Professor Stephen Nicholls[/caption]
As the 47th annual Mardi Gras lights up Sydney this weekend, here’s how pharmacists can build trust and champion inclusive healthcare.
The history of LGBTQIA+ discrimination has had a profound impact on how people from this community access healthcare today. Centuries of systemic exclusion and stigma have created significant barriers to equitable healthcare, continuing to shape healthcare policies, provider attitudes, and patient experiences.
The majority of the LGBTQIA+ community accesses mainstream primary care and health services.
But many will experience discrimination or prejudice from health professionals when seeking care, said Rainbow Pharmacist Professor Lisa Nissen FPS, Director, Health Workforce Optimisation, Centre for Business and Economics of Health at the University of Queensland.
‘This can range from assuming certain aspects of behaviour based on their appearance, showing judgement about their sexual practice or being non-inclusive of partners in conversations,’ she said.
‘Most will have faced some forms of discrimination, harassment or homophobia in their daily life and will be looking for environmental cues in the health setting that it is a safe and accepting environment.’
What could LGBTQIA+ discrimination look like in a pharmacy setting?
Discrimination happens when, for example, a patient presents a Medicare card with their birth name on it, however the pharmacist knows that as a transgender person they identify by another preferred name – which has been written on the script by the prescriber, said Prof Nissen.
‘Choosing, on purpose, to call out their birth name and label their medicines by that name, rather than confirming their preferred name and labelling their medicine [accordingly] would be discriminatory and offensive to that person,’ she said.
Microaggressions are also commonplace. For example, when discussing the oral contraceptive pill for hormone regulation with a lesbian patient, assuming they have a male partner or asking, ‘Do you have a boyfriend?’ can be exclusionary and dismissive of their identity.
Other examples of microaggressions include:
- asking who is the man and who is the woman in the relationship
- ‘you don’t look or seem gay or lesbian’
- asking a women ‘how long have you been with your husband?’
- asking a trans person ‘when are you having the surgery?’
What’s the impact?
Substantial. In fact, as a result of direct and indirect perceived discrimination and microaggression, almost half of all gay, lesbian, bisexual and transgender people hide their sexual orientation or gender identity in public for fear of violence or discrimination.
They may also withdraw from healthcare settings, leading to a significant physical and emotional burden and reducing access to care.
The impacts on mental health are also staggering, with almost double the number of LGBTQI+ Australians (74.5%) experiencing a mental health disorder at some point in their lives compared with heterosexual Australians (41.7%).
‘For members of the LGBTQIA+ community, microaggressions can feel exhausting and lead to mistrust,’ said Prof Nissen. ‘It can create a sense that they are not valued as patients and that their health concerns will not be taken seriously.’
What makes a pharmacy a welcoming and safe environment for LGBTQIA+ patients?
Improving communication with LGBTQIA+ patients is ‘really not that difficult’, said Prof Nissen.
‘Just be respectful and let patients take the lead,’ she said. ‘It’s okay to ask if you don’t know something – generally people will be happy to explain things that they are comfortable sharing.’
However, like all patients they are entitled to share only what they are comfortable with disclosing.
‘Remember there is often quite significant mistrust that may need to be overcome with time,’ said Prof Nissen.
If a patient is uncomfortable disclosing their gender identity or sexual orientation it may take several interactions before they share information with you, or they may choose not to share.
‘If there is something specific you need to know (where their gender identity or sexual orientation is important) that is absolutely relevant to their medical treatment, frame a question or the conversation around the fact that “there are important considerations with the treatment that we should discuss”,’ she said. ‘Then offer to have a chat perhaps in a private space.’
Other steps can include:
- wearing an LGBTQIA+ Pin
- including pronouns on name badges
- updating email signatures with an LGBTQIA+ flag
- displaying posters or stickers in the pharmacy.
‘Undertake LGBTQIA+ specific health education activities and show patients that staff have been trained in inclusive healthcare,’ said Prof Nissen.
What challenges do LGBTQIA+ pharmacists face in the workplace?
Because of their LGBTQIA+ status, some pharmacists may conceal their orientation or gender identity for fear that they will experience discrimination in the workplace, said Prof Nissen.
‘Many have and will experience verbal and physical abuse in their workplace from patients, families, and colleagues,’ she said. ‘Patients may refuse treatment from an LGBTQIA+ pharmacist, leading to career setbacks for many, with some ultimately leaving the profession.’
As with all members of the workforce, pharmacies need to be inclusive of LGBTQIA+ staff.
‘We need to be aware that they “don’t speak for all LGBTQIA+” people or know all there is to know about LGBTQIA+ healthcare,’ said Prof Nissen.
‘If you have a member of staff who does identify as LGBTQIA+ they may not want to be “out” at work or “identified”. They need to be supported in balancing their personal identity with their professional identity, professional norms and behaviours.’
Does your pharmacy warrant a ‘Rainbow Tick’?
The ‘Rainbow Tick’ is a blueprint for health and human services organisations seeking to provide a safe and inclusive workplace and services for the LGBTQIA+ community.
The six standards it incorporates include:
- organisational capability
- workforce development
- consumer participation
- a welcoming and accessible organisation
- disclosure and documentation
- culturally safe and acceptable services.
‘The standards are designed to be used by the whole organisation, but can also be applied to specific services or sites within an organisation,’ said Prof Nissen.
LGBTQIA+ community members will usually be on the lookout for signs that your pharmacy is inclusive, such as posters or badges.
‘Applying processes in the pharmacy such as forms and dispensing approaches, will also reflect diversity and will help pharmacies to be a safer destination for patients,’ she added.
Further resources include:
- Community health pride – LGBTIQ+ inclusive practice resources
- Download – Rainbow Inclusion
- Rainbow Health Australia
- LGBTIQ+ Health Australia.
Hear more from Professor Lisa Nissen about how the pharmacy profession measures up to the Rainbow Tick at the NSW ATU this weekend, from 28 February to 2 March. There are only a few spots remaining, register now to attend.
