Meet the Guest
Mary Kathleen Haber, FNP, IBCLC
In this episode we Mary Kathleen Haber about inclusive sexual health assessments. We cover a lot of information including why inclusivity and language is important, important questions to ask, how to frame sexual and reproductive health questions across the lifespan, how our current questioning my be limited, and how we can make our environment more inclusive. Mary Kathleen also reviews the sexual health assessment she uses in her practice.
Main Questions Asked
- So obviously we are biased, but sexual health is such a critical piece of who we are and impacts our overall health and well-being. Can you start out by sharing with us what an inclusive sexual health screening means to you?
- At what age do recommend talking about sexual health and how does that conversation vary depending on the age of your patient?
- This may change depending on the age of your patient, but what is the first question you start out by asking to inform how you are going to frame and discuss sexual health with a patient?
- What language or terms do you recommend clinicians use to be inclusive?
- As we know, communication extends beyond just what is verbally said between patients and clinicians. What are some other things you are mindful of when communicating, like maybe the environment or your body language?
- We have previously recorded a couple of episodes about sex shame on behalf of clinicians and how that can impact clinician/patient communication. What thoughts do you have on clinician sex shame or beliefs and how that impacts communication with patients?
- What tips do you have for clinicians who may be struggling with personal sex shame or have different beliefs than their patients?
- What is the one thing you would want all listeners to know about sexual health screening?
- Where can folks go to learn more about sexual health screening?
Instagram and Facebook folks to follow: feminist, freestatejustice, q4bl_march – Queers For Black Lives, mdcenterforgenderandintimacy, womenwhitebuffalo – Women Of The White Buffalo, unmatchedathl – Unmatched Athlete (LGBTQ+ youth athletes), antiracismctr – Center for Antiracist Research, teensforreproductiverights, yalesph – Yale School of Public Health, together.rising, kckidsdoc – Dr. Natasha Burgert – Pediatrician, blackliturgies, iamjarijones – Jari Jones (transwoman experience), bmorehrc – Bmore Harm Reduction Coalition, menopause_society, 19thnews – newsroom reporting at the intersection of gender, politics, and policy, ILCA – Transforming world health through lactation care by supporting IBCLC’s & healthcare providers, acog_org, kaydenxofficial – Kayden X Coleman (He/Him) (transman/father experience, queersextherapy – Casey Tanner, MA, LCPC, CST, thelilynews, impact, thetaskforce – National LGBTQ Task Force
Nicole: . [00:00:00] Hi everybody and welcome to the Woman-Centered Health Podcast. Today we are speaking with Mary Kathleen Haber, a family nurse practitioner, contributing writer to those nerdy girls and international board certified lactation consultant about inclusive sexual health screenings.
And holy buckets, are we so excited for today? This is an episode that has been a long time coming and probably should have been one of our first ones, but here we are. We’re doing it today and it’s gonna be awesome. But before we start our interview, we just wanna thank all of you for listening and to let you know that nurses can now earn CES for listening to the wch podcast.
And you can get key takeaways, resources, and transcripts by visiting our website, women centered health.com. Also, Stephanie and I put this podcast together in our free time and often use our personal funds. So please consider supporting us. You can support us by subscribing and giving us a five star ratings on iTunes or wherever you’re listening to us.
And if you are able to offer a financial donation, visit our website and click the support us tab. All right, let’s meet [00:01:00] our guest.
Stephanie: Hi, Mary Kathleen, thank you so much for being a guest on our podcast. I know I have loved working with you on those nerdy girls. And just a shout out to, to those nerdy girls, if you haven’t listened. We had our first nerdy girl guest, which was Sarah Gorman. So if you haven’t checked out that, episode yet, she talks about misinformation.
So Mary Kathleen, could you first provide a little bit of details about your background?
Mary-Kathleen Haber: First I wanna say thank you so much for having me. I’m honored, very nervous. I want to do a good job sharing all the information that I cherish so deeply. My name is Mary Kathleen. I use she her pronouns and my path to where I am today is very long and with many offshoots. I began in public health in 2002, researching fetal and infant mortality and maternal mortality.
With Baltimore City, then it [00:02:00] grew, the project grew to regional, to Maryland. I covered Western Maryland and then eventually went to the national scene advising people on fetal and infant mortality, maternity mortality review. And why that’s important is because fetuses and infants are the most vulnerable among us.
And so when we study their outcomes, we learn how to protect the whole community. So I began there not as a nurse but felt sitting at a computer wasn’t my life’s work. So I did go to nursing school, became a nurse. I worked at a major academic teaching hospital on a high risk maternity ward, and eventually I became a nurse practitioner.
I really wanted to work for upstream. So I went into primary care, family, primary care and then went a little bit downstream and started working with chronically ill and end of life people and stage diseases and, and up working with a lot of comorbidities, [00:03:00] mental health comorbidities with substance use disorder.
And ended up being someone, one of the only practitioners in my practice who was comfortable with reproductive health. So I took that on and really became a champion for sexual health assessment, reproductive health substance use treatment, all in the primary care so that we weren’t fragmenting care and.
Then after the pandemic, I said, no, I need to go back upstream and I need to go way back upstream. So now I run a practice that I started that focuses on the perinatal period working with new families newborns, infants, toddlers. And I’m loving that work. And yes, even in that work I do do sexual health assessment, which I’ll tell you about later.
Stephanie: Awesome story. I always love that question because I think nurses in particular have such a, like, they kind of enter the field at all different times and have a different trajectory. [00:04:00] So,
Mary-Kathleen Haber: Isn’t that the best thing about
Mary-Kathleen Haber: I.
Stephanie: So thank you. So our next question, which is also we love the answer to this one. So what informs your perspective?
So in other words, why do you do what you do and what is most valuable to you?
Mary-Kathleen Haber: All right. How long is this podcast? We’re gonna be, we’re gonna be here a while. No. I’ll try to make this brief. it’s a pretty personal story. I don’t know how personal your other guest yet but I grew up in the seventies, eighties and nineties in LA and West Hollywood. And I don’t know if that immediately hits you with the impact that may have had, but I was growing up when H I V was hitting the scene in West Hollywood, which is a a city known for its welcoming.
Environment for the LGBTQ community. And so that was the neighborhood, the city that I grew up in. And by virtue of being there [00:05:00] I was born an ally, started working as a volunteer in the first day hospice for people living with H I V when I was 13. And did my first informal research looking at like an actual project a qualitative review on the impact of an accepting environment on the disease outcomes of people living with hiv.
