an with many years' experience working with multicultural and Aboriginal patients.
The interaction: The 20-minute interaction, in English, was initiated by Dr B, who did most of the talking. The patient's mother and grandmother assisted with communication. Mr A and his family asked no questions and gave limited, non-verbal responses to the doctor's questions.
Communication goals: Dr B had clear goals:
I wanted to reinforce that [the patient] was at risk of progression to end-stage renal disease and that he would benefit from treatment, of blood pressure in particular . . . and treatment of other things like anaemia. . . . The main thing was that he doesn't need dialysis at the moment, but that he needed to be monitored and to take his tablets.
The expectations of Mr A and his family were unclear. It later became apparent that they believed that his disease had been cured during his admission. They had no appreciation of its chronicity and of his need for regular tests and medications.
The participants' assessment: Dr B was uncertain of the outcome of the interaction:
Perhaps his mother got some idea . . . I hope they at least understand he is at risk of needing more dialysis. I think they now understand he has kidneys that aren't working so well . . .
After the consultation, the Yolngu researcher discovered that the family's understanding of the doctor's advice was that Mr A should be taking medication. Despite Dr B's extended explanation of chronicity and prognosis, the interaction did not achieve a shared understanding of the state of the patient's kidneys, the significance of test results or the importance of blood pressure control. The family had understood little. This prompted the Yolngu researcher to recall Dr B to explain further, while she provided interpreting assistance.
Consequences for clinical management: Miscommunication reduced the ability to actively engage Mr A and his family in controlling his blood pressure, in retarding progression of his renal disease and in planning for future dialysis. Lack of effective communication about the need to relocate to Darwin for treatment, away from family and community, could result in the patient's reluctance to accept dialysis in the future.
3: Sample interaction (B)
Setting: The open waiting area at the dialysis unit.
Participants: Ms "C", a 50-year-old woman who had been on dialysis for five years. She speaks Yolngu languages and is fluent in conversational English. She has graduate qualifications as a teacher.
Sr "D", a 31-year-old female nurse with 10 years' experience in renal services, both as a nurse and patient educator, but with little formal training in cultural awareness.
The interaction: The interaction, in English, was initiated by Sr D. She determined the timing and location to fit in with her work program and with the patient's dialysis schedule. The nurse did most of the talking and the patient asked few questions.
Communication goals: Sr D aimed to provide education through feedback and discussion of routine monthly test results. She aimed to integrate information about dialysis, medication and diet, specifically related to the test results.
Neither participant mentioned what Ms C might have wanted to communicate.
The participants' assessment: Both believed that the communication had, to some extent, been effective. Ms C said, "I could see it all clearly. . . . I didn't have any misunderstanding."
However, through analysis of the video with each participant and with further discussion, evidence of extensive miscommunication emerged. The nurse had emphasised, during the interaction, that Ms C's haemoglobin level was low and had discussed its significance in terms of her health and the use of erythropoietin. In the exit interview, Ms C indicated that she believed that all her results were normal.
Sr D had discussed results of biochemical tests and the use of specific medications. She said, "[The patient] knows a lot about medication and dialysis treatment. . . . She knows what medication she's on."
However, at exit interview, it became clear that Ms C