I recently ran across an article in Women's Health called "The Doctor's Office Isn't Always a Safe Space for LGBTQ People." This advice could save a life: basically, it's an article sharing tips on self-advocacy in the doctor's office. Jessica Halem is the former LGBTQ director at Harvard Medical School and currently a board member of the Tegan and Sara Foundation, which is an organization advocating for the health, economic justice, and representation of LGBTQ girls and women.

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Jill Riley: Before we really dive into this project, can we just get a little background on the Tegan and Sara Foundation and how you got involved?

Jessica Halem: Yes, of course. I mean, I hope all your listeners' ears perked up because they're big fans of the wonderful musicians, Tegan and Sara. And of course, if you're a fan of their music, you know that they are lifelong activists as well. About five years ago, the two of them started this foundation, put together a wonderful board of directors. For the past five years, we've been really doing what they've done on the road for their entire career, which is building community, connecting with the audience, listening to what the LGBTQ community needed.

This foundation lets us move money to where it's needed most on the front lines of the LGBTQ community. We fund wonderful things like summer camps for LGBTQ kids all over Canada and the United States, as well as a lot of community grants — there's one right there in Minnesota — on-the-ground grassroots organizations that are really building communities, supporting each other in ways that maybe other funding sources are not doing.

So Tegan and Sara, the artists, are everything you would imagine: they're real, they're political, they're smart. And together, we've been able to raise and give away...this year alone, we have given away $200,000. And it's just a real joy and a pleasure to be able to get to work with two amazing people like Tegan and Sara.

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They are incredible. Every time that they've been in The Current studio, we just walk away with a great experience and a and smiles on our faces. It's always fun to listen to them interact. That word community is so important because they really have built that community. Well, Jessica, if we could get into our topic today: the doctor's office, and [how] it isn't always a safe place for LGBTQ people. Why is that? What is going on there?

Well, you're probably already: saying even "the doctor's office," you can feel your heart start to beat a little bit faster, your blood pressure is probably going up, you're probably getting a little nervous and anxious. For anyone, thinking about going to the doctor's office often can mean a lot of scary things. So in general, the doctor's office is a scary place for most people.

For LGBTQ people, this issue of safety really comes down to, can I be myself? Can I be open? Can I be honest? When you add in this idea of not being open and honest with a doctor, you've got a real recipe for disaster, right? So if you are talking about an office that's not safe, a place that's not safe to be yourself, bring your whole story, tell the truth about your life, in an environment where you will not be judged, won't face stigma or shame for sharing your real stories...unfortunately, it's not happening for LGBTQ people. They are being faced with great shame, great discrimination. You know, everything from "I don't know what you're talking about"...true stories of doctors actually leaving the room. "I can't take care of you, you're going to have to go somewhere else."

These are these are grave issues for anyone going into the doctor's office, and for people facing such huge health disparities, it's really life or death.

You mentioned discrimination in the doctor's office. How common is that discrimination? I have to guess more common than I think.

Yeah, we think about this discrimination and have studied it in two distinct ways. One is all of the barriers and issues of discrimination that we face before we've even gotten naked in the office, right? Before we're even alone with a doctor, we think about all of the ways that having health insurance discriminates against LGBTQ people. Many of us are in workplaces that don't offer it.

Before marriage was legalized, we didn't have access to health insurance in the same way we think about the actual health needs we have. Is transgender medicine covered under your health insurance? Is HIV care treated the same way? Fertility: thinking about fertility issues, making a family.

So all of these actual real policy issues, even before we've gotten in the door, can really create some serious problems in our healthcare. Then we think about that second level of discrimination, which is now I'm in the door and the doctor, the nurse doesn't even understand my unique healthcare needs. They don't know how to talk to me, they don't know how to ask the right questions, but they also are not trained in the unique healthcare needs of LGBTQ people.

I wonder then, even before someone goes into the doctor's office: just mentally preparing for a doctor's visit that might go in that direction is awful for someone to have to do. But that preparation and really, knowing how to advocate for oneself...I'm a straight white woman, and I have a hard time doing it. How do we do that? Do you have any tips on that?

This is a great question. I just get the, "How can I take advantage of this opportunity and make sure that I'm putting my best foot forward and protecting myself, getting what I need out of the situation?"

So first, we're sort of honoring and recognizing the barriers that I face, even just getting in the door. But then how can I make sure that I'm actually really getting what I need? I think that even just preparing and thinking about it is the first, most crucial step. Prepare for it, think about it, get right with it, instead of going in blindly. Just even processing a little bit the night before, maybe talking about it with your friends and family. "Hey, I'm nervous about going to the doctor tomorrow. Could we just talk about it? Like, can I just walk it through?"