And that was in eighth grade and we won in 19 88, 89. We won second place in the science fair.
Mary-Kathleen Haber: So,
Stephanie: Science Fair project. I was like looking at pennies and soda so.
Mary-Kathleen Haber: Oh yeah, first place was like wheat germination. I mean, people did definitely raise eyebrows, but if it was clear that this is like part and parcel of who I am from a very beginning. But I don’t just work with people from the L G B T Q and I’m gonna say [00:06:00] formally here that I shorten it because it really is much more than BT Q.
There’s two spirit, there’s intersex, there’s asexual much more. But just for the sake of my tongue working, I will shorten it to l Bt Q. When I say it in writing, I try to write out the whole thing every time. So that’s one community. Another community is, I was raised poor experienced homelessness, slept in shelters I was raised for several years by a black man when my biological father was very challenged and incapacitated with drug use.
You see all these identities coming together here. My dad was, had, my biological father had inappropriate boundaries and was a veteran who had P T S D and ended up becoming violent. I used to see these in a very narrow way before I got into [00:07:00] healthcare. Like, these are personal flaws. These are things to be ashamed of.
These are things that are stigmatized for a reason because these are bad people or bad things. And now that I’ve become involved in the healthcare system, I really see these as systems that are honestly many times put into place purposefully. To marginalize members of the community and to create patriarchal power systems that keep certain people in power and other people not in power.
And so I told you it was very personal, but you can see how all these different personal aspects of my history have informed what I care about. Substance use disorder, mental health, sexual health, infectious disease L G B T Q and that intersectionality is so important to any work that we do in healthcare.
So yeah, that’s, that’s some of what [00:08:00] informs what I do. And now a lot of what informs what I do is that I’m a parent of a teen. I’m a parent of two teens. And so I really wanna get some of this right for them.
Nicole: Well, one, thank you so much for sharing that with us. That’s a very powerful story. And two when can I buy your book? I feel
Nicole: this needs to be written.
Mary-Kathleen Haber: All right. Give me 10, 15
Nicole: I don’t, I don’t think you need that long.
Stephanie: No. Talk to
Mary-Kathleen Haber: working.
Stephanie: Talk to Sarah. She wrote a book.
Mary-Kathleen Haber: talk to Sarah. Oh my God. She’s written many books. She’s about to publish
Mary-Kathleen Haber: book.
Stephanie: daunting. I know.
Mary-Kathleen Haber: Yeah.
Nicole: We’ll be the first ones to purchase it and you can come back and talk about it if you’re not already on the podcast. Four more times to talk about other things.
Mary-Kathleen Haber: I hope to be back because you’re gonna find that you want [00:09:00] me to talk about. Inclusivity and sexual health assessment. I’m gonna have a hard time sticking to that, but I’ll do my best.
Nicole: That’s fair. That’s it’s with intersectionality, it’s hard to not, right? We are, we are. Respect that. Okay, so we’re, like we said, we’re so excited. And today we are gonna talk about inclusive sexual health screening. So let’s just jump right in. So obviously we are biased, but sexual health is such a critical piece of who we are and it impacts our overall health and wellbeing.
Can you start out by sharing with us what an inclusive sexual health screening means to you?
Mary-Kathleen Haber: All right. Can we envision a funnel ourselves and ask our dear listeners to envision a funnel? So inclusive sexual health screening is sort of the narrow part of the funnel, but at the top is inclusivity in our general lives. Inclusivity in the medical system, [00:10:00] inclusivity in hiring practices, the educational system.
So I wanna place that in the forefront because I want everybody to always be thinking about the top of the funnel. And then these principles filter down to one particular like screening tool for the purpose of like risk reduction and sexual health wellness, not just risk reduction.
So, The first thing I think of is I want everybody to be able to benefit from and participate in any screening I do. So that means access to materials and tools for people who don’t speak English or using language and material that adheres to the principles of universal health Literacy.
Do you have a sense of what I mean by that?
Stephanie: Maybe just briefly go over it. We do have a nice episode on health literacy, but for listeners who maybe haven’t listened to that one yet,
Mary-Kathleen Haber: Okay. I [00:11:00] love this topic so much because we typically think of assigning a level of health literacy to our patients by saying something like they have low health literacy, therefore I have to meet their needs. But I like to talk about universal health literacy as something we practice. As professionals, the way we practice for us, for example, universal precautions in the hospital for infection control, we practice universal health literacy means that we make sure that the onus is on our shoulders, that we’re communicating in a way that everyone can understand regardless of their level of education, that we’re not making any assumptions, right?
You might have someone in with a PhD in literature who has a level of literacy. That means we need to bring down the medical language to, like I say, a universal standard. So an inclusive environment includes that on our shoulders, using [00:12:00] universal health literacy standards and then assessment tools that are relevant to various groups, including members of the L B LGBTQ community.
And I would say most importantly, it’s being humble in the face of the innumerable. Lived experiences of the patients we serve, right? We, we only know our own lives. And then in textbook we learn through case studies, but the best thing we can do is just be good listeners. Definitely do more listening than talking.
So for inclusivity in the sexual health tool, the first thing we wanna do is normalize and reduce stigma.
Nicole: I actually am gonna go ahead and take us into the weeds for a moment before we get to the next question, cuz I think this is important and I think you can answer it on the fly and I think you’re gonna have a beautiful answer. So why do you think it’s important for clinicians to have and know how to do an inclusive sexual health screening?
Mary-Kathleen Haber: Okay, so I have many, many examples of why this is important.[00:13:00] We do live in a world where a certain identity is normative, and that is the cis white, straight lived experience. And so we come in with unconscious biases. With that normative in mind, and I’ll give you an example. I had a medical director who’s a leading expert in the care of people with H I V.
And when I was pushing this sexual health assessment to be sort of used generally in primary care, he said, well, I don’t wanna scare away the little ladies with pearls with some of these questions. And I thought, oh my God. Okay. We are not being inclusive. if we separate what certain groups needs are from other groups, those assumptions will lead to people missing out on crucial healthcare both risk reduction and wellness.
So by using universal inclusivity standards, [00:14:00] we get assessment tools that capture. Opportunities for the most number of people possible.
Stephanie: Great, great discussion point. And I do hear that a lot like, how am I, I gonna ask this little old lady what opening she has sex with or that kind of thing.
