Optimism: A Building Block for Organizational Change

I believe that optimism can be taught. Or more specifically, remembered and conjured when needed. Finding ways to deal with these difficult moments requires us to engage our own personal mix of optimism, resilience, and self-efficacy. And the very act of using these personal attributes in small ways everyday can actually build up our reserves and make those necessary muscles stronger. The beauty of resiliency isn’t found in the ability to keep taking the hits, but in the bouncing back part. Every time we bounce back, we get stronger and wiser. The bounce can get faster, and the hits can sink in less deeply.

"Optimism: A Building Block for Organizational Change," Medical Care, December 2018

The 'Pronoun Go 'Round': Our Changing Language Around Gender

How we define gender is shifting, and so is the way we talk about it. Most notably, the way we use gender pronouns. For example, he/him for a man, she/her for a woman or they/them for someone who doesn’t identify with either gender. It’s a change that has come easy for some, but for many people it’s an adjustment that can be anxiety-inducing as they worry about saying the wrong thing. And then there are still others who simply don’t get why there is a need for a change.

Under the Radar with Callie Crossley, November 13, 2018

Who Gets to be the Authority on LGBTQ Medical Terms?

[Reposted from the blog Paging Dr. Rainbow]

"Hello! I have a question for the experts: Do any medical organizations have established guidelines against the usage of the term "homosexual"? I know GLAAD, The Associated Press, the NYT and many media sources and universities advise against usage of the term, but do we still use it in a medical setting? I had a lecturer today say that MSM, MSW, WSW, WSWM, etc. are incorrect and to use the terms, "heterosexual, homosexual, and bisexual" when giving a case presentation. I challenged the idea and was told they are "medical terms" and we always use the "medical terms." So, help a student out!"

-PA in training seeking better answers

Dear PA in training seeking better answers:

First off, let me say how pleased I am to hear that you have cases with LGBTQ patients in your education. It wasn’t that long ago that cases like this weren’t available, discussed, or appreciated as an important part of patient care. We have come a long way.

Language that describes the LGBTQ community has changed and will continue to change. But language is just a tool to use to describe what we observe, learn, or hear from our patients. So, everyone will have to be a bit flexible as we continue to listen better and illicit more information from patients. In fact, at the turn of the last century in the US, the “medical term” was “invert” which represented the conflation of gender and sexual orientation and then the word “homosexual” became more widely used. Both were terms used more with derision and judgement than care from the medical community. So, there’s that history.

Today, we know “nonbinary” is a widely used word to describe a gender identity or expression that some would have called “androgynous” just a few years ago. And of course, transsexual was a word we used to use as well, but now use the word transgender. I am sure there are cases and textbooks that haven’t been updated accordingly.

So, finding an authority on “medical terms” seems to be the issue with your lecturer. I can say with authority -- we do not use the word “homosexual” to describe patients anymore. It actually isn’t a word that people use to describe themselves or does a good job of describing behavior that needs to be discussed.

What is key here is appreciating two distinct differences in discussing sexual orientation – first, language that describes the SEXUAL BEHAVIOR of our patients and secondly, language that patients use to describe themselves. What we still like about MSM is that it describes sexual behavior and doesn’t assume identity. We know plenty of men have sex with other men and are married to women. We also know plenty of women describe themselves as lesbians but have had or will have sex with men.

In terms of who else is an authority on medical terms for the LGBTQ community – the NIH now uses the phrase “sexual and gender minorities” and the hospitals you will work with have electronic health records that probably already have SOGI (sexual orientation and gender identity) data collection in place and use words like “gay” and “cisgender”.

Medical terms are only authoritative if they are helpful in understanding, valuing, and supporting the patients you are being trained to care for in the future.

If this analysis doesn’t work, attached here are guidelines from Harvard Medical School here.

-Jessica Halem, MBA, LGBT Program Director, Harvard Medical School

Thank you Jessica for your awesome contribution to our blog! What an amazing conversation starter you have been!

Supporting Transgender Patients Today and Everyday

A note to the LGBTQ and Allies of Harvard Medical School:

Today is a hard day for our community and families. Yesterday, the New York Times reported that the current federal administration was: “considering narrowly defining gender as a biological, immutable condition determined by genitalia at birth, the most drastic move yet in a governmentwide effort to roll back recognition and protections of transgender people under federal civil rights law.”

We know that the sex we are assigned at birth and our gender identity are not the same. We can’t exam a baby at birth and project the life they will live, who they will love, and how they will come to see themselves.

