Question

A 45-year-old First Nations woman living on-reserve has type 2 diabetes diagnosed 5 years ago. Her HbA1c is 9.1% despite metformin and gliclazide. She has missed several appointments and says that the clinic does not feel like it is for people like her and that she fears being judged, as several relatives have had diabetes complications. Which physician response best demonstrates a culturally safe, CanMEDS-aligned approach?

Accepted Answer

Acknowledge the impact of colonisation and past experiences with health services, explore her priorities and, with her permission, involve an Indigenous health worker or Elder

Answer

Emphasise that poor adherence is the main reason Indigenous people have more diabetes complications

Answer

Increase her gliclazide dose and schedule more frequent visits without further discussion

Answer

Explain firmly that complications are inevitable unless she follows medical advice closely

Answer

Discharge her from the practice if she misses further appointments

Practice question