Mary-Kathleen Haber: Mm-hmm.
Stephanie: But I love that. Okay, so let’s talk about like the age that you, you start talking about sexual health.
So what age do you recommend clinicians start talking about sexual health and how does that conversation go? Depending on the age of the patient.
Mary-Kathleen Haber: All right. We’re just gonna make some listeners uncomfortable potentially, but I don’t think it’s ever too early. And I’m serious about that. As a family nurse practitioner, as a lactation consultant, I end up working with parents of newborns and I start, right, then I start with them for their children.
And then if I’m at the entry point is with [00:15:00] toddlers, I start with them. And that’s just about reproductive health before sexual health becomes something we talk about in adolescence. But with reproductive health, it’s just naming things appropriately. I have heard practitioners say, okay, mom, okay, dad, I’m going to look at Molly’s privates.
Molly, I’m gonna look under your underwear at your privates. And then they go into a safety talk about it. Okay? Just want you to know that mom and dad and your doctors are the only one who can look at your privates. There’s some problems with that. What are some potential problems you see with that?
Stephanie: Well, sometimes doctors or parents are the perpetrators of sexual abuse.
Mary-Kathleen Haber: Absolutely.
Stephanie: so we should be teaching kids that they have to consent to
Mary-Kathleen Haber: Mm-hmm.
Stephanie: examined. Yeah.
Mary-Kathleen Haber: Okay.
Stephanie: the the private word is not using the correct and it’s making it seem a little bit [00:16:00] like there’s a secret or shame associated
Mary-Kathleen Haber: We’re introducing stigma right there from the very beginning.
Nicole: Yeah. My husband and I have had conversations, so I, you know, we are very much pro body parts and so it’s her vulva, not her vagina. That’s different. And he’s like, vagina’s good enough. I said, no, it’s not. I said, because there’s a distinct difference. If she comes home and says someone, I mean, it’s all bad, right?
If she comes home and says, they touched my vulva versus they touched my vagina, versus, which sounds a lot different, then they touched me down there. Like, those
are all different. Yes.
Mary-Kathleen Haber: going like way back from the idea of abuse, but just like clinically for history and physical or an hpi like a toddler at preschool might end up with some irritation from sitting in wet pants. And they come home and if they have the terms to describe it, they, when they go to their pediatrician, [00:17:00] they can say, you know, my VMA stings, which, you know, is very different so I think clinically it’s very useful to start early teaching parents to use actual terms.
And we’re gonna talk about language later because it becomes different when you’re an adult and choosing terms for yourself. But to start with, Terms, vulva, labia, vagina even anus, you know, we say tushy, tush, whatever. I think that’s adorable. I use that word. But it will come to play in language later when it comes to some sexual health assessment.
Penis, scrotum, testicles perineum, you know, these things. So I think that is really important to start young, even though that’s not sexual health assessment, that is reproductive health and it flows naturally into a more comprehensive and accurate description of sexual health. And the other thing I want to say here is there’s a lot of talk right now in the news about healthcare [00:18:00] for trans youth.
And it’s framed. In a sexual context, which then becomes a moral context. And I just wanna push back against that, that it’s really that’s general healthcare. That’s not sexual healthcare because that’s about personhood rather than any sort of sexual activity. So there’s, it’s, it’s a moral or it’s, it’s sort of meta from our cultural, moral discussions that are happening now.
Did that make sense?
Mary-Kathleen Haber: Okay. So yeah, it’s never too young. And then you asked about varying the age of the patient. So if the entry point for a listener is older really it’s, it’s different one-on-one you’re gonna ask the patient based on their lived experience, what is the language they use for themselves.
Okay. And so much of what we do in a effective sexual health assessment is by listening and mirroring the language [00:19:00] used by our patients. Let them take the lead. Now sometimes people are new to the idea that someone would listen to, to them in that way, or embarrassed. And sometimes you have to be the one who offers some gentle guidance.
But I promise you, when you allow space for this, patients are really grateful, even if they’re uncomfortable in the beginning.
Stephanie: Yeah. So could we walk through like a scenario? So say you have a newborn in your clinic with their parents and what, what do you exactly say to the parents related to the reproductive health?
Mary-Kathleen Haber: Yeah, so there’s newborn, there’s toddler, there’s elementary age. For the newborn, like I said, when you’re doing the head to toe assessment, you’re just naming it as you’re doing it, letting them know, okay, you’re checking behind the ears, you’re checking the hips, to see if there’s any problems with that.
You just name it as you’re doing it, and that sets a tone for the normalcy of it. [00:20:00] Okay. A lot of times in doing a health assessment, even for an annual physical, regardless of the age of the patient we may briefly go over the urinary tract, like do you have incontinence or anything like that. But a lot of times we will be either skip or be very brief about the reproductive health, but more so the sexual, you know, genitalia.
And so I just say in every assessment include that, you know, Head, knee, shoulder, toes, the song we’ll add, add our reproductive parts, add our sexual parts, add our butt. Okay, we gotta be talking about the anus. It’s appropriate for everyone. It’s appropriate for someone who’s using it for sexual pleasure, but it’s also appropriate for postpartum women who have hemorrhoids.
Oh my God, how many women leave the hospital with these horrible hemorrhoids and aren’t told you can push those suckers back up. So yeah, we need to start talking about butts too.
Stephanie: I [00:21:00] also wanna add I think for listeners who have listened to us over the years we had an episode with Tony Bon Leonard, who was one, one of the founding mothers of the Reproductive Justice Movement. And she talked about in that episode just how. Using the right terms and learning the different parts of your body, how freeing that was, how empowering that was for her personally.
And so I think again, it, it kind of goes back to what you said, Mary Kathleen, like, if you don’t know the terms, you can’t communicate about them and you don’t even, in your own mind, can’t even like really process what’s happening to your body.
Nicole: And in addition to terms, part of what Tony talks about too is just knowing then how your body works. Like how do you become pregnant? What [00:22:00] does your menstrual cycle really mean? And you know, when you lay that, map that out, like how does that impact your body? Like so much of that is missing is basic body functions.
Mary-Kathleen Haber: I am so glad you brought that up because I think we’re gonna cover it in those nerdy girls coming up soon in our reproductive health squad. But I forgot to mention, I used to be a school health nurse in a middle school, and
Stephanie: Such an awesome job.
