Viva Case 2: Marlee West

Aboriginal GP registrar with Anxiety/PTS

Mali is an Aboriginal GP registrar presenting with anxiety, sleep disturbance, and nightmares. Since relocating to a rural town, she has become socially isolated and is worried about making mistakes at work and being judged. She also describes distress linked to her mother’s passing and her grandmother’s experiences of the Stolen Generations, raising issues of cultural trauma and discrimination.

4:38 – Key issues in presentation

• Anxiety, nightmares, poor sleep

• Social isolation after relocation

• Fear of mistakes and judgement at work

• Distress linked to family trauma and discrimination

5:33 – Structured problem list

• Clinical: anxiety, nightmares, assess for self-harm

• Cultural: bereavement, intergenerational trauma, Stolen Generations

• Psychosocial: isolation, anxiety, sleep disturbance

• Professional: fear of mistakes at work, judgement by colleagues

7:01 – Exploring psychosocial & cultural background

• Use safe, respectful language

• Offer Aboriginal health worker involvement (with consent)

• Explore family supports and cultural background

• Apply trauma-informed care: avoid retraumatisation, ensure safety, confidentiality

8:29 – Communication strategies

• Empathetic listening and collaboration

• Ask one issue at a time, check understanding

• Maintain safety in consultation

• Use affirmations and open-ended questions

9:28 – Avoiding stereotypes

• Treat as individual, not defined by race

• Avoid assumptions about Aboriginal identity or experiences

• Ask open-ended questions, listen actively

• Respectful language, no presumption

10:49 – Differential diagnoses

• PTSD (nightmares, trauma, flashbacks)

• Adjustment disorder (relocation, work stress)

• Anxiety disorder

• Depression

• Bipolar disorder (less likely)

11:31 – Differentiating & red flags

• PTSD: trauma history, nightmares, poor sleep

• Adjustment disorder: triggered by move/workplace

• Depression/anxiety: low mood, anxiety, poor concentration

• Red flags: suicidality, risk to self/others

12:37 – Culturally safe management plan

• Offer Aboriginal health worker support

• Link with Aboriginal medical services

• Ask about gender-concordant doctor preference

• Involve family/support person if desired

13:53 – Non-pharmacological supports

• Psychologist with Indigenous health experience

• GP registrar/college wellbeing services (RACGP, Doctors for Doctors, supervisor support)

• Counsellor, support groups

15:01 – Trauma-informed care principles

• Acknowledge trauma, avoid retraumatisation

• Empower patient to set pace and boundaries

• Confidentiality unless risk present

• Collaboration, active listening, open-ended questions

• Use silence appropriately to support sharing

16:40 – If symptoms worsen or she cannot work

• Assess patient and workplace safety

• Sick leave if necessary

• Liaise with supervisor/college

• Psychologist referral, CBT, counselling

• Ensure improvement before return to work; consider modified duties

• Monitor closely, weekly reviews if needed

• Reassess for suicidality

18:31 – Debrief and Shaun’s Feedback

• Recognised key principles well: anxiety/PTSD, cultural trauma, professional stressors.

• Always structure your problem list across clinical, cultural, psychosocial, and professional domains to show breadth.

• Avoid over-sensitising. Let the patient define what cultural safety means to them. Don’t assume negative experiences; ask what matters to them.

• You listed differentials well, but the question also asked about red flags. Strategy: jot “Differentials | Red flags” on paper so you don’t forget.

• Management was strong: good mention of registrar support. Always include SNAP to capture lifestyle, stress management, and sleep hygiene.

• Don’t forget crisis supports (helplines, acute referral if deteriorating).

• Cultural safety management should include pharma and non-pharma. You could add SSRIs as an option, with a discussion about cultural acceptability.

• Use strength-based framing: highlight resilience, achievements, and community ties to build empowerment.

• Include return-to-work planning: discuss fit for work, safe duties, or modifications, not just binary “fit/unfit”.