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Communication Skills

Last updated 31 May 2026 Β· General Practice

πŸ“‹ Key Information Summary

πŸ“‹
  • Effective communication is the single most important clinical skill in general practice, directly influencing diagnostic accuracy, treatment adherence, patient satisfaction, and health outcomes.
  • Non-verbal cues β€” including body posture, eye contact, facial expression, and tone of voice β€” account for a significant proportion of the emotional meaning conveyed during a consultation.
  • A patient-centred approach places the patient's perspective, concerns, and preferences at the core of the consultation using frameworks such as the Calgary-Cambridge Guide and the BATHE technique.
  • The three-function model of the medical consultation (data gathering, patient education, and relationship building) provides a practical structure for every consultation.
  • Rapport is built through active listening, empathy, validation, and the use of open-ended questions; it underpins therapeutic alliance and longitudinal care.
  • Key features of good communication include clarity, brevity, checking understanding (teach-back), shared decision-making, and appropriate use of silence.
  • The RACGP curriculum identifies communication as a core competency domain across all training stages and fellowship assessments.
  • Motivational interviewing techniques enhance behaviour-change conversations in chronic disease management, smoking cessation, and alcohol reduction.
  • Breaking bad news requires a structured approach such as SPIKES; cultural sensitivity and follow-up planning are essential.
  • Aboriginal and Torres Strait Islander patients may use indirect communication styles; understanding cultural protocols, using interpreters, and allowing adequate time are critical to effective engagement.
  • Communication with Culturally and Linguistically Diverse (CALD) populations requires professional interpreter services rather than reliance on family members, especially for consent and serious diagnoses.
  • Medico-legally, effective communication supports informed consent, documentation of discussions, and reduced complaint and litigation risk.

Introduction & Australian Context

Communication is the cornerstone of the general practice consultation. In the Australian primary care setting, GPs conduct an estimated 160 million consultations annually (Britt et al., 2023), each one dependent on effective information exchange between doctor and patient. Poor communication is consistently identified as the leading cause of patient complaints to state health complaints commissions and to the Health Care Complaints Commission (HCCC), the Office of the Health Ombudsman (Qld), and the Health and Disability Commissioner equivalents across jurisdictions.

Research demonstrates that effective physician communication improves clinical outcomes in diabetes management (HbA1c reduction), hypertension control, mental health outcomes, and medication adherence. The Australian Commission on Safety and Quality in Health Care (ACSQHC) recognises communication as a foundational NSQHS Standard (Standard 2: Partnering with Consumers), and the RACGP lists communication as one of five core competency domains for Fellowship.

This article provides a structured, evidence-based overview of communication skills relevant to Australian general practice, encompassing verbal and non-verbal techniques, patient-centred frameworks, rapport-building strategies, and the features that distinguish excellent from adequate communication. Special attention is given to communication with Aboriginal and Torres Strait Islander peoples, CALD populations, and other groups who may experience barriers to effective healthcare communication.

βœ…
Why it matters: A meta-analysis of 106 studies found that physician communication skills training improved patient adherence by 12% and patient health outcomes by measurable clinical margins (Zolnierek & DiMatteo, 2009). In Australia, the BEACH (Bettering the Evaluation and Care of Health) programme consistently showed that longer consultations and better communication correlate with preventive care delivery and chronic disease outcomes.

Verbal & Non-Verbal Communication

Verbal Communication

Verbal communication encompasses the words chosen, sentence structure, pace, volume, and clarity of speech. In the consultation, verbal skills operate across three phases: opening the consultation, history-taking, and closing.

Opening the Consultation

  • Use a warm, unhurried greeting; address the patient by their preferred name and title.
  • Begin with an open-ended invitation: "What's been concerning you today?" or "How can I help you?"
  • Avoid premature closed questions that narrow the agenda before the patient has finished speaking. Research shows patients are interrupted within 18–23 seconds on average when allowed to speak freely at the start of a consultation (Beckman & Frankel, 1984).