Mary-Kathleen Haber: Oh my God, it was incredible. I had more than one occasion a girl become pregnant, not knowing that she had a middle hole.
Okay. So it starts with we have three holes. The first hole is for p, the middle hole. You’re going to at a certain time have menses, clear fluids, sticky fluids. I love talking about the different fluids that come out of the vagina. You could have me on just for that. Cause our, our bodies are so flippant, amazing.
You know, the egg white when we’re fertile, that kinda stuff. Okay, have me back. But [00:23:00] any case, the middle hole for the fluids and the babies if we choose, and then the back hole for the poops and poop is so important. And we need to teach our people about poop too.
Fiber, have me on to talk about fiber. I told you I had trouble with tangents. But yes, function, anatomy and function. I think it should be taught at every single visit. The problem is our healthcare system talking about systems, is we’re rushing people through. And so people think, well, I don’t have time to do that during my visit.
The parents should do that, or the school system should do that or whatnot. But in fact I think if we demonstrate for parents, make it more comfortable for them, then we don’t have to take it all on in the appointment. We can say, I encourage you to research and have a research library or website library for parents so that they can share in that education.
Stephanie: Well, and a lot of [00:24:00] states really don’t do any of this in their school districts.
Mary-Kathleen Haber: I know. Well, even here we live, I live in a very, very progressive state. My son is in ninth grade and he is, the son of a reproductive health specialist. So he comes home and he says, mom, you won’t believe what they tried to teach today. I mean, it was just like, talk about misinformation. My daughter is older and when she went through it, there was shaming about like, what girls wear.
You know, if you wanna be safe from rape, you have to be careful about what you wear. Not joking. This is in the 2010s and twenties in a progressive state. So anyway, yes, it’s, it’s, there’s a lot of work for us to do.
Nicole: Yeah, definitely. And I think kind of also talking about age, I think a group that often gets left out, you know, you talked about the young and. I think often when we think about talking about sexual health, we’re thinking of that like teen, to 25, like thinking about that group that’s at really high risk.
But I think a [00:25:00] group that’s been left off and I’m, and I think is maybe gaining a little more attention, and I’ve heard this as well, is the folks who may be getting divorced later in life, like that group, but then also elderly folks. I think we just assume that you stop having sex after menopause or, you know, in that retirement stage.
And so we are no longer having those like sexual health conversations at an older age. And then I also think, well you’re, you know, you’re at that age where you should probably know better or you like, you know, these things and that’s so not the case. And so I’m wondering if you could speak about, how do you frame those conversations with maybe like a fresh, divorced person or elderly folks?
Mary-Kathleen Haber: Well, so sexual health, I’m so glad you brought that up, because sexual health isn’t just about risk reduction. It’s about wellness satisfaction. And so a person doesn’t have to be newly divorced and with a new partner, they can be with their partner of 30 years, but on new blood pressure medication and experiencing [00:26:00] erectile dysfunction or perma menopausal and vaginal dryness.
And so sexual health assessment includes all of that, but just the. The admission and de-stigmatization that pleasure is important and it’s an important part of who we are and it’s good for us. Like the hormones released when we experience orgasm are good for us, you know, that kind of thing, regardless of our age.
So I love having conversations with people who are considered elders by some, but still really active or wanna be active and talk about. I had one elder fellow who was suffering from erectile dysfunction and we couldn’t fix it. And so then we started talking about other forms of play, you know, in, in the primary care setting.
I’m like, what are you guys doing with oral sex? What are you guys doing with your hands? Skin, the best organ, the largest organ? What are you [00:27:00] doing with your skin? And, you know, entertainment role play videos, like, let’s, let’s get into all the options. And this was like a fairly conservative, older gentleman.
And let me tell you, he went home and he had a conversation with his partner and came back with, a pretty big smile next time. And then of course, what you are talking about is risk reduction and that’s also, as important. And no elders shouldn’t be left outta the conversation.
People with uteruses who are para menopausal should not be left out of the conversation. We’re we’re also starting to see a more acceptance of polyamory in society and. So I think you’re right. This goes to the idea of having a very inclusive sexual health assessment that doesn’t imagine this is only needed for certain groups, right?
We don’t just want to do a sexual health assessment with people with penises who have anal sex.[00:28:00] We wanna include every group, and that’s just a lot of internal work. Maybe trainings, listening to podcasts like this. Being open to the conversation and the ideas
Nicole: So we kind of got a little tangential, which is what happens. So
let’s, we’ll, oh, I know. No, this is great. I love this. There’s so much information. So I think let’s jump to this and, and this may change depending on the age of your patient, which would make sense, but what is the first question You start out by asking to inform how you’re gonna frame and discuss sexual health with a patient?
Mary-Kathleen Haber: All right. Well, I did sort of set the stage that there’s reproductive health and sexual health and sort of like a Venn diagram. One may be a little bit more inclusive of the other, but they overlap. first thing I wanna say is just normalize it. So what I like to advocate for again, is looking at a little bit of a systems approach.
Can you get a [00:29:00] statement in your new patient packet, for example, that says, we conduct sexual health assessments as part of our, your yearly wellness exam, or for every reproductive or genital or urological health visit or pregnancy visit. And then With a visit that is for an annual or for one of those problem visits, have the person have access to the screening tool before they come into the exam room.
And we now use a lot of MyChart and filling out forms so that way a person can look at it in the comfort of their own home. So they’re not surprised or taken off guard with just do you have anal sex that that would be off offputting. So I think that’s one thing is, is setting the stage for it, that it’s a normal part of your practice for wellness and problem visits.
I think it’s also important to have everybody in the setting know that this is. A cultural norm that you’re setting. So [00:30:00] whether it be the person at the front desk, the ma, one of the practitioners the lab technician, because we are gonna start talking about also even further up the system, the e EMR and how we need to be putting in pronouns.
We need to be putting in assigned sex at birth, but also then the gender identity of today. So everybody who’s in the office is gonna be, have access to that. I sadly had a pharmacist who wasn’t taught the language and had known a patient before they transitioned, and then the patient used different pronouns and they felt flummox.
So audibly they referred to the person as it. And the consequences emotionally for that patient were devastating. So I say let’s start with how we do our sort of new patient packet. How we get the screening tool to the person[00:31:00] so that they can review it before the room and then above that fighting for an e EMR that has the fields that we need.
