatic stress very common And stress from the way they are treated in the UK May tell distressing stories - doctor needs personal housekeeping Hard to get old information Consultations usually take a v long time Confidentiality v important

6. Gay and lesbian patients Huge change in public attitudes in last 20 years Diverse in terms of age, class etc Need to feel their sexuality will be accepted by doctor Vary a lot in how much they define themselves by their sexuality Doctors need phrases which indicate theyre not assuming everyone is heterosexual Doctors need knowledge about sexual health for gay and lesbian patients Next-of-kin issues important

7. What can we do when language is an issue? Excellent non verbal communication appropriate to culture Learn a few friendly expressions Express yourself as simply as possible Dont rush things Family member interpreters - with care and with reservations Practice staff with language skills - preferably trained in interpreting Telephone interpretation (plus non verbal)