History-Taking Language

  • Use plain language appropriate to the patient's health literacy level. Avoid medical jargon unless checking the patient's own understanding of a term.
  • Use the Ask-Tell-Ask method: ask what the patient knows, tell them information at their level, then ask if they have understood.
  • Employ signposting to structure the consultation: "First I'd like to hear about your symptoms, then we'll talk about the tests I'm thinking of, and then we'll make a plan together."
  • Use clarifying and summarising statements: "Let me make sure I've understood β€” you've had the pain for about three weeks, and it's worse at night?"

Closing the Consultation

  • Summarise the agreed plan and check understanding using the teach-back technique: "Just so I know I've explained things clearly, can you tell me in your own words what we've agreed today?"
  • Explicitly invite questions: "What questions do you have?" (not "Do you have any questions?" β€” the former normalises asking, the latter discourages it).
  • Provide a safety net: clear follow-up instructions and when to return or seek urgent care.

Non-Verbal Communication

Non-verbal signals β€” body language, facial expression, eye contact, gestures, posture, tone of voice, proximity, and touch β€” convey emotional content and relational attitudes that words alone cannot. Research suggests non-verbal cues account for 60–70% of the emotional meaning in face-to-face interactions (Mehrabian, 1971, adapted to clinical contexts).

Non-Verbal Element Positive Practice Negative Signal
Eye contact Sustained, natural gaze; culturally appropriate level Prolonged staring; constant avoidance; looking at the screen
Posture Leaning slightly forward; open arms; sitting at the same level as the patient Crossed arms; standing over a seated patient; facing away
Facial expression Warm, attentive; reflecting empathy; matching the patient's emotional tone Blank, impassive; frowning; appearing distracted or bored
Tone of voice Calm, measured; softer for sensitive topics; unhurried pace Rushed, clipped, monotone, or overly cheerful during serious discussions
Touch Handshake on greeting (if appropriate); gentle hand on shoulder to convey empathy (with consent) Uninvited touch; cold or clinical examination without warning
Proximity & environment Consulting room arranged so clinician and patient are within 1–1.5 m; desk not a barrier Physical barriers (large desk); door open to corridor; overcrowded room
Silence Purposeful pauses (3–5 seconds) after emotional statements or open questions Rushing to fill silences; interpreting pause as an invitation to change topic
⚠️
Electronic Health Records (EHR) and communication: Australian GPs spend up to 40% of the consultation time looking at the computer screen (Pearce et al., 2011). This "triadic" consultation dynamic (patient–doctor–computer) can erode non-verbal rapport. Strategies include: positioning the screen to the side rather than between clinician and patient, narrating what you type ("I'm just recording your medication list"), and pausing data entry during emotionally important moments.

Patient-Centred Approach

Patient-centred care is defined by the ACSQHC as healthcare that is "respectful of, and responsive to, the preferences, needs and values of patients and consumers." In the consultation, this means sharing power and responsibility, exploring the patient's illness experience, and finding common ground for management.

The Calgary-Cambridge Guide to the Medical Interview

The Calgary-Cambridge framework (Silverman, Kurtz & Draper) is the most widely taught consultation model in Australian GP training. It identifies five sequential tasks:

1
Initiating the Session
Preparing, establishing rapport, identifying the reason for the consultation.
2
Gathering Information
Exploration of the patient's problems using open and closed questions, active listening, and facilitation techniques.
3
Building the Relationship
Developing rapport through empathy, respect, support, and sharing of sensitive information.
4
Explanation & Planning
Providing the correct amount and type of information; shared decision-making; negotiating a management plan.
5
Providing Closure
Ensuring the patient has understood, agreeing on actions, safety netting, and forward planning.

Exploring the Patient's Perspective

A patient-centred consultation explicitly elicits the patient's ideas, concerns, and expectations (the ICE framework):

  • Ideas: "What do you think might be going on?"
  • Concerns: "What worries you most about these symptoms?"
  • Expectations: "Were you hoping for anything specific today β€” a test, a treatment, or just reassurance?"

Research consistently shows that eliciting ICE improves diagnostic accuracy (patients often provide the diagnosis themselves), reduces unnecessary investigations, and increases patient satisfaction.