That way to get to your question when we’re in the room. Thank you for that. Allowing that tangent. When we get to the room and we start with a discussion that we’re gonna be talking about your sexual health, your wellness and risk prevention they know that I’m gonna ask about how many sexual partners they have, and then we have set the stage for that to be normalized and de de-stigmatized so that they’re not put off by that.
great. Really good.
Nicole: So then if I, if I come to you, And I, you know, I’ve got, I’ve gotten the emr, I’ve filled out all the things, what’s the first question you’re gonna ask me? Or how do you start to phrase that?
Mary-Kathleen Haber: So it depends. If I’m doing a risk assessment, I will ask how many sexual partners do you have? And then I’ll ask, how many sexual partners does your partner have? We always forget to ask that. If [00:32:00] it’s just a wellness visit, I just make sure that when we’re doing the head to toe, I ask them about the wellness of, their parts.
Again, using the words that are meaningful for them. So if a person says I’m a trans male, I don’t call my middle hole vagina. I call it a front hole, then use that. Term if it’s, a person who’s pering menopausal, you definitely wanna ask about stress incontinence, vaginal dryness.
You wanna ask about sexual activity, both pleasure and risk. So yeah, two different ways to start, whether you’re doing a wellness visit or a risk assessment.
Nicole: And just to be clear, so you had said how many sexual partners do you have? You are saying that as in like presently right now. Not have had
like as in over time. Okay. I just wanna make sure cuz the way that our listeners may have heard it had and has isn’t, you know, a big difference. So I just wanted to clear that up.
That you’re talking about presently, [00:33:00] not like historically.
Mary-Kathleen Haber: I mean, I have my assessment tool up and we can put it on your website after this podcast, but I can go through it. Would that be helpful?
Stephanie: Yeah, I think so.
Mary-Kathleen Haber: So basically we, we start, this is a tool that I developed with some amazing people, including social workers, other nps, community liaisons and we use cdc, we use Gilead.
It was just like a very wonderful community collaboration. But what we say is, prevention isn’t one size fits all. Let’s talk to find a way to help you stay safe and enjoy your sexual health. And we say answers honestly and openly as possible knowing that this is a shame-free environment and only answer the questions that you’re comfortable with.
So you circle all that apply and so it’s, I have blank sexual partners, and there’s a list underneath that. I have blank sex, and the list is anal, vaginal, oral, or other types. I have sex without condoms or dental dams. [00:34:00] For oral sex. I, I can’t wait to talk to you about dental dams later. I do wanna say something about condoms.
Another language inclusive, language friendly way to frame condoms is internal and external rather than female and male. Because we can use external condoms on sex toys, they can be used by any gender. so we don’t wanna call them male condoms.
And then internal condoms can be used both in front holes, vaginas, or can be used in back holes, butt holes, whatever. So I like to phrase it that way, but, so number three, I have sex without condoms or dental dams for oral sex. They can choose often, sometimes never. I have. Had sexually transmitted infections in the past?
Never. Currently. So that gets to what you were just pointing to, Nicole. My last s t i testing and I say s t i sexually transmitted infection. And I think everybody’s comfortable with that move from disease to infection, but I always like to point it out. Less stigmatizing and [00:35:00] problematic and more specific languages sexually transmitted infection.
So my last s t I testing was in and then they put the year I know the blank status of my past and present sexual partners. My and that’s it. H I v status or s t i status, or I don’t know, the s t I or h i V status. And I have talked with my partners about their sexual health history, yes or no? I am, am not, or I’m not sure about having sex or considering having sex with someone who is h i v positive.
And I frequently never, sometimes use drugs and or drink alcohol when I’m having sex. And then we also ask about pronouns. Gender identity, and then other sexual organ function dysfunction vaginal dry dryness, low self drive inability to achieve orgasm, and then anything else they want to talk about.
The purpose of this screening tool was to initiate either prevention of the things we can prevent [00:36:00] or treatment of the things that we can treat. So for example, if a person screened positive in any part of that test, then we can initiate a prep conversation cuz pre-exposure prophylaxis is so exciting.
And now we have one pill, one a day, or we have an injection. So the other thing I am really excited to see is the advertising for that has become more inclusive, right? So the commercials now show gay people, they show trans people, they show in heterosexual looking relationships, different ages.
And that’s super important for the endeavors of inclusivity for prep.
Nicole: Thank you for sharing that, and if you wouldn’t mind sharing that, we absolutely can put that on our page. I think that would be really popular with listeners. I, I’ve seen that in some groups where people are like, how are you assessing this?
You know, what kind of questions are you asking? But.
Mary-Kathleen Haber: I really wanna say we at [00:37:00] any given moment, any of us is doing the best that we can. So it’s not to say it can’t be improved, especially since language is always changing. I always think of any assessment tool that we ever do, even if it’s past, research standards of being valid.
And this one ne hasn’t necessarily, but it has to be known to be a work in progress. So I’ll just give you that caveat.
Stephanie: Thanks. That’s awesome. So you kind of hit on these in your response and when you were explaining your questionnaire, but I wanna ask explicitly so clinicians understand. So what language or terms do you really recommend that clinicians use to be inclusive? So one of the ones that comes to mind that I learned for the first time was the middle hole.
Are there, what else would you say about inclusivity?
Mary-Kathleen Haber: First really important to, to really use a person’s pronouns. When we first started talking about pronouns, some of us use the word [00:38:00] preferred pronouns. We’ve left that behind because this isn’t a preference, this is essential to somebody’s identity. So you wanna start with pronouns. One thing I do wanna say is if you’re initiating this in your practice, you don’t wanna force Your colleagues to use pronouns or your patients to use pronouns you wanna accept it if they offer, and I say that because you may work with people who are not out in their work environment or may face prejudice in their work environment. And so I’ve seen activities where at a staff meeting everybody has to say their pronouns and well, that’s very awkward for somebody who may use one pronouns outside of work and a different set of pronouns.
So I feel like that should be optional. But certainly if you feel comfortable modeling your pronouns and letting your patients know they can model their pronouns. And then I hesitate to give specific terms for specific things because each person is different. Right. I have a patient who [00:39:00] calls his Entire genital area.
His dick, that’s his word for it. Another person might say, my front hole, as you said, somebody might say my middle hole. So the words are ever changing and sort of innumerable and specific to individuals. So what I really say is, listen, be humble. Don’t think you know the right terms. this is the intersection of health literacy and sexual health assessment.
