Over her long career Dr Lucy O’Hagan has developed deep insights into the profound but often complex relationship between patients and doctors. Reading about her own struggle with what it means to be a truly useful doctor is both fascinating and absorbing.

From working with people living on the margins and her own burnout to her efforts to better serve her Māori patients and the humour that’s sometimes needed to get through the day, she keeps her eye on one key question: What is it to be a good doctor in this place?

Extracted from Everything but the medicine: A doctor's tale, by Lucy O'Hagan, published by Massey University Press. $39.99

Coloniser tends those dispossessed by colonisation

It’s tricky writing about being a Pākehā doctor to Māori. The coloniser tending to those dispossessed by colonisation is always an awkward dance. The doctor’s room is itself a politicised venue, like entering an inner sanctum where we expect the patient to worship all that we stand for. We ask them to believe: in us, in what we think is best for them, in a Western version of health, which is essentially health for those privileged enough to not be worried about housing or work or putting food on the table or dealing with government agencies who will judge them.

Sometimes we sing from the missionary’s hymnbook: ‘Swallow my pills and you will be healed.’ Sometimes we pull out our great bible of health literacy and translate it into simple language for those we assume know nothing of health at all.

Sometimes we go on a crusade, mount a drive-through of the poorer indigenous suburbs, dropping health pamphlets from our high horses.

Sometimes we say it is their fault if they die young; we can’t be responsible for poor life choices like chicken nuggets and Coke, while those in power have imported blue cheese with sips of Perrier because French water must be better.

Sometimes we get millions of dollars to research the problem and we peer at them through our telescopes, then build careers on our pompous conclusions, claiming we are the ones who know why these people have poor health outcomes.

It works on paper, that mission to drive down the rate of diabetes and kidney transplant and alcohol abuse. It makes absolute sense in terms of epidemiology and equity and public health and fairness, written neatly in a manifesto in an office, downtown, where the dispossessed are kept out by security guards.

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It’s much harder when I am face to face with real people like Aroha. Aroha hasn’t been to a doctor for 30 years and confesses to having a beer in the car before her 10 a.m. appointment. She only came because she needed a letter for Kāinga Ora Housing New Zealand, or maybe it was Te Hiranga Tangata Work and Income, or perhaps it was for Oranga Tamariki, who have control over her moko, or possibly some other agent of state that is requiring my assessment and approval before they will offer her any concessions.

My sense of Aroha is that she is wounded. But she is also ātaahua, brave and honest, doing her best to move her whānau out of the wilderness of the dispossessed into some other place. She wants somewhere for her whānau to put their feet. She also wants me to pronounce Kāinga Ora properly. For some reason, not quite clear to me, we do a lot of laughing.

She refuses my blood test to screen her for diseases that run rife in the Māori population but she does have a cervical smear, her first ever. I’m not sure I could explain why she suddenly agreed to me placing a speculum in her vagina when all she came for was a letter. I literally have no idea how that happened. But I know there was an awkward dance inside me: seeing Aroha, feeling self-conscious at my health altar, knowing Aroha is a target for the health colonisers who know best how she should live her life and who have provided me with a series of medical things I must do to her while she attends my altar.

These things do not include seeing Aroha or laughing with Aroha or hearing Aroha explain that she drives drunk because her post-traumatic anxiety is so severe she would otherwise need to stay home but she prefers to work.

And I wonder if maybe Aroha did that smear because she sensed that dance in me and maybe she felt bad for me with my computer full of grand delusions, or maybe it was because I happen to be in a room with a faulty office chair that sometimes does a sudden descent if I sit down quickly, and so I ended up looking ridiculous with my knees around my chin and that made us both giggle.

Or maybe it wasn’t that, maybe she had wanted me to ‘smear her mea’ all along but just couldn’t say until she knew I had heard the bit about the trauma and let it be there between us, as it will always be between the coloniser and the dispossessed: the anguish of many generations, a thing hovering for us to notice, wonder about and handle with care because maybe it is in that hovering thing that the kōrero about health really begins.

I don’t know the answer, but I know that this cross-cultural post-colonisation health kōrero is only just beginning. After 30 years as a doctor I am barely getting to understand in some hazy form what is really going on in that room.

It’s hard to tell Aroha’s story. I don’t want to create negative stereotyping that reinforces racist rhetoric about hopeless Māori. Of course there are Pākehā like Aroha and Māori not like Aroha, but I do want us to start in the really hard places, with the stories that make us squirm and despair so much we are compelled to seek collective redemption.

And I’m glad Aroha’s smear came back normal.

Everything but the medicine: A doctor's tale is available in all good bookstores now.