In every corner of the HMS system, I am inspired by the providers who are taking care of transgender, nonbinary, and gender nonconforming patients with sensitivity and respect. Many of you have announced this care with your websites, rainbow stickers, and the forms in your office. Some of you are doing this quietly with no other support, just approaching each person with openness and care knowing everyone has a rich and meaningful story to tell you.

Historian Joanne Meyerowitz, in her award-winning book: “How Sex Changed”, describes that throughout history, individuals expressed genders that were different from sex. And by the 1950s, even American doctors decided this distinction was medically sound. "They distinguished biological sex from the sense of a sexed self, which they labelled "psychological sex" and later "gender". They began identifying component parts of gender, distinguishing gender role from gender identity, and also separating gender from sexuality." 

So, doctors created this distinction as a way to understand people. It wasn’t what they could see in a microscope or brain scan, but what they saw in their patients. Just like you are doing today. 

Today, the Class of 2022 of HMS medical students is nearly 20% LGBTQ and many embracing a nonbinary identity. Many more on top of that percentage are here to carve out a career that cares for transgender patients. I am not afraid by the latest from this current administration because I get to support you all in your work. I know today you will approach each patient with a little more care and curiosity. You remain a vital bulwark against the hardships faced by transgender, nonbinary, and gender nonconforming patients. I’m proud to stand with you. 

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Today Is the Day: A Call to Action for Providers During LGBTQ Pride Month

The LGBTQ community needs health care providers to open their eyes and commit to our health, well-being, and healing. We need them to be aware of our history and the reasons why so many of us don't trust that doctors and nurses will treat us with respect. We need them to refuse to go along with historic or religiously based attitudes that belie our humanity. We need them to embrace their role as a positive, powerful force in mitigating the discrimination and shame felt by patients. Seeing and healing this foundational pain is the first step to our health and wellness today.

The BodyPro for the HIV/AIDS Workforce. HIV Case Management and Social Work. Viewpoints. June 12, 2018

Why Do You Call Us Ladies? History, Gender, and Manners in Public Life

The term ‘ladies’ itself has a history that illuminates how power, privilege, and oppression have functioned throughout American history. From early modern times through much of the twentieth century, the term ‘lady’ signified women with power and authority over others by virtue of their race, class, marriage, or ancestry. A lady was a queen or head of household who oversaw subjects, children, servants, and slaves.[1] As Evelyn Brooks Higginbotham notes, “Ladies were not merely women; they represented a class, a differentiated status within the generic category of “women.”” During Reconstruction, for example, married black women who didn’t work outside of the home and aspired to such status were socially condemned for even trying.[2] A lady was a quintessentially normative white woman who set the standards by which other women were judged.

Read the full article at Public Seminar.

The Future of Lesbian Health

"Strong Women," Curve Magazine, April/May 2017

By Jessica Halem

Since 2001, I have been an LGBT health advocate. I learned the most about this type of advocacy from my five years as the executive director of the Lesbian Community Cancer Project in Chicago. It was there that I met lesbians like Peggy, who died of ovarian cancer. She was without her partner at the end because her homophobic parents flew in and seized control of her care. And then there was Shannon, who died of breast cancer. She was an artist, didn’t have health insurance, and had never had a mammogram—until it was too late. My dear friend Lisa died of lung cancer. She ignored the signs for months because she was busy organizing our support groups, taking care of her partner and everyone but herself.

Lesbian health is about all of this—homophobia, access to health insurance, and the challenge of putting ourselves first in a busy, stressful world. But to hear most doctors talk, you would think tackling our BMI (Body Mass Index) would magically solve all these problems. Obesity is often the first thing out of their mouths when it comes to lesbian health—but it shouldn’t be.

What we really should be talking about is strength. How are we building strength in our bodies, our muscles, our bones? How are we building strong hearts, relationships, and communities? In what ways are we already strong, and where do we need to get stronger?

Me? I'm 44 years old and keep suffering from lower back pain. As soon as my doctor described how core strength would support my back, it all made sense. Suddenly, it wasn’t a conversation about weight but about strength. Many of us avoid going to the doctor because we don’t want to talk about our weight—especially with a straight doctor. Prioritizing a strong back and core was exactly what I needed to motivate my feminist lesbian soul. 

I propose centering lesbian health—our health—on strength and resilience. Lesbians building muscles. Lesbians with strong hearts. Lesbians whose backs can bear the weight of it all. Resilience is the ability to bounce back or quickly adjust to change. As lesbians, we should see this as a crucial and powerful goal. Resilience is built on strength.