So I came in thinking I’m such a hotshot. I grew up in the L G B T community and I’m gonna be so good at sexual health assessment. And I remember saying to someone what did I say? I said do you have receptive anal sex? And when my mentor named Mina Carter, she’s a fabulous nurse practitioner, heard me, and that I got like, An awkward response or whatever.
She’s like, why don’t you try using the word bottom? So when you’re first starting out, you’re not gonna know all the terms. And I don’t want that to be a stumbling box. [00:40:00] You can say, I’m new at this. Um, term that I know from my teaching is receptive. Anal. Tell me if that’s a practice you do, what you call it.
Like, be honest about how it kind of is awkward and new to you. Right? Because our patients like to know that we’re human, right? They, they like when we say we don’t know, and honestly, our patients are the experts. And that’s not just like a fad or a thing. It, it is true. So I like to answer the question that way.
I do have resources though, so I mean, these sort of dictionaries of terminology are, you know, 40 pages long. But I will, after this podcast get those to you so you can put up on your podcast. Is that okay?
Nicole: Yeah, that sounds great. And do you have, you know, when we ask like, what are your pronouns? Like, how do you, do you have a way of asking? Like, because if you wanna initiate the conversation about what parts they have sex with or what they call their parts, like how do you ask [00:41:00] that question so that you know what language to use?
Mary-Kathleen Haber: Okay. So if it’s a brand new patient regardless of whether it’s wellness or risk assessment you can just say, typically in medical language we use this term, I wanna be respectful for language that you might use. So in my charting and in my speaking with you, what terms do you want me to use?
Nicole: Oh, I love that.
Mary-Kathleen Haber: And then a very important thing to put or to say to your patients is this in this room and with the notes that I write for you, your care plan, the things that you’re gonna take home, I’m gonna use language that’s meaningful and respectful to you. I want you to know that the system isn’t necessarily caught up.
So when I order labs or I put coding, it might use terms that are medical and not specific to you. And I don’t want you to take that as I am personally disregarding what you’ve taught me. I think that’s really important because someone who’s told you that they feel uncomfortable with the [00:42:00] term vagina then gets a result back that says they have bacterial vaginosis could really feel disrespected unless you have told them that that’s gonna happen.
And that’s just part of the system. You see what I’m saying?
Nicole: Yeah, that totally makes sense. And I know you had hit on this too, but you know, as we know, communication extends beyond just what is verbally said between patients and clinicians. So what are some things that you are mindful of when communicating, like maybe your environment or your body language?
Mary-Kathleen Haber: Environment. Environment. Environment I love. Okay, this is, this is one of my favorite things. There should be cute, beautiful baskets of condoms everywhere. Lubin, condoms everywhere in a primary care setting. In pretty baskets, you know, not sterile containers, but like ribbons and bows.
So that everyone feels like it’s fine to take, have both internal and external condoms. Ooh. have dental dams too. Before you put those out [00:43:00] there in the public space of your waiting room, have everybody who might be asked how to use them, take them home and try to use them because I did this.
It is hilarious. Nobody has that I’ve worked with, has ever used a dental dam. We really need to start normalizing that if we want to bring down the risks of H P V and throat and mouth cancers. So hand out the dental dams and have staff use them at home so that they can be good teachers and good advocates.
Same thing with internal condoms. Not easy to use. Pass them out. Have people try that way they can be like, oh, I, I know this trick. Like if you put it in this way. But yes, environmental cues. If you have a waiting room that has condoms, internal external dental dams has lube. This is saying a lot about your practice.
If you have signs up that just offer, like we love to talk about your sexual health. Ask us [00:44:00] anything. If you have flyers that say, do you wanna know more about how you can prevent H I v ask us. And these can be, you know, I don’t really like the promotional materials from the the drug companies.
But you can make your own. we’ve got great Word documents that can add all sorts, make pretty attractive single question flyers or posters that, that have some of these very simple questions. And then you’re just setting the tone that this is a safe place for me to ask questions.
You could even like, go straight to the thing that you think people are most, do you think you’re too old to enjoy sex or to be at risk for something? Come ask us.
Stephanie: have you found a place that you can get these very inclusive and pretty educational materials or posters?
Mary-Kathleen Haber: There is, you know, I don’t wanna be promoting[00:45:00] pharmaceutical, but there is a pharmaceutical in In the world of h I V prevention and treatment that has great non-branded materials,
Mary-Kathleen Haber: I think they’re, I really like them. I think they’re better suited for the younger audience. I think if you’re in OB G Y N office or a woman’s health clinic or primary care clinic that maybe serves an older population or less urban population, then you might wanna design your own based on where you live and who your client population is.
I would design my own patient education materials and it’s not hard, like I said, doesn’t have to be a list of information and resources. It just has to be one statement that spurs a conversation surrounded by visuals that match the aesthetic of your office. Does that make sense?
Stephanie: Totally. Yeah.
Mary-Kathleen Haber: I hope that we get further with [00:46:00] that.
I mean, CDC d has some good, I, you know, when you come April is sexually transmitted infection awareness month when you go to the cdc. Depending on what the theme of that year’s education, advocacy efforts are, you can often find c d c materials that are attractive and informative and fun.
Stephanie: Yeah, I always see that as like a big gap and have for a long time, and I keep hoping that somebody will address that. But
I mean, I think part of it, yeah, it’s not probably a lucrative business, but.
Mary-Kathleen Haber: yeah. I mean, I have designed For my practices in the past, all the materials that we used along with pharmaceutical and cdc, depending on when it’s relevant, but not every practice has somebody who’s willing to do that. And so then you’re gonna rely on the pharmaceutical non-branded material or the cdc.
Stephanie: Yeah. Thanks for that. I just wanted to, wanted to [00:47:00] ask because I hadn’t looked in a long time, So a lot of these conversations that you’re having with patients might be a little bit more d difficult for other clinicians because they might be dealing with some personal sex shame or just really have different beliefs than their patients.
What tips do you have for those clinicians who are kind of new to this topic?
Mary-Kathleen Haber: Yeah, this is super hard. And I’ve dealt with it because I’ve been trying to champion this work in the primary care setting for a long time. We have certain standards when we enter the healing arts. And one of them is non-discrimination. And so a part of me wants to say if you feel like you can’t meet the standard of non-discrimination that you expect when you’re hired, if you can’t meet that standard in your patient care, then maybe you should choose a different career.
