“If you look at your pharmacist and they’re stumbling over their words and messing up your pronouns . . . not knowing how to get through, you’re not going to want to come back,” said fourth-year student Breanna Laffin, at Dalhousie University’s College of Pharmacy.
Breanna, alongside a team of researchers at Dalhousie are advocating for an overhaul of the College of Pharmacy’s curriculum to empower the next generation of pharmacists to be informed allies to their LGBTQ+ patients.
What is an ally?
In the American Journal of PharmaceuticalEducation (AJPE), an ally is defined as one who is associated with another as a helper that provides support and assistance in an ongoing struggle or effort. Pharmacists should be allies to their patients by ensuring optimal health outcomes and by helping them achieve therapeutic objectives.
The pharmacy as a healthcare haven
So how and why are some pharmacies turning themselves into safe and allied for LGBTQ+ people? An AJPE studyfound that among young LGBTQ+ patients, access to healthcare was rated as relatively easy by only 68% of participants. Pharmacies are crucial spaces where health gaps can be closed by having pharmacists foster trusting relationships with patients. As healthcare providers they are able not only to discuss medication but provide a safe environment as the most accessible healthcare workers to the general public.
Changes to the pharmacy’s physical environment—such as the simple act of adding a pride flag somewhere near the counter can have a big impact, said Kyle Wilby associate professor at Dalhousie’s College of Pharmacy. “Things like having a community pharmacy take part in community events such as Pride or by displaying products in a way that is gender neutral.”
As well as changes to how pharmacists interact with patients can be a powerful way of helping people who identify as LGBTQ+ comfortable with receiving healthcare. For Wilby it’s about, “really developing rapport with your patients and understanding their specific needs.”
Dylan Moulton, clinical pharmacist and guest lecturer at the University of Alberta said, emphasized the importance of respecting patient’s pronouns. “There's a lot of discussion when it comes to topics about identity regarding ethical perspectives or even cultural or religious perspectives, but in the grand scheme of things, by not identifying our patients in the way that they need to be identified and they deserve to be identified, we’re instilling harm.”
Moulton noted that by fostering an environment where patients are comfortable to disclose identity, they are subsequently able to access a higher standard of care. He stressed the importance of pharmacists disclosing pronouns to solidify pharmacist-patient relationships and inculate trust.
“From a pharmacy line specifically, there's a lot of very simple things you can do. Asking a person's pronouns is one of the biggest things that makes a huge difference and a lot of people really underplay the value of respecting one’s pronouns and more importantly asking for one’s pronouns.”
In rural, small-knit areas of the country, Wilby, the pharmacy can be a crucial safe space for these patients, said Wilby. “Many times LGBTQ2S+ people could still be concealing their identity and not wanting a broader community to even know.”
Many resources exist for pharmacists to uphold high standards of care for members of the LGBTQ+ community. The fourth edition ofThe Sherbourne Guidelines published by Rainbow Ontario has outlined gender-affirming primary care, with unique considerations for trans health.
Back to the classroom?
Dalhousie University’s College of Pharmacy is changing its curricula to be more inclusive for of the LGBTQ+ community. “Canada is actually putting in integrated approaches to addressing . . . LGBTQ+ health across the four years of study in pharmacy degrees” said Wilby.
As a pharmacy student, Laffin highlights how important a curriculum change is for her cohort, and the realities of being one of the only queer students in the classroom.
Laffin explains, “when writing the cases, professors include diversity markers and when they do, they don’t really make it essential to discuss the diversity markers. . ..There can be accidental inclusion of diversity markers that are promoting stigma at the same time. This is where the biggest barrier to including diversity in our courses is. . . potentially misrepresenting a whole population.”
Problem-based cases, set in the social aspect of pharmacy, without discussion of the various aspects of patient identities—and how they can intersect—have shown that professors are simply not sure how to include diversity, she said.
“The pushback can come from professors . . .. They don’t know what they don’t know. Faculty at the college aren’t super diverse themselves, so it does make writing about diversity a bit more difficult. . .. How can they fight for diversity when they’re not even here?”
During his time at the University of Otago in New Zealand, Wilby helped with an overhaul of its pharmacy curriculum after being approached by an LGBTQ+ student. Wilby successfully began to provide LGBTQ+ content in the program’s required courses for the academic year of 2020. The result was an hour-long lecture attended by 120 students, along with a two-hour workshops attended by 30 students.
In an article published in Currents in Pharmacy Teaching and Learning, Wilby described the changes as needing to have personal and relatable depth. “I needed the material to resonate with students, demonstrate parallels to their own experiences of cultural conflict, and provide them with known faces of people who have been discriminated against based on sexuality and gender in pharmacy practice.”
Overall, he emphasized, the pharmacy workforce is pushing to see these competencies become a reality—so he hopes real change is around the corner.