Providing Respectful and Inclusive Minor Ailment Assessments for a UTI
When assessing patients seeking treatment for urinary tract infections (UTIs), pharmacists may need to engage in conversations that involve very personal and private matters for the patient.
Genitourinary anatomy is an important patient characteristic that must be considered as part of the patient assessment process for UTI treatment. In a pharmacy setting, the only way to determine a person’s genitourinary anatomy accurately is by talking to them. Trans men, trans women, and intersex people exist, and bodies come in all shapes, sizes, and with different anatomies.
This article provides an overview of elements of the College’s Human Rights Policy and Code of Ethics that would apply to minor ailment assessments for a UTI and how they inform the pharmacist’s approach. It also includes practical suggestions for implementation from community pharmacist Rami Safi.
Obligations Under the Human Rights Policy and Code of Ethics
It is important for pharmacy professionals to respect a patient’s human rights1; a key part of this is providing inclusive care to patients that is free from judgement and discrimination. These expectations are reflected in the Code of Ethics under the Principles of Non-Maleficence and Respect for Persons/Justice, and in the College’s Human Rights Policy.
| Relevant Policy/Code of Ethics Principles | Application to UTI Minor Ailment Assessment |
|---|---|
| Human Rights Policy “Pharmacy professionals are required to act in their patients’ best interests and provide an environment where the rights, autonomy, dignity, and diversity of all people are respected.” | The assessment for a UTI might involve the disclosure of personal and sensitive information by the patient to the pharmacist. Pharmacists should be aware of the legislative requirements and expectations outlined in the Pharmacist Prescribing: Initiating, Adapting and Renewing Prescriptions Guideline, which includes assessing the environment to ensure it is appropriate considering the nature of the dialogue. |
| Human Rights Policy “Patients can expect that their human rights will be upheld when accessing pharmacy services. This includes feeling safe and respected within the registrant-patient relationship to optimize the trust necessary to effectively provide care to patients.” | Treatment of UTI as a minor ailment is limited to “uncomplicated” cases and as such, may be restricted to female anatomy based on clinical resources. Navigating a minor ailment assessment involving a trans man (a person who identifies as a man with female genitourinary anatomy) with UTI symptoms requires the use of inclusive language. Pharmacy professionals should be conscious of any assumptions they may make about someone’s genitourinary anatomy based on their gender presentation or identification. A pharmacist may be able to prescribe for this patient, if clinically appropriate. |
| Code of Ethics: Non-Maleficence (do no harm) “As we strive to benefit our patients, we must be diligent in our efforts to do no harm and, whenever possible, prevent harm from occurring.” | Conducting minor ailment assessments for UTIs is an evolution in practice, and pharmacy professionals should consider how this change interacts with the Code of Ethics and their obligations to patient-centered care. Providing care which is thoughtful to the lived experience of patients helps ensure that pharmacy professionals are able to abide by the principle of non maleficence, and provide the most robust and relevant care. |
| Respect for Persons/Justice All persons are worthy of our respect, compassion and consideration. We demonstrate this when we respect our patients’ vulnerability, autonomy and right to be self-governing decision makers in their own healthcare. The principle of “Justice” requires that we fulfill our ethical obligation to treat all patients fairly and equitably. | When providing an assessment for a UTI, gathering required information about sensitive parts of a patient’s body in a respectful way helps build trust and demonstrates care. Through understanding a patient’s identity and lived experience, pharmacy professionals promote autonomy and provide fair treatment to all patients in an inclusive and equitable manner. |
The principle of Beneficence in the Code of Ethics requires pharmacy professionals to actively and positively serve and benefit the patient and society. Providing relevant care often starts from a place of curiosity and a genuine desire to serve your patients by understanding their specific situation and needs.
When talking with patients about UTIs, pharmacists should consider whether they may need to adjust their communication style, language or information gathering technique to reflect their patients’ preferences and understanding, as well as the sensitivity of the matter. Discussing urinary issues or any issues related to genitalia should be done in the most respectful way possible.
