4 reasons to take the free CMS course on LGBTQ health

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CMS has a free online course called Improving Health Care Quality for LGBTQ People. Here’s 4 reasons you should take it!

I'm grateful that there are so many resources out there if you care about health equity and communication. In honor of Pride month, I'm going to highlight one of them: a free online course from Center for Medicare and Medicaid Services called Improving Health Care Quality for LGBTQ People and I'll share 4 reasons you should take this course.

Hi everybody. I'm Dr. Anne Marie Liebel, and this is 10 Minutes to Better Patient Communication from Health Communication Partners, your partners in health-equity focused education and communication. Visit healthcommunicationpartners.com.

Now I'm in a lot of what we could call DEI conversations and I have been for many years. And I realized I had gotten a little complacent, like somehow just by being in equity-oriented conversations I was picking up stuff that I needed to know about lgbtq health, like just by osmosis. And obviously, that's not true! And I could not remember the last time I'd sat down and educated myself about lgbtq health. You know I'm someone who cares a lot about the language choices we make, and I'm glad I sat down to take this course because I learned things!

It's described as being for health care providers and staff who are responsible for collecting Medicare patient data from LGBTQ persons. So I am not the target audience And I found the course helpful and enlightening. So I'm going out on a limb here and saying if you're interested in getting more comfortable talking about sexuality and gender with anyone, plus understanding some of these concepts better yourself, or you need a refresher, you might find this course useful.

So let me tell you some of the specifics. It's called “Improving Health Care Quality for LGBTQ People.” It's on the CMS.gov site. So the esiest way to find it might be to go to CMS.gov and put in the search box lgbtq and this course should be one of the first results. It takes about one hour, it's free, It was developed with help from folks at the Fenway Institute in Boston. Obviously I'm gonna go ahead and put the link in the notes. And the course centers around what's called sexual orientation and gender identity data, so they use the acronym SOGI, which they pronounce soh-gee.

And the course's purpose is right up front there, it says: It is critical to respect each individual's sexual orientation, gender identity, and gender expression. To deliver high quality and culturally competent care, it is also important to engage patients on their sexual orientation and gender identity (SOGI) during the clinical encounter. And really, throughout the whole course, they weave through good arguments, I think, about why it's important to do this. Why it's important to know these things, to pay attention, to ask these questions, and the benefits of doing so. Most important, of course, is to be able to provide better care. Healthier people. So they talk about Federal policy developments, market competition, they give you a bunch of other reasons on top of providing better care. So here are 4 reasons why I think you should take this course!

#1 TERMINOLOGY

One of the course objectives is that you'll be able to correctly identify sexual orientation and gender identity terminology to build trust with LGBTQ patients.

Right away, they are careful about terminology. They say, Sexual and gender minorities often include those who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ), although there are many people who are also sexual or gender minorities and choose different terms to call themselves. It's important to point that out first, and show how careful they're going to be about terminology. And the kind of claims you can make about what kinds of terms groups of people like.

The first lesson, for example, starts with terminology. So much terminology! You might want to take notes at that section. There's even some history on the terminology, they point out how language changes over time, they note that some groups tend to prefer some terms, but they also give you caveats. Trying to make claims about groups' preferred terminology is inherently tricky.

We get right into issues of stigma. For example, a video on the causes of health disparities in older LGBTQ adults, starts with the word homophobia. And we go right there: homophobia and transphobia and that this often starts in the home! They're not stepping around these issues! They talk about historical atigma and prejudice in the medical context, and talk about nondisclosure as being a survival strategy. So yes, reason #1: the way they deal with terminology.

#2 ASSUMPTIONS

You know I care about unearthing assumptions, and they deal with assumptions. Listen to this one, I love this: you can never assume you know someone's gender identity. I think that's just good life advice.

If you're a clinician, here's one for you: It is important that health care providers ask a patient their sex assigned at birth, gender identity, and sexual orientation to ensure the highest quality of care. And that's challenging some assumptions about the kinds of screening you do and the patient's data that you collect.

Another assumption that they challenge is that people don't want to talk about this with their providers! They give us Surveys, and voices of patients, and the consensus is it's important to ask these things, and we don't mind your asking. In the course they talk about there's many ways to ask, not just verbal and face to face. I talked about this issue in a past episode; I'll put a link in the notes.

But they also point out, If a patient does not feel safe or for other reasons elects not to share SOGI information, health care providers must respect that decision.”

They also challenge the Assumption that these are just conversation that young people need to have, saying, Providers should ask older patients about their sexual activity because many older adults are sexually active and need the same sexual health care as younger patients.

#3 COMMUNICATION

So much of this is about communication. So aside from terminology I wanted to point out a few elements that I appreciated. Open-ended questions! They talk about open-ended questions! I've done a past episode where I give you several of them, some of them are on this topic. I'll throw that in the notes as well.

They talk about communication and making mistakes. Let me share this with you: Promoting culturally sensitive communication among staff is also of critical importance. Often the most important, but challenging, communication strategy is to have staff consistently use correct names and pronouns with patients. Because mistakes do occur, staff should learn to feel comfortable apologizing, and should work together to maintain a culture of accountability. So yeah, mistakes are gonna happen. We're gonna trip up when we try to use the correct pronouns and correct names. And we've gotta be ok with apologizing, making mistakes.

There's plenty of what not to say' throughout the course along w plenty examples of what to say. They also give you sample questions, sample statements, and even a few ICD 10 codes.

#4 DESIGN

I like that the course is a mix of video and text. I think they also do a nice job with key concepts. They do a summary at the end of each lesson, and I think that's good instructional design.

When you take it, click on the references tab. Because the resources document, it's a pdf, it's about 6 pages long and it's full of links and I think you're gonna want it. Including A link to the Sexual and Gender Minority Clearinghouse that CMS has.

And as part of the design, I think there's these three concepts that we hear dealt with separately and together: gender expression, gender identity, and sexual orientation. So part of their design is dealing with these three topics together and separately, and educating us on them.

There's some great stuff in there that I don't have time to tell you about. Like The gender unicorn! If you don't know about the gender unicorn, go ahead and google it. It's kind of an improvement on the genderbread person.

And ultimately, I think that much of what they're advocating is just good practice. Good practice for everyone, not just LGBTQ patients.

I’m Dr. Anne Marie Liebel. This has been “10 Minutes to Better Patient Communication” from Health Communication Partners. Audio engineering and music by Joe Liebel.

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