One of the tips that I share with folks all the time is a wonderful strategy of just mapping out the process in your mind before you go. What train are you going to take? Or the bus? How are you going to get there? Where are you going to park? Are you going to eat before you go? Are you going to get a coffee when you get to the hospital? How much time are you going to give yourself? Is your morning clear so that you can get there? What are you going to wear? Is it comfortable? And how are you going to make sure that you write down some of the things before you go in that you want to talk about?

We know that we sort of have this fight-or-flight process that happens when we get anxious. So you know, the second most important tip that I love to share is — and this is true for everyone — write down what you want to talk about before you go into the doctor's office. So if you do feel those microaggressions, or those moments of bias or discomfort that we know are going to happen on your way to the doctor's office, you can handle them. You can take a deep breath, you can get through them, but that you've got your piece of paper. Even if you're full of anxiety and fear or anger about what's just happened, you've got your piece of paper and you can sort of say, "Okay, let me go through this. Let me talk about what I'm here for, what I want to get out of this visit, what's not feeling right." We know our bodies best. We know what's changed, we know what's different. And that's the story that we need to tell when we get to the doctor's office.

So again, advocating for yourself starts by preparing yourself, knowing what you want to talk about, knowing how you can really feel most comfortable before you even get into the door.

It's important for anybody to find the right doctor: sometimes it's just not a right fit. Are there any resources that somebody can [use to] verify that the doctor actually knows how to care for someone in the LGBTQ community?

I'm so glad we're talking about this, because I think it comes as quite a shock to most people when they realize that that that it is a near impossible for us to figure that out before we go. For anyone with a health issue or a health concern, of course you want to try to find somebody who understands that health concern. If you're having heart problems, you go and see a cardiologist, right? If you've got a mole that's changed, you go see an expert on skin: a dermatologist.

The truth is that most doctors and nurses in the United States are not trained in any way about the unique health care needs of LGBTQ people. They are not trained in it in medical school. If we're lucky, they receive a little bit of it in their residency programs. I'm happy to say, Minneapolis has a wonderful family medicine program that does great training in this, but it's few and far between when we find training programs that integrate the unique healthcare needs of LGBTQ people into this education. So we first have to recognize that we we have a real problem in the United States, and that our doctors are not trained in this.

So we know we're looking for a needle in the haystack. But one of the solutions that we have is again, another self advocacy tip: can we call ahead of time and ask if there's anyone in the practice who identifies as a member of the LGBTQ community, or has knowledge and training in LGBTQ health issues? You can ask the folks at the front desk to call, you can ask your insurance provider. It's true, more times than not, they're going to say, "I have no idea," but at least it starts the conversation. We have to start asking before we get in the door. "Hey, are you ready for me?" And if not, "Get ready!"

It's one thing to prepare for the doctor's office, or OB-GYN appointments...but I have to imagine we haven't even really touched on the barriers to mental health treatment.

Yeah. We know that this is a crisis happening everywhere. We hear stories about not enough beds for young people. In the U.S. right now, we know COVID has exacerbated this. We are really in a crisis of mental health care, support and needs. The same goes for mental health as with our physical health: we know that they're both so important, we want to treat them as a symbiotic relationship, that one really supports the other.

So again, calling your health insurance companies, calling the therapy offices, calling around to the places that are around you and saying, "I am a member of the LGBTQ community, and I'm looking for a provider who will be affirming and knowledgeable about my needs." And perhaps they are also a member of the community. Or perhaps they are somebody who has raised their hand and said, "I got you. I will take care of you." And it might not be everything we need. They might not have that training or all the real knowledge. But are they willing to go into this with me? Are they willing to create a safe, affirming space and together — whether it's your mental health or physical health — we can go on a journey of getting me what I need, but we have to start with a provider that's really open and affirming.

Is there anything that allies can do to help?

I love when allies are ready to become accomplices in this goal of changing health care for everyone. When we make healthcare more affirming for LGBTQ people, when we create a more equitable health care system — meaning we give people what they need, not necessarily the same for everyone — and we're really listening and caring for people where they're at, that raises the bar of health care for everyone everywhere. It's my hope that both sides of that interaction are listening this morning: you know, those in the medical field to take away some of this advice as well.

Wellness Wednesday is hosted by Jill Riley, and produced by Anna Weggel and Jay Gabler. Our theme music is a portion of the song "F.B. One Number 2" by Christian Bjoerklund under the Non Commercial Share Alike 3.0 International License. This week's photo is by Damian Romero (CC BY-NC-SA 2.0). The image was altered: it was cropped, filtered to greyscale, and supplemented with a logo.