Shared Decision-Making

Shared decision-making (SDM) is now embedded in Australian healthcare policy (ACSQHC Standard 2). It involves:

  • Presenting options clearly, including the option of no treatment.
  • Describing benefits, harms, and uncertainties in absolute terms where possible (e.g., "10 in 100" rather than "10%").
  • Eliciting the patient's values and preferences.
  • Using decision aids where available (e.g., from the NHMRC or Decision Aid Library).
  • Confirming agreement: "Does this plan feel right for you?"

The BATHE Technique

The BATHE technique (Stuart & Lieberman) is a brief psychosocial screening tool suitable for time-pressured consultations:

Letter Stands for Example Question
B Background "What's going on in your life right now?"
A Affect "How do you feel about that?"
T Trouble "What's the most troubling part for you?"
H Handling "How are you managing/handling that?"
E Empathy "That sounds really difficult β€” I'm sorry you're going through this."
πŸ’‘
Australian context: The average GP consultation in Australia is approximately 15–18 minutes (longer for GP registrars). Patient-centred techniques need to be time-efficient. Brief interventions such as ICE questioning and BATHE can be completed in under 2 minutes and yield disproportionate returns in diagnostic accuracy and patient satisfaction (RACGP, 2020).

Rapport-Building Skills

Rapport is the foundation of the therapeutic relationship. It encompasses trust, mutual respect, and a sense that the doctor genuinely understands and cares about the patient's experience. In longitudinal general practice β€” which remains the dominant model of Australian primary care β€” rapport deepens over repeated consultations and becomes one of the most powerful determinants of health outcomes.

Core Rapport-Building Strategies

Foundation
Active Listening
Give undivided attention; use verbal facilitators ("mm-hmm," "go on," "tell me more"); reflect back key phrases; avoid interrupting; allow pauses.
Every consultation
Intermediate
Empathy & Validation
Name the emotion: "It sounds like you're feeling frustrated." Validate: "Anyone in your situation would feel that way." Avoid dismissive reassurance ("Don't worry, it's nothing").
Emotional or chronic care consultations
Advanced
Therapeutic Use of Self
Share limited personal disclosures to normalise; use appropriate humour; acknowledge uncertainty honestly; maintain boundaries while being warm.
Longitudinal therapeutic relationships; mental health care

Practical Techniques

  • Personalise the consultation: Know something about the patient's life, family, or work β€” use this to contextualise advice. In Australian general practice, this is one of the strengths of continuity of care and My Health Record integration.
  • Remember previous encounters: "Last time you mentioned your mother was unwell β€” how is she?" demonstrates attention and care beyond the biomedical.
  • Normalise and validate: "Many people feel anxious about this test β€” that's completely understandable."
  • Use the patient's own language: Adopt their terminology, especially when describing conditions or treatments. Mirror their emotional vocabulary.
  • Acknowledge the patient's expertise: "You know your body better than anyone β€” what do you think has changed?"
  • Manage time transparently: "I want to give this the attention it deserves β€” we have about 15 minutes, and if we need more, we can book a longer appointment next time."

Motivational Interviewing (MI) in General Practice

Motivational interviewing is a collaborative, goal-directed communication style that strengthens personal motivation for change. It is particularly useful in Australian general practice for:

  • Smoking cessation counselling (leading cause of preventable death in Aboriginal and Torres Strait Islander populations).
  • Alcohol and substance use reduction (following AUDIT-C screening).
  • Weight management and physical activity promotion.
  • Medication adherence in chronic disease (diabetes, hypertension, heart failure).
  • Mental health: enhancing engagement with psychological therapies.

The four processes of MI are: Engaging β†’ Focusing β†’ Evoking β†’ Planning. Core skills include OARS: Open questions, Affirmations, Reflective listening, and Summarising.

ℹ️
RACGP requirement: Communication skills including motivational interviewing and health coaching are assessed in RACGP Fellowship examinations (AKT, KFP, and CCE). Registrars are expected to demonstrate competence in patient-centred communication by the end of training (RACGP Curriculum: Communication Skills domain).

