What is Māori patient-centered medicine for Pakeha general practitioners?

Abstract

This research was designed to see whether the clinical method espoused by Moira Stewart et al in the book "Patient-Centered: Transforming The Clinical Method" is appropriate for Pakeha general practitioners to use in clinical consultations with Māori patients.

This thesis uses qualitative methodology. One of my supervisors and I selected from the kuia (old women) and kaumatua (old men) of Hauraki those whom I would approach to be involved. Nearly all responded in the affirmative.

The kuia and kaumatua talked about their tikanga, about the basis of tikanga, about the spirituality of their Māori worldview. They talked about the need to maintain their tikanga, about qualities that they respect. They described different roles within Māoridom, especially those of the kuia, whaea (mothers) and Tohunga (experts). They refer to a GP as a Tohunga because of the GP's special expertise. The GP is able to use his or her special expertise to heal Māori patients, but needs to be able to get through barriers to do so. They are also clear that Māori and Pakeha live in two different worlds which can merge in some circumstances.

I came to two conclusions. The first is that the elements of Patient-Centered Medicine are relevant to the consultation of a Pakeha GP and Māori patient, and provides a framework that is productive. The second conclusion is that there is a better framework for working with Māori patients, within which Patient-Centered Medicine can be practiced more effectively. Māori already have a framework (tikanga) in which they function, and if in their settings, especially the marae, he or she is welcomed and has a place in their world; tikanga accommodates the GP as a Tohunga and Māori respond to him or her as such.

In summary, a Pakeha GP who has some knowledge of tikanga or Māori culture and who has a basic knowledge of the Māori language of tikanga of Māori culture and who has a basic knowledge of the Māori language can work very well for his or her Māori patients by working within the framework of Tikanga Māori and by being patient-centered in consultation.