The Importance of Terminology in the Profession of Pharmacy

To the Editor: It is time for pharmacists to join together and embrace common terminology in describing our profession. As pharmacy faculty members who provide patient care, we interact with pharmacy students, pharmacy practice residents, residency candidates, and colleagues in a variety of practice settings. We have far too often encountered the use of the word “clinical” linked to a specific pharmacy practice setting, most commonly in reference to an inpatient pharmacy environment. Further confusion with the role of outpatient pharmacy practitioners occurs through the use of the term “retail” to describe community pharmacy practice. While the use of this inaccurate terminology occurs in our daily encounters with students, residents, and colleagues, the need for consideration of this as a profession-wide issue was reinforced in a recent article published in the Journal.1(p1-5) In the study, pharmacy students were surveyed on their career plans postgraduation and given the opportunity to choose between retail (chain), retail (independent), clinical, hospital staff, or other. While we understand that the authors may have intended simply to provide categories for respondents, we suggest the adoption of a consistent manner for utilizing terminology across our profession in teaching, practice, and scholarly activities with regards to the terms “clinical” and “community pharmacy.”

The concept of “clinical pharmacy” has been addressed in a variety of forums. The American College of Clinical Pharmacy recently published a definition of this term. A key concept highlighted within this definition is that clinical pharmacy occurs in all health care settings and is provided in any environment in which pharmacists interact directly with patients. The Merriam-Webster Dictionary supports ACCP's statement by categorizing “clinical” as an adjective with the definition: “of, relating to, or conducted in or as if in a clinic; involving direct observation of the patient.”³ Since the word “clinical” is an adjective, it should only be used to describe a noun. Thus, “clinical” is not an appropriate word to use to identify a setting; this term should only be used to describe a setting. These grammatical considerations about the word “clinical” are important in how the term “clinical” is appropriately used in communications related to the profession. For example, when students state that they would like to be “clinical” pharmacists, the correct interpretation should be that they are interested in providing direct patient care. A suitable follow-up question would be “in what health care setting do you hope to practice clinical pharmacy?” “Clinical pharmacy” has the potential to be provided in all patient care pharmacy settings.

Pharmacists themselves define “clinical” activities as occurring across the diverse spectrum of practice. The American Pharmacists Association-Academy of Pharmacy Practice and Management (APhA-APPM) surveyed the officers in the academy's 6 sections to define each section's membership. Elected leaders could chose from 24 career options to define their section. Elected leaders from 5 of the 6 sections included clinical pharmacists as part of their membership. Clinical activity was associated with all the sections except the administrative practice section.

Another relevant terminology consideration involves the words used to identify and describe outpatient pharmacy settings, specifically the terms “retail” and “community” pharmacy. The Merriam-Webster Dictionary defines “retail” as “to sell in small quantities directly to the ultimate consumer.”³ This dictionary defines “community” as “a unified body of individuals.”³ While the term “retail” focuses on a product and the consumer, the term “community” relates to individuals. With the profession focusing on its future as providers of direct patient care, terminology which emphasizes our covenantal relationship with patients is preferable to terminology defined by product provision. This may explain why there are no pharmacy organizations whose names include “retail.” Notably, the National Community Pharmacists Association (NCPA) changed its name from the National Association of Retail Druggists (NARD) to NCPA in 1996. (NCPA, 2009).

Additional support for the use of the term “community” instead of “retail” can be found when accessing the Internet-based medical search engine, PubMed (www.pubmed.gov), for scholarly work. Of the medical subject headings (MeSH) searchable within PubMed, “retail” is not included in any terms associated with “pharmacy.” In contrast, the term “community”, is included in the MeSH term “Community Pharmacy Services.” When conducting a keyword search in this international database, “retail pharmacy” returns 371 articles whereas “community pharmacy” results in 9,332 articles. Based upon formal definitions, pharmacy organization standards, and research access considerations, the term “community” should be preferred over “retail.”

The risks associated with misusing terminology related to the pharmacy profession are great. Associating the descriptor “clinical” with some, but not all, pharmacy practice settings has the potential for creating a hierarchy within the profession, a division between “clinical” pharmacists and other practitioners. Categorizing pharmacists and pharmacy settings may limit the potential for the profession to move forward with provision of direct patient care because of erroneous expectations based solely on title or setting. This is particularly hazardous if determined by policymakers both internal and external to the profession, or if it limits opportunities to identify and develop patient care services in all of our pharmacy practice settings.

As pharmacists and faculty members, it is our responsibility to lead by example for the profession. We have the distinct honor of helping to shape the future of our profession through our influence on the pharmacy students of today. The terms we use will be adopted by future pharmacists who are now in our classrooms and our pharmacies. As the profession evolves, pharmacists must advance together as a united group of professionals. We challenge all pharmacy faculty members and pharmacists in any setting to embrace our commonalities across the profession through consistent use of terminology, most particularly related to the terms “clinical” and “community.”

Jennifer Rodis, PharmD
Maria C Pruchnicki, PharmD
Kristin A Casper, PharmD
Marialice S Bennett, BS in Pharmacy
Bella H Mehta, PharmD
The Ohio State University College of Pharmacy