What cultural safety means
The definition used across Australia's health practitioner regulation scheme, and adopted in Good medical practice: a code of conduct for doctors in Australia, starts from one idea:
"Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities."
In other words, it is the patient, not the doctor, who decides whether care was culturally safe. Culturally safe practice is the ongoing critical reflection by practitioners on their own knowledge, skills, attitudes, behaviours and power, so that care is accessible, responsive and free of racism.
Wording from the Medical Board of Australia code of conduct (section 4.7), issued 1 October 2020. Check the Board website for the current version.
Awareness, competence and safety
| Concept | Focus | Who judges it |
|---|---|---|
| Cultural awareness | Knowing that cultural differences exist | The practitioner |
| Cultural competence | Knowledge and skills about other cultures | The practitioner or an educator |
| Cultural safety | Reflecting on your own culture, assumptions and power, and changing how you practise | The patient, family and community |
The shift is from learning facts about "other" cultures to examining yourself. A doctor can know a great deal about a culture and still deliver care that a patient experiences as unsafe.
What the code of conduct expects
Section 4.7 of the code applies specifically to Aboriginal and Torres Strait Islander health. It asks doctors to:
- Acknowledge colonisation and systemic racism, and the social, cultural and economic factors that affect health.
- Recognise and address their own biases and assumptions, and provide care free of racism.
- Support self-determined decision-making and work in partnership with patients, families and communities.
- Foster safe working environments for Aboriginal and Torres Strait Islander patients and colleagues.
Section 4.8 extends culturally safe practice to all patients, asking doctors to understand how their own culture and assumptions shape their interactions. The code also makes clear that culturally safe practice does not require care that is medically unsafe.
What it looks like in a consultation
| Instead of | Try |
|---|---|
| Assuming what the patient wants to know | "How much would you like me to explain about the results?" |
| Deciding who should be in the room | "Would you like anyone with you, family or a health worker?" |
| Reading silence as agreement | Pausing, then checking: "What do you think about that plan?" |
| Labelling missed appointments as non-compliance | Asking about transport, cost, work, family duties or past experiences of care |
| Using a family member to interpret | Booking a professional interpreter, in person, by phone or video |
| A plan you designed alone | A plan you agree together, including traditional or family approaches where safe |
Power, racism and your own culture
Doctors hold power: to diagnose, prescribe, refer, certify and decide who is believed. Patients who have experienced racism in health care may expect it again, and may avoid care as a result. Culturally safe practice means noticing how your manner, assumptions and systems affect that experience.
- Notice your first assumption about a patient and check it against what they actually tell you.
- Speak up when colleagues or systems treat patients unfairly; the code expects you to foster a safe workplace.
- Reflect after difficult consultations: what would this patient say about how they were treated?
- Include cultural safety in your continuing professional development; colleges such as the RACGP require it.
For doctors who trained overseas
Many IMGs bring rich cross-cultural experience. The adjustment is usually to Australian expectations of shared decision-making, plain-language explanation and patient autonomy, and to the specific history of Aboriginal and Torres Strait Islander peoples. Your own cultural background is part of the reflection, not something to set aside.
Practical steps: complete a recognised cultural safety course, learn about the Traditional Owners where you work, and get to know the local Aboriginal health workers and community-controlled services. See Aboriginal and Torres Strait Islander health for IMGs for the clinical side.
Cultural safety in exam stations
- Ask before assuming: identity, preferred name, who should be present.
- Offer an interpreter when language is a barrier and speak to the patient, not the interpreter.
- Explore the patient's beliefs about the illness before giving advice.
- Agree the plan rather than prescribe it, and check it is workable for the patient's circumstances.
These behaviours are marked under the "approach to the patient" domain of the AMC Clinical. See AMC Clinical communication skills.
Common questions
Who decides whether care is culturally safe?
The patient. The definition used in Australia states that cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities.
Is cultural safety the same as cultural competence?
No. Competence is about the practitioner's knowledge of other cultures. Safety is about the practitioner reflecting on their own culture, biases and power, and is judged by the patient.
Is cultural safety a legal requirement for doctors?
It is part of the Medical Board of Australia's code of conduct, which all registered doctors are expected to follow.
Does cultural safety mean doing whatever a patient asks?
No. The code makes clear that culturally safe practice does not require care that is medically unsafe or inappropriate.