Some years ago I was visiting Aurukun, a community in the far north of Queensland, when an elder woman offered to take me fishing by the river. She set me up with a rod, and while she went to sort out her own, I wandered down to the water’s edge and started to cast.
A few minutes later she came over quickly and moved me back from the bank. A crocodile, she explained, could come out of that water and take me from where I was standing. I had felt completely safe. I had no idea I was in any danger at all.
I have never forgotten it. Standing there, confident and relaxed, I was the one person in that situation who did not understand what was happening. She could read the river. I could not. The knowledge that mattered most was not mine, and it had not once occurred to me that I was missing it.
In healthcare it is easy to assume we are the ones who understand the situation in front of us. We hold the clinical knowledge, the training, the authority. But when we care for someone whose world we do not fully know, we can be like I was at that riverbank: confident, well-meaning, and completely unaware of what we cannot see.
Cultural awareness in healthcare means recognising that patients may understand communication, illness, authority, family and trust differently from the way we do, and that we each carry our own cultural assumptions into every interaction. When we care for Aboriginal patients, that awareness can be the difference between someone feeling safe enough to speak and quietly disengaging from their care.
This insight runs through Milton Bennett’s work on intercultural sensitivity, where he quotes psychologist George Kelly:
“People do not respond directly to events; they respond to the meaning they attach to events.”1
The same interaction may feel respectful, rushed, safe, confusing or intimidating depending on the meaning a person attaches to communication, silence, questioning, eye contact, authority or family involvement.
The practical observations that follow come from a long interview I recorded with someone who has worked for decades in Central Australian communities and speaks one of the local languages fluently. They are patterns worth being aware of, not rules to apply to every Aboriginal person. Aboriginal Australia spans hundreds of nations and languages, and many Aboriginal people live and communicate in entirely mainstream ways. The aim is not to memorise a checklist, but to stay alert to the possibility that the meaning in the room may not be the one we assume.
1. Silence does not always mean understanding
One of the most common mistakes clinicians make is assuming that a quiet “yes” means a patient understands or agrees. For many Aboriginal patients, particularly where English is a second or third language, asking questions directly may feel uncomfortable or disrespectful.
Rather than asking “Do you understand?” it is often more effective to ask: “Can you show me how you’ll take this medicine?” or “Can you tell me the story back?”
Checking understanding through demonstration or retelling is often safer than relying on verbal agreement alone.
2. Use simple, concrete language
Medical language that feels ordinary to clinicians may be unfamiliar or confusing to patients. Even people who speak conversational English well may miss large portions of healthcare conversations if complex or abstract language is used.
Simple changes can make a significant difference:
- Instead of “Keep your fluids up” → “Drink more water”
- Instead of “We’ll do a blood test” → “We’re checking your blood for sickness”
- Instead of “dye for imaging” → “paint in the blood to help us see inside during the X-ray”
Concrete explanations are often far easier to understand than abstract medical terminology.
3. Be aware of shame and discomfort
In many Aboriginal communities, shame-based social dynamics strongly influence communication. Public attention, correction, praise or questioning may cause discomfort or withdrawal.
Clinicians may notice silence, looking away, minimal responses, or soft speech. These behaviours are not necessarily signs of disinterest, dishonesty or non-compliance. Often they reflect discomfort, respect, uncertainty or a desire not to stand out socially.
Creating a calmer, less pressured interaction can help patients feel safer to engage.
4. Eye contact and body language matter
Many non-Indigenous clinicians are taught that good eye contact shows confidence, honesty and engagement. In some Aboriginal contexts, however, prolonged direct eye contact can feel rude, confrontational or disrespectful.
A patient looking away may still be listening carefully.
This is an important reminder that body language is culturally interpreted. Clinicians should be cautious about assuming meaning too quickly based on non-verbal behaviour alone.
5. Family and kinship systems influence care
Kinship systems in Aboriginal communities can strongly shape who speaks to whom, who provides care, and who makes decisions. A man may avoid direct interaction with his mother-in-law. Certain health topics may be considered “men’s business” or “women’s business.” Cultural responsibilities may influence who attends appointments or provides support.
Healthcare interactions may become confusing if clinicians unintentionally place people into culturally inappropriate situations. Sensitivity to family and kinship structures can help avoid embarrassment and improve engagement.
6. Fear and mistrust may already exist
Some Aboriginal patients arrive at healthcare settings carrying significant fear or mistrust based on previous experiences. Hospitals and clinics may feel unfamiliar, intimidating or culturally unsafe. Fear of needles, procedures or hospitals may also be reinforced across generations.
In some communities, traditional beliefs about illness and healing may exist alongside biomedical understandings. Patients may attend both a clinic and a traditional healer, reflecting different ways of understanding sickness and wellbeing.
This does not mean healthcare should abandon clinical standards. But understanding that different explanatory frameworks may exist can help clinicians approach conversations with more curiosity and less frustration.
7. Learning is often observational
Traditional learning styles in many Aboriginal contexts are highly observational: watch first, then do. This means direct questioning may not always be the best teaching method. Repeated explanations, visual demonstrations and storytelling approaches are often more effective than rapid-fire verbal instructions.
Instead of asking many questions, clinicians may find it more helpful to demonstrate, repeat key messages simply, and invite the patient to show or explain things back in their own way.
8. Building trust takes time
Effective engagement in Aboriginal healthcare often depends heavily on relational trust. In my own cross-cultural experience, I have learned that people are often far more willing to listen once they feel safe, respected and known relationally.
Direct questioning too early can feel intrusive. Even seemingly ordinary questions such as “Where are you from?” or “What language do you speak?” may feel uncomfortable initially.
Building rapport often happens more slowly than many clinicians expect. Taking time to sit, listen and communicate calmly may improve both trust and clinical outcomes.
9. Cultural awareness improves patient safety
Many of these cultural differences may seem small at first, but in healthcare the communication disconnect can have significant consequences. When clinicians misunderstand silence, avoid building relational trust, use language that is too abstract, or misinterpret body language, patients may disengage from care or leave without fully understanding important health information.
Cultural awareness is not about knowing every fact about a culture. It is about recognising that your own lens may not be the only one in the room.
This kind of awareness sits alongside cultural humility, the habit of staying curious rather than assuming you have someone worked out, and culturally safe practice, where it is the patient, not the clinician, who decides whether care felt safe. For everyday illustrations across a range of cultural backgrounds, see our cultural awareness examples.
Cross-cultural communication challenges are explored further in our Communication for Safety course, which focuses on practical strategies for improving communication, cultural awareness and psychologically safe practice within Australian healthcare and care environments.
Organisations and managers can book a free consultation with Culture Creek Australia to discuss their team’s needs.
References
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Kelly, G. A. (1963). A Theory of Personality: The Psychology of Personal Constructs. New York: W. W. Norton. Quoted in Bennett (1986). ↩
Updated 12 June 2026
