We call on the GPhC to pass guidance requiring that course material in all Pharmacy schools includes ethnically diverse teaching, including where cases are presented - especially in clinically relevant instances where disease presentation differs between white and black and minority ethnic (BAME) patients. Clinical descriptions such as erythematous, pallor and rubor are not typical of all patients and students are often not taught otherwise. This is only one example. Teaching must be representative of the society we live in. Pharmacists are one of the most easily accessed healthcare professionals and are present in both primary and secondary care settings. Their duty to deliver the highest quality of person-centred care extends to all members of the public and these values are not met if their education does not actively prepare students for this. 

As well as under-preparing students in understanding and recognising signs and symptoms of certain diseases in BAME patients, white normality in teaching also means that BAME students do not feel represented and included in their studies. This leads to health inequality, and intersects with racial inequality. 

As a healthcare professional who is often the first port of call, having knowledge of disease presentation and the requirements for referral are vital. The meningococcaemia rash in children is usually less visible in dark-skinned people (1). The teaching of the importance of, and often reliance on, this sign as a diagnostic indicator of meningitis can lead to delays in diagnosis in dark-skinned people, with often fatal consequences. This is just one example of many. 

As experts in medicines, understanding drug regimens is crucial to know which medicines to give and when to ensure optimum treatment. One of the most common being drug treatments for hypertension, which vary according to the patient's ethnicity (2). An understanding of the reasoning behind this evidence based decision, aids treatment choices and prevents guidelines being followed blindly. 

Prognosis of conditions will also influence treatment and referral. Black females are at greater risk of heart disease, and more likely to die from it at a younger age, than women of other races (3). Angina, presented as chest pain, is a type of heart disease. This can be easily mistaken for heartburn which is a symptom of indigestion. Awareness of prognosis can help to avoid misinterpretation and therefore mistreatment. 

This learning later feeds into exams where questions must not be presumptuous. For instance, having to make an assumption about the ethnicity of the patient being presented, by the country they were born in. These exams are in place to check students’ understanding and prepare them for practice where stereotypes and assumptions must not be made. 

Representation within the pharmacy degree is vital, so that future Pharmacists can provide the same high quality of care to all patients and in doing so, work to bridge racial disparities within healthcare. Representation can save lives.

References: 

(1) Lessons From Research For Doctors In Training: Recognition And Early Management Of Meningococcal Disease In Children And Young People (2007). 2nd ed. [ebook] London: Meningitis Research Foundation. Available at: https://www.rcpch.ac.uk/sites/default/files/Lessons_from_research_for_doctors_in_training_-_Recognition_and_early_management_of_meningococcal_disease_in_children_and_young_people.pdf [21/06/2020].

(2) National Institute for Health and Care Excellence (2019) Hypertension in adults: diagnosis and management (NICE guideline 136). Available at: https://www.nice.org.uk/guidance/ng136/chapter/Recommendations#starting-antihypertensive-drug-treatment  [21/06/2020]. 

(3) Black Women's Health Imperative (2018). Heart Disease in Black Women: The big issue you might not know about. Available at: https://bwhi.org/2018/02/12/heart-disease-black-women-big-issue-might-not-know/ [21/06/2020].