Consulting a Patient Who Distrusts Doctors
MMIHardAnswer the question
Consulting a Patient Who Distrusts Doctors
A Māori man, Tūhoe, 55, comes to your GP clinic for the first time in many years. He says: 'I don't trust doctors — last time I came in, I felt like I was being talked down to and rushed out the door.' His blood pressure is severely elevated. How do you conduct this consultation?
What does 'institutional racism' mean in a health context, and why is it relevant to Tūhoe's experience?
How do you address the immediate clinical risk (severely elevated BP) while rebuilding trust?
What follow-up plan would respect his autonomy while not abandoning him to a high cardiovascular risk?
Speak it out loud and we'll type it for you (free), or type your own notes — then mark yourself below.
- SPIKES for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, Strategy.
- Listen → empathise → check understanding → agree a plan together. Calm voice, no jargon.
What strong answers doReveal the benchmark
Hidden so they don't bias your answer. Score yourself first, then reveal them to compare.
- Start by listening, not fixing: treat his distrust as both a clinical finding (years of avoided care) and a relational signal, and ask him what happened before so you can do better.
- Define institutional racism as systematic differences in care by race (shorter consultations, less information, less follow-up), citing NZ evidence that Māori receive less analgesia, fewer referrals and less investigation than non-Māori with comparable presentations.
- Tell him the blood pressure number and why it matters, ask permission before moving into management, and design follow-up he will attend (longer appointment, same clinician, whānau, a kaupapa Māori provider) with a clear safety net.
Mark yourself
Score each skill against the rubric, then add a line of evidence. Scale:
Empathy
0/3Responds to expressed distrust as both clinical information and a relational signal
Communication
0/3Balances listening, transparency, and clinical urgency without coercion
Cultural Safety
0/3Understands institutional racism as a structural pattern, not just individual prejudice
Ethics
0/3Holds shared decision-making even under clinical time pressure