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We applaud Dr Partridge's recent thought provoking editorial1 which is timely with recent articles focusing on medicine, poverty, and marginalised groups.2 We wish to add that the issues raised by Partridge are also highly relevant in Australia with respect to indigenous Australians who have unacceptably high levels of morbidity and mortality compared with non-indigenous Australians.3 Also, in addition to the influence of the doctor/patient relationship on health care, we wish to question the model of care used by doctors and other health care providers when servicing minority groups.4
We have had the privilege of providing a paediatric respiratory outreach service to remote indigenous communities in far north Queensland over the last three years. In these children we found a high rate of persistent asthma and non-optimal use of asthma devices as well as poor asthma knowledge. Also, by using the community controlled primary health care model instead of the standard practice of servicing through the hospital system, we were able to achieve very high attendance rates (98%) at our clinics4 as well as in our recently completed prevalence study (95%) (unpublished). Although high attendance rates may not necessarily equate to better care, they do provide a greater opportunity for addressing important elements of health maintenance such as health education and preventative medicine in contrast to an “acute medicine” approach.
It is easy for doctors to resort to a defeatist approach when providing care to minority groups—put the onus on the patients and blame culture and language differences. It is harder to examine and question one's interaction with one's patients and critically to examine how best to provide a genuine service. As stated by Richard Smith: “they deserve the best, not the poorest, care”.2
author's reply Professor Chang and Drs Shannon and Masters make important points that widen the issue to remind us all that there are other sectors of society who need special attention. My personal view is that the problems that affect asthma care delivery are the same throughout the world; it is only the magnitude of the individual problems that varies from country to country.
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