Áine Mac Grory questions whether the care we deliver is genuinely tailored, or simply standardised
There is something reassuring about a protocol. A flowchart. A guideline with a neat summary box that tells us exactly what to do next.
Healthcare is built on the pursuit of certainty. We are trained to recognise patterns, categorise symptoms and align diagnosis with treatment pathways. Structure keeps patients safe and systems functioning.
But there is a quiet limitation embedded in that comfort.
Diseases may follow patterns. People rarely do.
‘One size fits all’ was never a clinical strategy. At best, it was a convenient starting point.
When ‘patient-centered’ becomes too familiar ‘Patient-centred care’ is now so embed- ded in professional language that it risks becoming automatic. It appears in policy documents, CPD modules and conference presentations. We invoke it easily and often with genuine intention. Yet familiarity can dull scrutiny.
Taken seriously, patient-centred care is not a soft ideal. It is a disruptive one. It requires us to move beyond diagnosis and into lived experience, beyond equality and towards equity, and beyond the reassurance of guidelines into the reality of individual circumstances.
Equality is straightforward: Provide the same information, the same options, the same pathway.
Equity asks harder questions. Can the pa- tient understand the information provided? Does the advice reflect their context? Is the conversation itself culturally comfortable? Is there trust in the healthcare system to begin with?
These are not abstract considerations. They shape whether care is accessed, understood and followed. Inclusivity exists in that less-tidy space between what is offered and what is actually received.
Menopause care is not experienced uniformly
Through my involvement with the Social Inclusion Committee of the Menopause Society of Ireland, I have had the opportunity to engage with the complexity of meno- pause care across diverse communities. The committee’s role is sometimes misunder- stood. It is not a patient advocacy forum.
Its purpose is practical: To identify and spotlight training, resources and approaches that help healthcare professionals deliver menopause care that is clinically sound, accessible and culturally competent across diverse populations.
The focus is on professional education — ensuring that pharmacists, GPs, nurses and allied healthcare professionals are equipped to recognise and respond to the varied ways menopause is experienced and discussed.
On paper, menopause is universal. Access to appropriate care is not. Language barriers, cultural norms, literacy levels, disability and financial pressures all influence how symptoms are described and managed. Yet clinical pathways often assume a baseline of access and confidence that cannot be taken for granted.
Community pharmacy sits at a particularly important intersection. We are accessible without appointment or referral, but accessibility alone does not guarantee inclusivity. A patient may ask about sleep disturbance or joint pain rather than vasomotor symptoms because cultural or
At that point, the structure of the consultation changed. The written safety net I would usually rely on was no longer relevant. I slowed down, used plain language, drew simple diagrams and asked her to talk me through what she understood, taking care not to make the exchange feel like a test.
In that moment, I found myself drawing on learning encountered through social inclusion work and resources such as those developed by Pavee Point’s Primary Health Care for Travellers Project, which empha- sises the importance of culturally sensitive communication, trust-building and aware- ness of literacy barriers — particularly for older Traveller women navigating complex health conversations.
Training resources from providers such as The Menopause Hub and the Irish College of GPs, while focused on clinical management of menopause, also highlight the need to adapt standard approaches so they remain inclusive of marginalised communities.
None of this required specialist equipment or extended appointment slots. It required awareness and a willingness to depart from the default script.
By the end of the consultation, she was still shy, still reluctant to use anatomical terms, but she began to ask questions.
Not because the clinical information had changed, but because her comfort level had.
Inclusion in practice
It would have been quicker to complete the transaction and move on. Pharmacy
is busy and time is limited. Yet genuinely patient-centred care does not always de- mand more time; it often requires different questions and closer attention to cues that something is not fully understood.
Inclusion is rarely dramatic. It is found in small adjustments: Recognising when nodding masks uncertainty, when literacy cannot be assumed, or when cultural discomfort shapes how symptoms are described. Disengagement is often interpreted as lack of interest, when it may in fact reflect previous negative experiences of healthcare or fear of judgement.
Health inequities are not theoretical. They are visible in delayed presentations, inconsistent adherence and uneven outcomes.
For a profession that positions itself as accessible and patient-focused, diversity, equity and inclusion are not peripheral concerns. They influence clinical effectiveness.
Menopause Society of Ireland and the work of the Equality, Diversity and Inclusion (EDI) Committee
It is a true pleasure to sit on the EDI committee of the MSI. Through this, I have seen the value of social inclusion work being done first-hand. It is inspiring. The EDI Commit- tee is shaped by colleagues whose projects continue to influence how menopause care can be delivered more equitably in everyday clinical settings. Dr Karen Soffe and Dr Maire Cleary’s collaborative work with the Traveller community in Kerry, developed in partnership with the Kerry Travellers Health Community Development Project and local HSE services, has highlighted the importance of culturally-attuned engagement and trust-building when discussing menopause. Their project, Leaving no Woman Behind: Providing Mid- Life Health Information and Care in the Irish Traveller Community, demonstrated how adapting language, format and delivery of information can make menopause education more meaningful and accessible for women who may otherwise feel excluded from mainstream healthcare conversations.
Alongside this, Nicola Wolfe’s development of the evidence-based Menopause Maze training programme has brought valuable focus to how menopause is experienced by women with intellectual disability and those using mental health services. The workshop explores both physical and psychological aspects of menopause and addresses how symptoms can be missed or misattributed due to communication barriers, diagnostic overshadowing and disempowerment. Her work reinforces the importance of equipping healthcare professionals and support staff with practical strategies to ensure hormonal health is considered within broader assessments of wellbeing and behaviour.
Exposure to this work has shaped how I approach menopause conversations at the coalface of community pharmacy. It has sharpened my awareness of what may remain unspoken in consultations, reminded me not to assume baseline health literacy or confidence in engaging with healthcare, and reinforced the need to adapt both language and pace to the individual in front of me. In practice, this does not require longer consultations or specialist clinics. More of- ten, it requires attentiveness, flexibility, and a willingness to move beyond the standard script so that information offered is not sim- ply delivered, but genuinely understood and usable within the patient’s own context.
From accessibility to meaningful care
Pharmacy rightly takes pride in its accessibility. Most communities can reach a phar- macy easily and without appointment. But accessibility only has value if it translates into care that can be understood, trusted and acted upon.
Patient-centred care is not simply about being kind or thorough. It is about being effective in the context of the individual in front of us. That requires curiosity about lived experience and an openness to adapt- ing how we communicate and support.
The guideline will always remain an es- sential starting point. It cannot, however, be the endpoint. The person in front of us is not a composite of protocols but an individual shaped by culture, history, literacy, trust and circumstance.
If care does not meaningfully account for those factors, ‘patient-centered’ risks becoming another familiar phrase we repeat without examining too closely.
And if it is not truly personal, it is difficult to argue that it is genuinely centered at all.
Áine is a Superintendent Pharmacist and pharmacy owner with over 18 years of experience working in community pharmacies across Ireland. In 2014, she earned her Master of Pharmacy (MPharm)degree in the UK. Her career journey has encompassed a variety of roles, including locum, support, and supervising, culminating in her recent transition to pharmacy ownership. She is deeply committed to upholding the integrity and vital role of community pharmacy in Ireland, combining her extensive experience with a passion for patient care and professional excellence.
