By the 2018–19 APhA–ASP Policy Standing Committee
According to a July 2017 article in Mental Health Clinician, in a survey of 176 medical schools in the United States and Canada, a median time of 5 hours in the whole of the curriculum was spent on Lesbian, Gay, Bisexual, and Transgender (LGBT)-related content. For pharmacy schools, the data is no better, with roughly 54% of schools stating no coverage of LGBT content in their coursework, as noted in a November–December 2014 Currents in Pharmacy Teaching & Learning article. Schools proclaim to educate their students on compassionate care, yet are falling woefully short with LGBT
education and training.
LGBTQ+ patients are three times more likely to suffer from mental illness. Attempted suicide rate is a staggering 41% in this community, 26 times the rate of the general population. Twenty-five percent of transgendered patients do not see a physician for fear of being mistreated.1 Therefore, the evidence is clear that in this country, the LGBTQ+ community faces numerous hurdles to accessing quality health care and is in great need of help.
Opportunity to be educated
With improving the health and well-being of the LGBT+ community a goal of the Healthy People 2020 Initiative, there is an opportunity for pharmacists and student pharmacists to be educated on treating members of this community. In particular, transgender patients receiving hormone therapy offer a unique opportunity for pharmacists to provide counseling, education, and assistance through challenging treatments. Guidelines exist through both the World Professional Association for Transgender Health and the Endocrine Society on treatment of gender-dysphoric/gender-incongruent persons. These resources are a critical tool for health professionals to provide optimal guideline-based treatment to transsexual, transgender, and gender non-conforming people. However, counseling alone is not enough in providing respectful and compassionate care.
The 127-year-old American Dialect Society named the word “they” as its word of the year for 2015.2 Pronouns and identifiers are a common cause for confusion that highlight the ever-increasing need for more education. The acronyms themselves have been rapidly changing. LGBT+ was the first acronym to appear in the 1990s. LGBTQ+ adds the previously derogatory “queer” to the acronym. This is now the preferred acronym according to the Gay and Lesbian Alliance Against Defamation Media Reference Guide 10th edition for journalists covering these topics. Further still is the LGBTQIA+ acronym, adding intersex and asexual/allies. The plus remains to signify the all-inclusiveness of the community.
Student pharmacists must know the power that language and attitude can have on patient–provider reactions. More education on this subject is imperative. Minimum competency standards and best practices must guide curriculum development in order to reach members of this community.
Progress within health care
An encouraging step forward was made at the University of Louisville Medical School in Kentucky, which begam integrating LGBTQ+, gender non-conforming, and differences of sexual development training into its medical school curriculum in 2015. The Association of American Medical Colleges has identified 30 competencies that physicians must meet across eight domains of care. A similar model and requirement should be required in all pharmacy school curricula.
The health care landscape is rapidly changing, and small positive steps are being made. For example, 3 hours of transgender-related care were incorporated into the Doctor of Pharmacy curriculum at the University of New Mexico and Washington State University. Clearly defined learning objectives were given, and data retrieved showed a statistically significant improvement in students’ confidence in providing care to transgender patients. Additionally, in Washington DC, all pharmacists and pharmacy technicians must now undergo 2 hours of continuing education focused on LGBTQ+ cultural competency.
Research supports the need for change, given the increased rate of suicide, substance use, and mental illness among the LGBTQ+ community.3 It is time for the profession to speak up as one voice and mandate better education and training to meet the significant health needs of the LGBTQ+ community. Formal education with measurable outcomes should be required in all pharmacy curricula. Training for pharmacists in transgender care should be mandatory, as we are the most accessible health providers.
References
1. Safer JD, Coleman E, Feldman J, et al. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes. 2016 ;23(2): 168-71.
2. Bennett, J. She? Ze? They? What’s In a Gender Pronoun. Nytimes.com. Available at: http://www.nytimes.com/2016/01/31/fashion/pronoun-confusion-sexual-fluidity.html. Accessed 2018 Nov 17.
3. Bishop BM. Pharmacotherapy considerations in the management of transgender patients: a brief review. Pharmacotherapy. 2015; 35(12):1130-9. DOI: https://doi.org/10.1002/phar.1668.