Jessica Halem on communicating with LGBTQ+ patients Part 2

10 Minutes to Better Patient Communication

In Part 2 of my interview with Jessica Halem, MBA, Jessica shares useful phrases and encouragement for the next time you’re speaking with LGBTQ+ patients.

Jessica Halem has spent the past 25 years working in LGBTQ health. First as the executive director of the Lesbian Community Cancer Project in Chicago, to serving on the Board of GLMA which is the largest association of LGBTQ healthcare professionals, to now 10 years in academic medicine at Harvard Medical School and the University of Pennsylvania, teaching the next generation of healthcare providers how to care for LGBTQ patients. She currently serves on the Board of the Tegan and Sara Foundation where she built the LGBTQ+ Healthcare Directory.

This is Part 2 (Part 1 here) of my interview with Jessica Halem. Jessica fills your cup to overflowing with useful phrases and encouragement for the next time you’re speaking with LGBTQ+ patients. Hi everybody, I'm Dr. Anne Marie Liebel, and this is 10 Minutes to Better Patient Communication, ranked #20 of Top 100 Podcasts in Social Sciences by Goodpods. Our online course, Equitable Patient Education, promotes high-quality clinical practice by helping prevent avoidable errors. Learners say, There's a lot of eye-opening information I hadn't considered before. For more information, visit healthcommunicationpartners.com.

In Part 1, Jessica and I talked about medicine’s historical role in creating and perpetuating LGBTQ health disparities, and the important work that’s been underway to address these harms. In Part 2, Jessica shares so many precious jewels of wisdom with us, it’s staggering. One of my favorite parts is how she lets us off the worry-and-guilt hook, and focuses us on what’s really at issue here: patient care. We pick up our conversation as Jessica teaches about opening a conversation with an LGBTQ patient by acknowledging past harms, and offering a new start.

Jessica: And so that’s a piece of what I always want to remind people of is saying, “Hey, I bet you’ve had a bunch of bad experiences before we met today. It might have just been on the way into the facility. It might have been over the years in the health care system, but I want you to know that I see you. I hear you. I’m glad you’re here. How can we start fresh? How can I start over with you? How can I start to heal maybe some of those bad experiences you’ve had? Or how can we just start anew, right? Can we start from the beginning? Tell me what do I need to know?” And those healthcare workers, again, they know the kinds of help that people need. It’s how to get there. So, you know, what do I want people to know is I just want them to know that saying things in a different way, recognize that historic injustice, whether it’s personal or communal or the big picture, hundreds of years of history is a great place to start.

Anne Marie: And that also takes the onus off them if we’re going to talk about a large history.

J: That's right

AM: Like you don’t, you might not know so much about this individual in front of you, but you know something about the history and you can at least motion to the group and motion to, you know, the widespread difficulties that you are aware of

That's right

before you try and dial down. We were talking before the show about how the willingness, you’ve seen the willingness to do the right thing. And you told me this great story about trying to–it’s not as easy as fixing a form or just adding another question.

That’s right. I wish it was. I wish it was!

And you said you’d have this meeting at Harvard Med School with a whole bunch of Senior Vice Presidents and they, you know, “what can we do?” and you’re like “we’ll look at the forms.” “Well, come to our next committee meeting on forms. There are 6 ,000 different intake forms.”

Every health care worker knows this story, that the forms, that the data collection is such a challenge. There’s so much, we’re almost swimming in data, but maybe not the right data, maybe not the right questions, maybe not the right check boxes. And that’s just the beginning. We do want to make sure that LGBTQ identities and behaviors and experiences are reflected in the forms. We do want to take a bit of that onus off of that health care worker. We do want to make sure that people and their real experiences are reflected on the form. So you do need to ask people their sexual orientation on the form. You do need to ask people about the genders of their partners. You do need to find out about their current gender identity and their sex assigned at birth. We can do a lot of this in the forms. But boy, those IT departments, they’ll have you believe that this is the biggest challenge you’ll ever face and I know it can’t be true! But, you know, it doesn’t, it doesn’t replace the good old -fashioned face-to-face conversation that a health care worker and a patient have to have. Tell me about your partner. Tell me about what kind of sex you’re having. Tell me about your gender. Tell me about your gender journey. But it can really start the conversation. And those forms can be an important place to capture the data correctly, but also make sure that we’re having the deep, deep conversations, face to face.

