Jessica Halem on communicating with LGBTQ+ patients Part 1

10 Minutes to Better Patient Communication

I get to talk–and laugh, a lot–with Jessica Halem, MBA. We discuss communication with LGBTQ+ patients, improv, and her fancy article in the New England Journal of Medicine. Her insights are as powerful as her joy.

You are in for a treat. Jessica Halem is a health communication expert who specializes in communicating with LGBTQ+ patients. I had so much fun interviewing her we went over time, and I had to split her interview into 2 episodes! And believe me, you won’t want to miss a word.

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. HCP’s online course, Equitable Patient Education, promotes high-quality clinical practice in patient education 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.

When Jessica Halem and I sat down at the mic, the time just flew. In this first half of our chat, she drops so much knowledge you might actually want to take out a notepad. Her insights are as powerful as her joy. She talks about her recent article in the New England Journal of Medicine about how medicine itself has helped create and perpetuate LGBTQ health inequalities. And her message is one of encouragement, appreciation, and possibility. And she teaches us about improv! I’m so excited to share this with you. Here’s Jessica!

Anne Marie: I’m live via Zoom with Jessica Halem. Jessica 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. Jessica, welcome to the show.

Jessica: Oh, my goodness. She sounds fabulous. I can’t wait for her to join us. I love that. I love whoever she is. She sounds terrific.

AM: Jessica, thank you so much for agreeing to be on the show. And this is a real treat for me. We have the Penn connection, but then I also found out in our pre-roll talk that you have a history in improv. So I’m a little bit nervous because, oh, the last thing I can do is improv, the last thing I can do is be funny. So really, I’m just going to learn from you during this podcast.

J: Well, you know, the secret, the secret of improv is that they’re not funny, they’re just present. That’s the secret. I just taught you two years of improv into one nugget, which is: don’t worry about being funny, just stay present, and you’re already perfect.

I love this. I love this. Do you hear that, everybody? Do you hear that? Remember that.

Yeah.

All right, I’m jumping right into the questions that I ask all of our guests.

Great, great.

So what is an issue or problem you are facing related to patient communication or patient education?

Well, the problem I have been trying to address to improve patient communication, patient education, are those moments, those difficult moments, between a provider and a patient. I am trying to tackle the alarming LGBTQ health disparities. I am trying to tackle that through cultural competency training, which it turns out itself needs an overhaul as well. I’ve been doing that for over 25 years, right? I’m sure that’s half of your conversations. If we were doing it perfectly, we wouldn’t be having this terrific podcast, but we’ve got some challenges, right?

Yep

We’ve got training’s not working. The education that’s already out there is not working. Thank goodness that you’re supplementing all of that. But I am trying to, you know, tackle the disparities that we see in my community, the LGBTQ+ community.

And you’ve anticipated where I’m going next with this. You know, how are you facing this, really? Because it is a communication problem. It’s an education problem. Yeah. How are you facing these LGBTQ health disparities in communication?

Well, what I love about your question is that it is a communication problem. It’s not a values problem. It’s not a goal problem. It’s not that people don’t want to do the right thing. I mean, I have been working with health care facilities big and small and providers all over the place for decades now. It’s not that people don’t want to do the right thing. It’s just they don’t know what to say and how to say it. We are not biologically different people. We need the same tests you already know about, the same screenings, the same care. There’s nothing fundamentally different. It’s just eliciting the information that people need, and translating it in a way where your care and concern can really come through, right?

So much! And I love that you’re starting with the fact that people really do want to do the right thing.

They do. They do. Yep. They do. And it’s so important to remind people in the work that you’re doing. I know you hear this every day. The values are there. The people who go into health care are terrific people. They want to do the right thing, but they just don’t have that education or training.

Right. Right. And it’s still kind of edgy, even among those of us who are in communication. Now, you recently were the lead author on an important article in the New England Journal of Medicine.

Fancy. Fancy! My parents are so proud. My parents are so proud. To be a non MD, a non Ph.D. and to, you know, have a first author article, it’s a testament to, as you just said, that this, we are still at the edge of this work. We are still at the edge of this work.

I’d like to tell people a little bit about this article. So this was the New England Journal of Medicine's kind of attempt to locate themselves as also responsible for these health disparities that we’re all witnessing over the course of their long history. As a high-profile Journal, as a well-respected journal, knowing that they have been part of the problem. And can you tell us a little bit about what your article was about?

That’s right. It’s very historic and important that the New England Journal of Medicine is trying to reflect on their own history of what they’re calling this Historic Injustice series. Historic injustices perpetuated on the basis of race, ethnicity. They have wonderful–it’s a whole series of articles that are free. You don’t have to have a subscription to be able to read these. They’re free, not behind the paywall. It’s the New England Journal of Medicine trying to really recognize Medicine’s role in creating the health disparities that we see today. And taking responsibility for healing that damage, that historic injustice. And just like we are learning about racism in medicine, we know that the pathologizing and the stigmatizing of gender differences, of sexuality, sexual minority people, gender minority people, we know that those experiences have been pathologized in the pages of the New England Journal of Medicine. So when we say we’ve got a communication problem, this isn’t just a verbal, I walk into the exam room, and you say the wrong thing, and it’s like a womp-womp. This is the written words that you studied as a Doctor. And we know this is true in other healthcare professions, too, actually taught you this categorization and this classification of differences, and what’s normal and abnormal, and healthy and unhealthy, and risk and not risk. So we know that it’s in the written word and the and the verbal communication as well.

Yes absolutely! Thank you for that. And that’s also why I’m just so excited to have you on the show today. And this next question is such a big question, so you can really take it any way you would like to. What are you learning from your work with health care professionals, your work with community health workers, your work with writing articles like this in the New England Journal of Medicine? What do you want to tell us, some of what you’re learning?

Yeah. Well, you know, I started off by saying just how good people are and what great work is happening. And I, when someone like me comes in to do a training or an education, I think the first thing that I observe from all of these amazing healthcare professionals on the front lines, in the back offices, at the front desk, in the exam rooms, is that they are doing really, really good work. And they’re really frustrated by how it feels like a drop in the bucket, right? They feel like they’re a part of this sort of tsunami waves of bad experiences that patients have had.

Thank you again to Jessica Halem. Tune in next time for Part 2 when Jessica rapid-fires the most useful, wonderful phrases you could use, or that could be inspiration to get you thinking and open things up for the next time you’re speaking with an LGBTQ patient. You will want to take notes and you won’t want to miss it. And there’s links to what we talked about today in the transcripts at h-cpartners.com.

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