[00:48:00] I know that sounds harsh, so that’s part of me. And another part of me feels like with compassion and helping somebody understand the lived experience, maybe through case studies that you can get a staff member who’s not comfortable, maybe because of differing cultural or religious beliefs.
Cuz why did they enter the healing arts anyway? I mean, there’s something there about caring for others. And so I think if, if you can be compassionate. Rather than just judgey. I mean, so much of what we’re talking about is leaving judgment behind. So let’s try not to be hypocritical. Leaving the judgment behind understanding that they come to this table with a lifetime of messages.
And maybe just start chipping away at the narratives they have in their brain from their experiences and stories that they’ve been told. With case studies and patient experiences and patient outcomes, you know, patient success stories. Then [00:49:00] maybe you can make some, progress with some resistant staff members for people.
This is a really, it’s so that’s a different thing than people who have maybe a trauma background. Or have sex shame or maybe are closeted themselves, that’s totally different. But I would say gentleness and compassion might be the way to go with our fellow staff members not knowing where their discomfort stems from, whether it be an ideology or whether it be a lived experience that has affected them.
I think it’s worth, starting there. And if you really can’t make any progress and you think patient outcomes are being affected, then, then it becomes an issue for hr.
Nicole: So ch. Two pieces. One, I just wanna make a plug for our other episodes. We actually do have two episodes. We speak with a sex therapist and they are specifically about working through your own sex shame. , and then like as clinicians, like how do we work through that? How do we help our patients work through that?
And so if you as a listener are finding [00:50:00] yourself feeling a little sex, Shay, you’re not alone. And we have episodes for that, but I cannot tell you what numbers they are because I can’t remember. But they’re really good and I would definitely recommend checking those out. And I believe they start with the titles.
I think if you search Sex Shame or Dr. Nikki, Julian,
Mary-Kathleen Haber: It just reminded me that going how I started, I didn’t start with this comfortably. I was, even with my background, it was super awkward as maybe I alluded to when my mentor Minka helped me out there. I literally signed up for every Insta account and Facebook account for every group that I wanted to learn more about how to be a better provider for.
So I am part of a, a queer Sex therapy Instagram account. I, another one that is really relevant to the work that I do in Baltimore City is working with black families. And so I sign up for every Instagram that has to do with cultural [00:51:00] competency, or I would say nobody becomes competent in other culture, but cultural humility black liturgies on Instagram is amazing because it centers you and the lived experience lived black religious experience.
So use social media to your benefit and I’ll tell you why. you increase your knowledge in these like ten second little blips and you don’t even notice. You’re increasing your knowledge and your literacy in these topics and your level of comfort. It just happens in these minuscule little ways.
So I highly recommend Listening to the podcast here, I can’t wait to do it myself, but also using social media as your friend.
Nicole: A hundred percent. And I think, I’m guessing you have a story and I would love if you could share a story cuz maybe we have some listeners who are like, well, does that really impact health outcomes? So I’m wondering if you could share a story that connects, like how you, or how maybe another clinician, how their communication impacted a patient’s health [00:52:00] outcomes.
Mary-Kathleen Haber: Yes. I have a sad one I can start with that really has a huge impact for me.
It was a lesbian couple I was working with. They wanted to have a baby. Nobody did a sexual health assessment to ask them about their behaviors. And so in order to get pregnant one of the wives Had sex with a male friend and got infected with H I V and now she has h i v.
The child has h I v and the partner, the other wife will not have sex with her. And so the, my patient was the woman with H I v talking to her about how to get her wife on board with prep so that she could resume sexual activity without fear. This story devastates me because I don’t know where she started her care, it wasn’t in our office, but had an ob, [00:53:00] G Y N said, I hear you’re planning on becoming pregnant, what are your plans for becoming pregnant?
That would’ve been an opportunity right there to talk about prep. Because not everybody can afford for total. That’s what I very important to talk about. And keep in mind the intersectionality of income level and resources. So that’s a story that really really has an impact, a positive story. A young man, it was a different clinician.
She came to me and she said, this young man just has infection after infection, after infection. Like, I’m not getting through to him. Can you talk to him? And again, in my clinic, I was the one who took on some of these more uncomfortable conversations and I just, I actually for a while, just had him in weekly for just little checkups and to hand him condoms, check-ins, I should say, not checkups.
He was low income. He didn’t have. The ability to keep in stock with condoms. So he just came in every week and I gave him [00:54:00] condoms. And then eventually I got him on prep, right? Because we know one of the risk factors for H I V is recurrent sexually transmitted infections of other types. so then I got him on prep and he’s protecting himself.
He’s protecting others. He’s got as many condoms as he wants. And then in all of that, he just knew he had a clinician that he could talk to about anything, right? I am this middle-aged white lady and this, 19 year old black man comes in and we just had the best relationship and rapport.
And I, I have to tell you, that leads into health and wellness of all varieties. Just that established trust. And if you can establish trust with someone around their health, their sexual health, You have got trust for everything. And we did, we, we ended up talking about PTs d and getting him treated for ptsd.
D because he was the victim of a gunshot wound. We got him into pain management because he was using[00:55:00] his grandma’s pain medication. Right. It’s, it’s all connected. So yeah, and, and we can post research, you know, if, if your clinicians listening, wanna, wanna see research rather than, than just hearing you tell stories, we can also post research about it.
Stephanie: Yeah, that reminded me of a story, just kind of realizing how many people have sex shame, including myself, and I remember screening. A patient for s t I testing and asking him how many partners he has. And he said something like, like, ever right now or like, all at one time. And I was like, all right.
Mary-Kathleen Haber: Yes.
Stephanie: And, and I had just never had any, I mean, I’m sure like patients that I’ve had, you know, have threesomes or, whatever, but there’s like this dance around that, those questions. But it is [00:56:00] so enlightening too, when, when you have a patient who kind of has like very minimal shame and just, and just says it, so,
and then it cut, catches you off
Mary-Kathleen Haber: Yeah, exactly. And, and in those situations you say, oh my God, thank you so much. I didn’t even consider that you have helped me so much. Like, now the next person I’ll be able to to, you know, bring that, that knowledge forward. I don’t know, did I, did I talk to you all about when we ask about sexual orientation and why that might be inappropriate?
Stephanie: Please do. We have talked about that before, but not everybody’s listened to every episode, so yes, please.
Mary-Kathleen Haber: Okay. This may be tangential, but I really did wanna get it in. One of the EMRs I work with, I work with more than one because I have various roles. Still ask sexual orientation. Now, why might that be inappropriate or misleading? Or problematic?