For example, some patients might not understand certain terms (e.g., ‘genitourinary’ or ‘antibiotic resistance’) or may prefer language such as “private area” instead of genitals.
The pharmacist can also ensure that the patient knows why they are asking these questions and that they can stop the assessment at any time if the patient wishes. For example: “The questions I am about to ask are medically necessary. Please let me know if the way I am communicating makes you feel uncomfortable. We can stop at anytime.”
Practical Ways to Promote Inclusive Care When Conducting UTI Assessments: Tips from Pharmacist Rami Safi
Rami Safi (he/him), RPh B.Sc.Ph., MACP, CRPO, is a Part A pharmacist and a member of the College’s Equity, Diversity, and Inclusion Registrant Reference Group. As an internationally trained pharmacist, he has navigated the experiences of being a newcomer to Canada and understands the barriers many people face in accessing equitable pharmacy care.
The information presented below provides helpful tips and considerations for all registrants who are looking to expand their understanding of how to provide care that is inclusive and respectful. It is important for us as healthcare professionals to challenge our assumptions and work with our patients to understand their unique needs and experiences.
- Consider encouraging all staff in the pharmacy who interact with patients to have personal pronoun information (E.g., she/her, they/them, he/him) on any name tags or online profiles as this helps patients understand who is providing them care
- Offer patients the opportunity to select which pharmacist they speak with, based on personal comfort, communication needs or preference for available staff with certain experiences/characteristics.
- Create a standard intake form for new patients seeking treatment for UTIs to ask sensitive questions such as:
- Is your anatomy female, male, or intersex?
- Are you, or is there any possibility, you could be pregnant?
- Have you ever had any surgeries related to your genitals?
- Create a standard script to use when completing an intake with a patient seeking a prescription for a UTI:
- Mention a few of the reasons why you may be unable to prescribe for a UTI
- E.g., “Before we explore your symptoms, I would like you to know that I am unable to prescribe for anyone who is immunocompromised, under the age of 12, has a prostate gland, is intersex, has undergone any structural surgeries2 related to the genitals/private area, has decreased urinary tract function or kidney stones. If any of these apply to you, I am happy to discuss your symptoms and how to manage any issues, and I will need to refer you to a physician or nurse practitioner for further assessment.”
- Mention a few of the reasons why you may be unable to prescribe for a UTI
- If an encounter is with an existing patient, consider what information you may already have about them, including:
- Do you have information about the patient’s genitourinary anatomy?
- Have they disclosed relevant information related to a UTI assessment in the past such as pregnancy, history of genital surgeries, that they are intersex or trans, that they are immunocompromised?
- If you do not have any information, refer to the recommendations on what to ask a new patient.
- Consider the following prompts to start conversations around a patient’s body when you aren’t sure what to say
- “To ensure I understand your situation, I may make some assumptions but please know that I am open to you correcting me…”
- “If I am making any incorrect assumptions about you or your body or your symptoms, please correct me… “
- Thank the person for any corrections or guidance that they give you, make note of it, and ensure to use the correct language for that person in all relevant future interactions
- If a patient seems extremely reluctant to provide the information needed, consider offering a virtual or telephone consult as a way of gathering the information
- If the patient is a younger person or you feel might benefit from having a support person there (such as a parent), offer to discuss the medical information with that support person present after obtaining consent to do so. If a patient seems uncomfortable discussing their treatment with a parent/guardian/partner around, consider how to provide the patient with a private space without that person present
I encourage pharmacists to use these practical tips to make their own scripts and forms.
The information presented in this article is for illustrative purposes only, and includes general examples, options and potential risks to consider. It is not intended to supersede any legal advice. The information is not directing you to a specific course of action, it is not to be construed as legal advice or opinion and is not to be taken as a position of the Ontario College of Pharmacists.
1For more information regarding the Ontario Human Rights Code, see https://www.ohrc.on.ca/en/ontario-human-rights-code
2Genital piercings are not considered structural surgeries