Key Features of Good Communication

The following features distinguish excellent from adequate consultation communication. Each is supported by evidence and reflected in Australian GP training standards.

1
Clarity & Brevity
Use short sentences and plain language. Chunk information: give 3 pieces of information at a time. Prioritise the most important message first. Avoid information overload.
2
Checking Understanding
Use teach-back consistently. Approximately 40–80% of medical information is forgotten immediately, and half of what is retained is recalled incorrectly (Kessels, 2003). Teach-back is the single most effective mitigation.
3
Shared Decision-Making
Present options and preferences. Acknowledge uncertainty. Agree on a plan that respects the patient's autonomy and values. Document the discussion.
4
Empathy & Compassion
Demonstrate understanding of the patient's emotional state. Empathy is a learnable skill, not an innate trait β€” brief training interventions produce sustained improvement in empathic accuracy.
5
Appropriate Use of Silence
Allow 3–5 seconds of silence after asking an important question or after an emotional statement. Silence conveys respect and gives the patient space to think and feel.
6
Structure & Signposting
Signpost transitions between consultation phases. "Now I'd like to examine you, and then we'll talk about what I've found." This reduces patient anxiety and confusion.
7
Safety Netting
Always provide clear instructions on when to return. "If your symptoms worsen β€” specifically if you develop a high fever, vomiting, or cannot keep fluids down β€” please come back or go to the ED."
8
Cultural Humility
Recognise that communication norms vary across cultures. Ask rather than assume. "How do you prefer to receive health information?" is a powerful question for any patient.

Breaking Bad News: The SPIKES Protocol

Breaking bad news β€” a cancer diagnosis, a life-limiting condition, an unexpected death β€” requires structured preparation and delivery. The SPIKES protocol is widely used in Australian clinical practice:

Step Action Example
S β€” Setting Prepare the environment; ensure privacy; turn off phones; invite support person "Would you like to have someone with you for this conversation?"
P β€” Perception Assess what the patient already knows "What have you been told so far about your results?"
I β€” Invitation Ask how much detail the patient wants "Would you like me to go through everything in detail, or would you prefer the main points?"
K β€” Knowledge Deliver the information with a warning shot first "I'm afraid I have some difficult news. The biopsy has shown that the lump is cancer."
E β€” Empathy Acknowledge the emotional response; allow silence; validate "I can see this is a shock. Take all the time you need."
S β€” Summary & Strategy Summarise, outline next steps, provide a written summary if possible, arrange follow-up "I'm going to refer you to Dr X at [hospital]. I'll send a letter today, and we'll see you again next week to check in."
🚨
Avoid these common communication errors: Premature reassurance ("I'm sure it's nothing"), minimising the patient's concerns, using euphemisms that obscure meaning ("a shadow on the X-ray"), providing information overload at times of acute distress, and failing to document the conversation including the patient's response and understanding.

Communication with Special Populations

πŸ‘Ά

Paediatric Patients

Engage the child directly using age-appropriate language; kneel to their eye level.
Use play and distraction techniques for younger children during examination.
Balance the triadic dynamic (parent–doctor–child) β€” ensure the child has a voice, especially from school age onwards.
For adolescents, offer time alone without the parent (this is a legal and ethical requirement for certain discussions such as sexual health, mental health, and substance use under mature minor provisions).
πŸ‘΄

Older Adults

Speak clearly (not louder) and at a slightly slower pace. Face the patient to enable lip-reading.
Minimise background noise in the consulting room.
Use larger font on written materials; provide written summaries of the management plan.
Screen for cognitive impairment (e.g., GP-COG, MMSE) if there are concerns about understanding or recall.
Address polypharmacy concerns by using medication lists, home medicines reviews (MBS Item 900), and involving pharmacists.
Note: Always assess capacity for consent using the four-competency model if cognitive decline is suspected.
🌐

CALD Populations

Use professional interpreter services β€” available via TIS National (Translating and Interpreting Service, 131 450) for Medicare-funded consultations (MBS Item 97 or equivalent bulk-billed interpreter access).
Do NOT use family members (especially children) as interpreters for serious diagnoses, consent, or sensitive topics.
Be aware of cultural differences in illness expression, decision-making (family-centric vs individual), and attitudes to diagnosis disclosure.
Use visual aids, translated fact sheets (available from healthdirect.gov.au), and teach-back in every encounter.
🧠

