Normalizing Pronouns in Pharmacy: Creating a Culture of Inclusivity

By:  Kayla Blackmon, Student Pharmacist; Katie Rogers, Student Pharmacist; Bryson Duhon, PharmD, BCPS

 “Hi, I’m Kayla, a pharmacist intern. My pronouns are she/her. How would you like to be addressed?”¹ 

As gender identities and expressions continuously expand, pharmacy students must develop the skills to competently provide healthcare to all individuals. 

Why do patient pronouns matter?

According to the 2017 Gallup poll, 4.5% of Americans identify as LGBTQIA+. This is a considerable number, comprising just over 10 million people. According to the American Psychological Association, LGBTQIA+ individuals are 2.5 times more likely to experience depression, anxiety, and substance misuse compared with non-LGBTQIA+ individuals.² This population is more likely to experience health disparities, as evidenced by the following statistics:

• 20% of transgender and gender diverse people have reported being refused medical care because of their gender identity.
• 33% reported a negative experience with a health care provider over the last year. 
• 23% reported avoiding necessary medical care for fear of discrimination.³ 

The use of pronouns extends beyond respect and inclusivity due to the historical neglect LGBTQIA+ persons have endured. Though this concept may seem independent of the patient’s care, the ability to provide competent healthcare involves incorporating the patient’s full identity.

There is no data to know exactly how many individuals use pronouns differing from those associated to the sex they were assigned at birth. As of 2019, Merriam-Webster incorporated a new definition for “they,” stating it can be “used to refer to a single person whose gender is intentionally not revealed” or “used to refer to a single person whose gender identity is nonbinary”.¹ The use of these pronouns on an individual basis is now recognized by definition and should be acknowledged by healthcare professionals and their institutions in order to foster an environment in which all individuals feel comfortable receiving healthcare. 

Relevance to Pharmacy

As one of the top three most trusted healthcare providers, pharmacists can deliver equitable healthcare to all patients, including those who have been traditionally marginalized or discouraged from utilizing the healthcare system, by avoiding assumptions related to pronoun use.

Physical, mental, and social health of non-binary and transgender patients transcends what is required for providing adequate healthcare. It must also involve respectfully affirming gender identity through pronouns. It is important to develop an environment of inclusivity, which begins with the institutions that train new pharmacists. By teaching pharmacy students how to appropriately provide their pronouns, patients may feel more inclined to engage in a discussion about their own pronouns in pharmacies.⁴  

What is the best way to ask about pronouns? 

As the opening statement suggests, the recommended way to ask for a patient’s pronouns is to first state your own, followed by asking how the patient would like to be addressed.¹ It is important to avoid asking what pronouns someone “prefers” or “uses.” Suggesting that other pronouns are accepted or interchangeable may allow the use of incorrect pronouns, thus refusing to acknowledge a patient’s gender identity.¹ 

Since the pronouns in existence are constantly evolving, it is likely you may receive an answer you were not expecting; however, acting surprised or judgmental about the way a patient identifies is a form of discrimination and contributes to health disparities. 

Another way to normalize non-binary gender identities is to wear pins or nametags on your lapel that display your pronouns. This can further cultivate a culture of inclusivity.⁴ 

How can pharmacy schools hold students accountable?

There is an abundance to learn regarding cultural competency for the LGBTQIA+ community in pharmacy. Here are some ideas to get started: 

• Implementing educational workshops and role play scenarios regarding the proper use of pronouns will help students confidently provide exceptional healthcare to LGBTQIA+ individuals.
• Asking for patient pronouns should be included in grading rubrics for every Objective Structured Clinical Exam (OSCE) throughout pharmacy school.
• Students should be exposed to a variety of diverse patient identities throughout their OSCEs and patient interactions to prepare them for the patients they will undoubtedly encounter in their professional career. 

These ideas can be applied in any setting throughout pharmacy school, including patient counseling, IPPEs, and APPEs; however, any inclusion is a step in the right direction for ensuring all patients receive proper care going forward. Pharmacy schools can further develop a culture of inclusivity by including pronouns on ID cards and email signatures. This contributes to the normalization of pronouns and underscores their importance.

As pharmacy students, we learn to treat all of a patient’s health needs. This should include cultural competency and diversity in gender identities. As accessible healthcare providers, we can have an impact on the way patients view their healthcare by normalizing non-binary identities. By striving to deliver equitable healthcare to patients of all gender identities, we can address health disparities and improve patient care. 

What other ways can pharmacy schools promote the use of pronouns?

Acknowledgements:  

The authors want to acknowledge the assistance of Roxanne Bogucka, MLIS, S-AHIP with literature searches and Ashley Castleberry for providing guidance on idea generation and feedback prior to submission.

References:

1. Mulkey N. Pronouns and Advocacy in Medicine. AMA J Ethics. 2020;22(3):E255-259.
2. Kidd J. Mental Health Disparities: LGBTQ. Psychiatry.org. Published 2017.
3. Stroumsa D, Wu JP. Welcoming transgender and nonbinary patients: expanding the language of “women’s health”. AJOG. 2018;219(6) 585.e1-585.e5.
4. Foster H. Gender Pronouns: A Provider’s Guide to Referring to Transgender Patients. Pride in Practice. Published September 1, 2019.

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Pulses is a scholarly blog supported by a team of pharmacy education scholars