I now work at Harvard Medical School, where I get to influence the next generation of doctors. I asked a woman on our faculty to tell me what she thought about the idea that strength is a powerful key to health. Dr. Jennifer Potter is an associate professor of Medicine at Harvard Medical School, the director of Women’s Health at Fenway Health, and an out lesbian. Dr. Potter says, “Building physical strength helps build psychological resilience and a sense of empowerment,” affirming that there is a strong connection between the mind and body.

I asked her directly how we could shift the focus away from weight with our doctors. Her advice was to say something like this at your next appointment: “I am aware that my body size is outside the ‘ideal body weight’ range for my height. I’m looking for a provider who can help me focus on wellness by helping me increase my strength or endurance, rather than focusing on diet or calories, which I’ve never found helpful. Is that something you think you can do?”

Imagine if our health care providers asked us to describe how we take care of our bodies and minds in a world that makes doing so a challenge—or if doctors communicated that they understood how homophobia directly impacts our health. Dr. Potter wishes you would tell your doctor more, like what brings you joy and what challenges you to go forward. Imagine you and your doctor talking about strategies for building physical and emotional strength, brainstorming together about potential solutions to life’s challenges.

Remember, self-care is an act of resistance. We are lesbians, we are strong—we got this.

Rebecca Fox pictured above. Photo Credit: Bayla Bryski

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How Should Physicians Refer When Referral Options Are Limited for Transgender Patients?

Transgender people encounter many barriers to health care, and recommendations about where their treatment would best be offered can promote or thwart good care. This case examines the care setting from the perspective of a patient whose experiences with specialists have been negative. We argue that an ethos of harm reduction and informed consent, with a strong emphasis on continuity of care within a primary care setting, should guide questions about how to refer transgender patients to caregivers and to good care settings.

Career Progression in Academic Medicine: Perspectives from Junior Faculty Women of Color

Women of color continue to be particularly underrepresented in academic medicine, and yet there is a dearth of research about this group’s specific needs. This qualitative study provides insights on how WOC junior faculty experience career progression. We hope that this study will help minority women and institutions identify ways to overcome these barriers, so that ultimately, women and men of all backgrounds are able to progress in their academic careers while also achieving their personal goals and meaningfully contributing to their institutional missions.

Author Caterina F. Hill is Research Associate for the Department of Global Health and Social Medicine at Harvard Medical School. Author Emorcia V. Hill is Director of Research and Evaluation in the Office for Diversity Inclusion and Community Partnership at Harvard Medical School. Author Michael Wake is Program Manager in the Office for Diversity Inclusion and Community Partnership at Harvard Medical School. Author Stacy Blake-Beard is Professor and CGO Faculty Affiliate at the Simmons School of Management. Author Jessica Halem is an MBA student and Research Assistant at the Simmons School of Management. Author Joan Y. Reede is Associate Professor and Dean for Diversity and Community Partnership at Harvard Medical School.

100 Women We Love 2012

Sun in Gemini. Moon in Sagittarius. Mind in gutter. Jessica Halem is what happens when you mix a hippie Midwest upbringing with a Sarah Lawrence education. The nationally touring comic brings brains and bawdiness to her racy, politically charged stage act and the result is little like a horny Gloria Steinem on nitrous oxide. “Humor is a powerful weapon for social justice,” says the former globetrotting executive assistant to feminist icon Bella Abzug and former Executive Director of the Lesbian Community Cancer Project. “No one knows what to expect from me,” she adds. “People hear lesbian feminist and are surprised when I start talking about glory holes. But that’s why I’m here, to complicate the way queer people are seen.” Jessica’s one-woman show Bad Feminist was such a huge hit at last year’s HOT! Festival that she landed her own monthly show at Dixon Place. She returns to the festival this year with See Something, Gay Something.

GO Magazine, June 15, 2012

Laughter is the Best Method

At Doblin Group, a Chicago-based consulting firm that specializes in innovation planning, you can tell that people are getting serious — because they’re rolling in the aisles. Doblin, which works with clients such as McDonald’s, Monsanto, and Whirlpool, tries to infuse humor into everything that it does — from writing reports to driving change. “Companies want innovation — theoretically,” says Larry Keeley, 43, the firm’s president. “But when innovation requires change, it can be terrifying. Using humor and storytelling can help people understand new ideas.”

That’s where the Friday morning staff meeting comes in. The firm’s analysts, designers, and strategists share data, offer updates — and riff. Their mantra? Make your presentation fast, funny, and relevant. Jessica Halem, 26, an associate at Doblin who moonlights as a stand-up comic, runs the show: “I bring an ability to think on my feet. But you don’t need to be a comic to do that.”

A version of this article appeared in the May 1999 issue of Fast Company magazine.