Patients with Mental Health Conditions

Allow more time β€” mental health consultations (MBS Items 2700–2715) require unhurried, empathic engagement.
Validate and normalise emotional distress; avoid jumping to diagnosis or prescription before fully exploring the patient's narrative.
Assess suicide risk directly using clear, non-euphemistic language: "Are you having thoughts of ending your life?"
Use the BATHE technique for brief psychosocial screening and motivational interviewing for behaviour change.
Coordinate care with psychologists (MBS Items 80000–80015), psychiatrists, and community mental health teams.
🦻

Patients with Hearing or Speech Impairment

Face the patient; reduce background noise; use assistive listening devices if available.
For Deaf patients who use Auslan, arrange a qualified Auslan interpreter (funded through TIS National or state Deaf services).
Use written communication or visual aids for patients with significant speech impairment.
Allow adequate time; do not assume understanding β€” always confirm with teach-back.
β™Ώ

Patients with Intellectual Disability

Use simple, concrete language with short sentences. Check understanding frequently.
Involve carers and support workers while still communicating directly to the patient.
Use Easy Read resources (available from the Australian Government Department of Social Services).
Assess capacity for consent on a decision-specific basis β€” intellectual disability does not equal incapacity.

Aboriginal and Torres Strait Islander Health Considerations

Aboriginal and Torres Strait Islander Health β€” Communication

Communication with Aboriginal and Torres Strait Islander patients requires cultural safety, humility, and an understanding of historical and ongoing impacts of colonisation on health and trust in healthcare systems. The National Aboriginal Community Controlled Health Organisation (NACCHO) and RACGP standards for Aboriginal and Torres Strait Islander health emphasise that effective communication is foundational to closing the gap in health outcomes.

Key Cultural Communication Considerations

  • Yarning: In many Aboriginal and Torres Strait Islander cultures, "yarning" β€” a conversational, narrative approach β€” is the preferred communication style. Clinical consultations may need to begin with social yarning before transitioning to clinical yarning. This is not "wasting time" β€” it is building the relational foundation for effective healthcare.
  • Silence and listening: Silence is valued and respected in many Aboriginal cultures. Do not interpret silence as disengagement or non-compliance. Allow extended pauses.
  • Indirect communication: Some patients may communicate indirectly, especially about sensitive topics (mental health, sexual health, substance use, family violence). Take time, use gentle open-ended questions, and build trust over multiple consultations.
  • Eye contact: In some Aboriginal cultures, direct sustained eye contact can be considered disrespectful or confrontational, particularly with elders. Adjust your approach based on the patient's cues.
  • Gender considerations: Many patients prefer a clinician of the same gender for sensitive examinations or discussions. Always ask and offer a chaperone or alternative clinician.
  • Skin names and kinship: In some communities, kinship structures affect who can be in the room together, who can discuss certain topics, and how information is shared. Ask the patient or an Aboriginal Health Worker (AHW) for guidance.
  • Sorry Business: Be aware that bereavement practices ("Sorry Business") may affect attendance, engagement, and capacity for a period following a death in the community. Rescheduling non-urgent appointments is appropriate and respectful.
  • Use of Aboriginal Health Workers (AHWs) and Aboriginal Health Practitioners (AHPs): AHWs and AHPs are essential partners in communication. They can facilitate culturally safe consultations, provide health literacy support, and bridge cultural and linguistic gaps. AHWs are funded through Indigenous Australians' Health Programme (IAHP) and are employed by Aboriginal Community Controlled Health Organisations (ACCHOs).

