Pharmacy Check-in: Meet Cassandra McLelland

Cassandra McLelland, PharmD, RPh, ACPR (she/her)
Antimicrobial Stewardship Pharmacist, William Osler Health System, Brampton, ON

Dr. Cassandra McLelland is a clinical hospital pharmacist of Ojibwe (M'Chigeeng First Nation), French Canadian, and Scottish ancestry. She graduated from the University of Waterloo’s School of Pharmacy in 2018 and completed a pharmacy residency at the University Health Network in Toronto. She currently practices as an antimicrobial stewardship pharmacist and serves as the vice-chair of the Indigenous Pharmacy Professionals of Canada (IPPC).

Q&A with Cassandra

We caught up with Cassandra during Indigenous History Month to talk about her practice and how pharmacists can provide safe, inclusive health care to Indigenous communities.

What is the #1 thing pharmacists can do to create a safe and inclusive space for Indigenous patients?

The #1 thing, as with all patients, is to approach all interactions with respect. Respect can be demonstrated in multiple ways: from using the proper terminology to address Indigenous patients (e.g. using “Indigenous” instead of “Indian”), to remaining open-minded when a patient wishes to use traditional Indigenous healing methods. If a pharmacy professional has misconceptions or biases about Indigenous peoples, it is important to work towards dismantling these so that they can provide a safe space for Indigenous patients that is free of discrimination.

Why is culturally sensitive health care important, especially in a pharmacy setting? 

Many Indigenous people have some degree of mistrust in the health-care system due to a long history of discrimination and racism. Examples of this include documented medical experimentation in residential schools, reports of forced sterilization of Indigenous women and the widely publicized deaths of Brian Sinclair and Joyce Echaquan. Culturally sensitive health care is essential to building a trusting therapeutic relationship and leveling the power imbalance that exists between Indigenous patients and health-care providers. In particular, cultural sensitivity in the pharmacy setting helps facilitate timely drug access and patient adherence; for example, knowledge of the Non-Insured Health Benefits (NIHB) and provision of medication information sheets written in Indigenous languages.

How can pharmacists play a greater role as advocates for inclusive and culturally sensitive health care, especially for the Indigenous community?

The first step is education. To be able to provide inclusive and culturally sensitive health care, we must first learn the proper terminology to use, the history of colonization and the impacts it continues to have on the Indigenous community, and the barriers that Indigenous people face when accessing health care. There are many resources online that are available for self-learning, and individuals can also advocate for education to be provided by their workplace, institution, or school. Pharmacists can also be advocates for the Indigenous community and other marginalized communities by sharing this information with others, and calling out racism and discrimination when they witness it.

What’s the biggest mistake health-care providers make in caring for Indigenous patients and how can they do better?

Throughout Canada’s history, Indigenous peoples’ autonomy has been greatly affected by paternalistic laws that have limited our ability to practice our culture, leave our reserve and make informed decisions regarding health care. For this reason, it is especially important to ensure that health-care providers respect the autonomy of Indigenous peoples. The pharmacy code of ethics states that pharmacy professionals must respect patients’ vulnerability, autonomy, and right to be self-governing decision-makers. Examples of this include obtaining full informed consent prior to treatment, providing information in a culturally sensitive and accessible format to support patient decision-making, supporting the decisions of Indigenous patients even if it does not align with the recommended care plan and respecting the role of family members in patient’s decision-making.

What is the most rewarding part of your pharmacy practice?

I feel very lucky to practice in a setting where I can have a direct and immediate impact on patient outcomes. In my role as an antimicrobial stewardship pharmacist, I work in a multidisciplinary team that aims to optimize the use of antimicrobials while minimizing antibiotic-associated harms and the emergence of multi-drug resistant organisms. It’s extremely rewarding to see patients’ clinical status improve after implementing antimicrobial recommendations.

Is there anything else you’d like to share about your practice, or about anything else that is important to you?

In addition to my clinical practice, I’m thrilled to be on the Board of Directors of the Indigenous Pharmacy Professionals of Canada. This organization is doing important work for Indigenous pharmacy professionals and patients. Follow us on Instagram, Facebook, or LinkedIn to stay updated!