Better cultural focus needed in preventive care

In thinking about the issues of access to preventive care and of management of chronic illness, I took myself as a point of reference. Here am I, a fairly savvy, reasonably healthy person, with training as a physician in modern scientific medicine, and with 50 years of experience within that system.
Knowing what I know and what I can anticipate at nearly every turn of medical events, I am nevertheless made to feel uncomfortable, and frankly less than welcomed, at most medical encounters. That is because the atmosphere generated is one of estrangement and of authoritarianism, a top-down, "we know what's good for you and we will do it for or to you for your own good" as opposed to a genuine sense of partnership, of co-operative effort or even of the fundamental requirement of what is meant by informed consent.
Much could be mitigated at the outset by some effort of welcome, like the small courtesies I described in my previous essay, those initial efforts beginning with introduction.
It was from that perspective I could consider why it is that our DHB and other health care facilities do not deliver enough in the way of preventive care especially directed toward Maori.
Clearly the technology and the information is available. So is the will, at least according to Kate Joblin and Julie Patterson. But the way is not easily provided.
In what follows I rely upon what I learned when I spoke with Jennifer Thompson and Dave Taylor of Te Oranganui and a few others - patients, as it happens. At Te Oranganui I was treated to a candour and openness that was refreshing. If my inferences regarding Maori attitudes are off the mark, the fault is entirely mine.
Cervical smears and mammograms are means of early detection of cervical and breast cancer.
Mortality rates for these two cancers are higher among Maori, and earlier detection is highly likely to make a difference; yet Maori are not coming for these procedures to the same degree as non-Maori.
Maori regard the female reproductive system as whare tangata, literally the house of the people or of creativity. In that culturally-defined attitude may lie the seeds of the problem and the hope of resolution. I tried to imagine what it would be like to come for a "routine" pelvic examination as a Maori woman, and I was immediately horrified and put off by the entire prospect.
We Western-trained physicians strive to create an impersonal atmosphere, particularly in the case of the most intimate of examinations. Patients are expected to be compliant and, frankly, passive; practitioners to be business-like and efficient. Clearly, the process is designed to avoid any semblance of intimacy lest some step take place across a boundary from the impersonal to the sexual. Despite the fact that the biologic purpose of the body parts being examined is a sexual one, the Western medical practice operates to keep even the word out of discussion in a view to generate safety for both practitioner and patient.
Actually, denial of the reality works just the opposite. Such examinations are probably off-putting for all patients, but even more for Maori.
Another thing I learned was that Maori regard the unit of health to be the family. That concept may be a route out of the problems of these examinations. Our routine point of view in scientific medicine has for too long been concentrated on individual pathology in that the science that underlies medicine focuses on the smallest social and physical units. There is no real justification for excluding family in the medical situation at every level short of the surgical theatre.
If, for example, we wish to affect mortality rates for lung cancer, then we can do a lot worse than aiming our effort at children and encouraging them to go home to parents and grandparents and say, simply: "Grandad, please don't die; please give up smoking so I'll have you around as I grow up". Or: "Dad, stop drinking so much so you can live to be at my wedding'."