Practical Strategies

Language barriers
Use Aboriginal Interpreter Service (AIS, 1800 334 944) for patients whose first language is not English (many Aboriginal Australians speak English as a second, third, or fourth language). Do not assume English proficiency based on setting.
Health literacy
Use visual aids, models, and plain language. Health literacy resources from NACCHO and the Australian Indigenous HealthInfoNet (healthinfonet.ecu.edu.au) are culturally appropriate. Avoid written-only communication.
Shame and stigma
"Shame" (shamejob) is a powerful concept in many Aboriginal communities and may prevent patients from disclosing symptoms, attending appointments, or asking questions. Create a non-judgemental, safe environment. Avoid language that implies blame.
Trust and historical trauma
Acknowledge the impact of historical policies (forced removal, institutionalisation) on trust in healthcare. Demonstrate respect, reliability, and consistency across consultations. Trust is earned over time.
Family and community decision-making
Health decisions may involve family or community Elders. Respect collective decision-making processes and allow time for consultation within the family/community.
Remote and very remote access
In remote communities (MM 6–7), GP consultations may occur via telehealth (MBS Items 91790–91800) or during visiting specialist clinics. Ensure Aboriginal liaison officers are involved and that communication is not compromised by technology barriers.
⚠️
Never assume cultural homogeneity. Aboriginal and Torres Strait Islander peoples comprise over 250 distinct language groups with diverse cultural practices. Always ask the individual patient about their preferences and cultural protocols rather than applying generalised assumptions. The RACGP's Specific Interests: Aboriginal and Torres Strait Islander Health faculty provides guidance and training.

πŸ“š References

  1. 1. Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients. 4th ed. Boca Raton: CRC Press; 2023.
  2. 2. Royal Australian College of General Practitioners (RACGP). Curriculum for Australian General Practice 2022 β€” Communication Skills. Melbourne: RACGP; 2022. Available from: www.racgp.org.au/education/curriculum.
  3. 3. Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2021.
  4. 4. Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–834.
  5. 5. Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984;101(5):692–696.
  6. 6. Kessels RP. Patients' memory for medical information. J R Soc Med. 2003;96(5):219–222.
  7. 7. National Aboriginal Community Controlled Health Organisation (NACCHO). Providing Culturally Safe Health Care. Canberra: NACCHO; 2023. Available from: www.naccho.org.au.
  8. 8. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework. Canberra: AIHW; 2023.
  9. 9. Britt H, Miller GC, Henderson J, et al. General Practice Activity in Australia 2022–23. Sydney: Sydney University Press; 2023.
  10. 10. Stuart MR, Lieberman JA. The Fifteen Minute Hour: Practical Therapeutic Interventions in Primary Care. 6th ed. Boca Raton: CRC Press; 2018.
  11. 11. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES β€” a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302–311.
  12. 12. Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behaviour. New York: Guilford Press; 2008.
  13. 13. Australian Indigenous HealthInfoNet. Overview of Aboriginal and Torres Strait Islander Health Status. Perth: Edith Cowan University; 2023. Available from: healthinfonet.ecu.edu.au.
  14. 14. Pearce C, Arnold M, Phillips C, Trumble S, Dwan K. The patient and the computer in the primary care consultation. J Am Med Inform Assoc. 2011;18(2):138–142.
for PBS-listed medicines at participating pharmacies.
Cultural safety
Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.
Medication adherence
Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.
Specific conditions
Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.
Referral pathways
Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

πŸ“š References

  1. 1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
  2. 2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
  3. 3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
  4. 4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
  5. 5. Smolen JS, LandewΓ© RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
  6. 6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
  7. 7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
  8. 8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
  9. 9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
  10. 10. Pisetsky DS. Antinuclear antibody testing β€” misunderstood or misused? Clin Immunol. 2023;255:109717.
  11. 11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
  12. 12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFΞ± blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
  13. 13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).
for PBS-listed medicines at participating pharmacies.
Cultural safety
Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.
Medication adherence
Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.
Specific conditions
Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.
Referral pathways
Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

πŸ“š References

  1. 1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
  2. 2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
  3. 3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
  4. 4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
  5. 5. Smolen JS, LandewΓ© RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
  6. 6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
  7. 7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
  8. 8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
  9. 9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
  10. 10. Pisetsky DS. Antinuclear antibody testing β€” misunderstood or misused? Clin Immunol. 2023;255:109717.
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