And thanks for teeing up my last question, which is, is there anything that you want to tell people who are having these face-to-face conversations, who do have the values are in the right place and the goals are in the right place and they want to do the right thing? Do you have anything that you want to share with them?

I am so thankful that they are going to try. I think my number one piece of advice is always that you were not taught how to do this well and you’re going to need to find your own path in asking the questions the way that you are comfortable and feel powerful asking. I don’t want any health care provider to feel, what’s that expression, on the back foot, on their heel? I don’t want them to feel like I’ve got to say it in the perfect way. I need the perfect script. “Jessica, just write it down and tell me exactly what to say, how to say it.” I need you to find your way to get to the place that allows that patient to open up to you in a way that is honest and meaningful, and gets them the kind of care that they truly need. So you want to ask a patient, I am here. I am listening. Tell me about your gender. Tell me about your gender identity. Tell me how you identify today. How is that going for you? Do you have any questions for me? Tell me about your sexual orientation, your sexual partners, how is that going for you? How can I help you? How can I help keep you safe, happy and healthy?” right?

Because that's what it comes down to.

Right.

You want to make sure they're getting the right care. And one of the things I'm loving is that you're not getting tied up in terminology or pronouns.

No, oh my gosh! I mean, I wish that, you know–I can’t make a living just telling people that if you ask someone their pronouns, you’d know everything about them. Unfortunately, that’s not true. I think for a lot of, especially young people, it’s an exciting conversation to have. But for most LGBTQ people, pronouns are not the beginning nor the end of the conversation. They’re just one piece of the person. You don’t know someone’s gender identity by asking them their pronouns. You don’t know someone’s sexual orientation by asking them their pronouns. Unfortunately, pronouns are how we speak of each other in the third person. We all have one. We all need one. We sometimes do need to speak of each other in the third person. But I will tell you a really valuable lesson this one's a bonus freebie which is: you could just use somebody's name. And if you don't know their pronouns, you do not need to make a big to-do about asking pronouns, you don't need to figure it all out, you don't need to feel terrible you got it wrong, you don't need to fall apart because you didn't ask! If I'm a patient I don't need to wait for that. I can talk to people like a person and use their name, speak of them in the first person. When I’m in the hallway talking about them, I can talk about them with their name, right? We don’t have to trip over ourselves with the pronouns, everybody. Let’s jump to the real heart of the matter, which is, “I’d much rather you know what my blood pressure is than get my pronouns right! I’d much rather you screen my cholesterol and just help me understand why my cholesterol numbers and my blood pressure numbers really, really matter, right?” And perhaps I am somebody that when everyone gets my pronouns wrong, my blood pressure goes through the roof. Sure, that’s a great conversation. But it's about the blood pressure numbers, the stress, the anxiety of being seen and understood in the world. And that's my hope for everyone listening to this, is to get to the heart of the matter and getting people the kind of care, the real health care needs that they have.

Jessica Halem, thank you for being on the show. Thank you for the wisdom that you're sharing. Thank you for the work you're already doing in the world and continue to do. I'm just delighted that you've spent this time with us today and you've shared these insights with our listeners.

I'm grateful that everyone listening to this is going to try and be part of this challenge we have in ensuring that all LGBTQ+ people can live long, happy, healthy lives.

So many thanks to Jessica Halem for coming by the show and sharing insights, encouragement and improv energy with us. Don’t miss Part 1 and links to what we talked about in the show transcripts for this and every episode at H-CPartners.com.

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