Stephanie: Well, I. I would say maybe [00:57:00] you identify as heterosexual, but you maybe occasionally, have sex with people of the same sex or gender. And you also don’t know, especially when you ask the gender, question or like, if you’re saying, oh, I’m gay, that means I only have sex with people who maybe are the same sex as me and you, but you also don’t know what their gender is And,
Mary-Kathleen Haber: Exactly. So in our business, in the healing arts we care about bodies and bits. Your sexual orientation has nothing to do with that. We care about behaviors and body and bits. And the reason why I think that’s important that we need to get that off. Now I know there’s gonna be people who disagree with me, and that’s okay.
I love civil disagreement. But I just propose that one of the reasons we take that off of the e EMR is because still to this day, [00:58:00] 2023 sexual orientation is definitely something that’s discriminated against. And it doesn’t have any meaning in the treatment of our bodies and our behaviors or addressing our behaviors.
So, as you said, you could have a trans man who lives a heterosexual life. But in terms of body and bits, that’s to middle holes. Or you could have a trans woman. Who lives a heterosexual life. And that’s two penises or the, the terms that they feel comfortable with. or you might have what some people call the down low. You have a happily married cis straight man who occasionally, whether with partner’s knowledge or not, has sex outside of, that one situation. So I’m gonna promote the idea that we get rid of asking about sexual orientation and recording it on EMRs.[00:59:00]
What do y’all think about that?
Stephanie: Love that. And I think, is that Frankie’s episode where they talk about that, I can’t remember if it’s Frankie’s, but it was like what, body parts do you use to have sex and what body parts. What is, what is your partner’s body part? What part, what body parts does your partner have that you have sex with or, or something like that.
Mary-Kathleen Haber: Yeah, the body parts matter because, for example like when you’re doing an HPV screening right now we typically have the materials to do a vagina or a front hole or middle hole. But really we wanna get to a place where we have the capability of swabbing any area that might be at risk. And, and once we do that in an, in addition to vaccination, but you know, downstream, once we do that, we’ll see a reduction in the mouth and throat cancers related to hpv.
Any anal cancers related to hpv. But if we start asking about that, then we can start talking about [01:00:00] dental dams and we can start talking about internal condoms. You see how it’s all connected?
Nicole: This kinda sparks another question. I know we’re getting low on time, so super quick, kind of in that similar vein, and I know that I’ve been asked, this is your marital status,
Mary-Kathleen Haber: Mm-hmm.
Nicole: I think that that also gets used as, some kinda surrogate indicator of risk or how we frame
Mary-Kathleen Haber: Such a good, such a good point. Why do we ask marital status maybe next to kin? I’m not sure. Why are we asking marital status? I mean, wouldn’t it be enough to just say next of kin or emergency contact? I don’t have an answer for that, but that’s a great question. Let’s question
Nicole: well. And again, like that whole, well, if you’re married, then you just have one partner in making that assumption
Mary-Kathleen Haber: yeah. Or, or you assume when you see the partner’s name, you assume a, a. This is, this goes back to our implicit bias. So interestingly, you’re just looking at a chart. You see what you consider to be a female name. You see marital status. You consider a male name. You’re like, [01:01:00] oh, married, heterosexual. They don’t need a sexual health screen.
Right? It happens without us. It’s unconscious. It happens without us even thinking about it, knowing about it. So if we remove those system prompts, then we can help the human inclination, or, I mean, I not even inclination, it’s like it’s just human to have unconscious bias. We should de-stigmatize that as well, right?
Because if we stigmatize it, we don’t want to admit to it, but just the normalization that we have, unconscious bias, let’s set up our systems to minimize activating those unconscious bias. So I love that. Identical. Let’s get rid of Mirow. Does.
Nicole: So what is the one thing, and I know it’s hard to stick to one, so maybe one to three things that you would want all listeners to. To know about sexual health screenings.
Mary-Kathleen Haber: I did think about this, I promise. I wanna say that it’s hard to get started in implementing these things which is because it’s hard. Doesn’t mean it’s not worthwhile. also that once you do get started,[01:02:00] your patients are gonna be so grateful to you that energy you get from seeing their faces just makes it all worth it.
A very quick example. This is a postpartum family. They have a two month old. I come in to help with a lactation issue into their home. They’re sitting there and we’re wrapping up and I say, I just wanna ask you about your sexual health, any tensions developing. And both of them just look simultaneously aghast and relieved and excited.
And they were a black southern family who just felt like they definitely couldn’t talk to an outsider, but even had trouble talking with each other. So they had misunderstandings about what was happening with each other, and they just, it just was a floodgate. And they started talking about how. The wife didn’t want to be frustrating the husband, but just wasn’t ready yet.
And the husband didn’t want to[01:03:00] come off strong, but didn’t know how to show affection other than, and so then we just started talking about communication within their marriage. And at the end, the husband came up and gave the biggest hug and said, thank you so much. This is life changing. We have never talked about this amongst ourselves.
And that energy drives you forward to make it a part of your routine health practice. So I would just say get started. Don’t be afraid of mistakes. Your patients are your experts. You can be humble in their presence. Admit that you’re learning, and they will love that. And they will love you for it.
Mary-Kathleen Haber: That was more than one
Stephanie: That’s, that’s okay.
It usually is.
Mary-Kathleen Haber: Okay.
Stephanie: It’s a nice summary, right. So Mary Kathleen, we’ve talked about you sharing your sexual health screening questionnaire with our listeners, which is great. Are there any more resources where [01:04:00] folks can go to learn more about sexual health screening?
Mary-Kathleen Haber: Yes. There are websites, like I said, there’s Instagram channels Facebook groups. I will share all of that in a nice little sort of set for you to put up on your
website. Because it’s, it’s too numerous to, to list out in the short time we have.
Stephanie: Great. So yes, please check out our webpage on this episode to get all that.
So Mary Kathleen, I would personally like to thank you so much for your time and commitment to advancing sexual and reproductive health through communication.
Do you have any last thoughts that you would like to add before we end?
Mary-Kathleen Haber: Sure. What I wanna say is that if you choose to take this on and develop your skills in this area, I don’t want you to think about trying to do it in a vacuum. So your community is your asset. I found mentors from nurse practitioner, MKA Carter, and community liaisons, Elijah Robinson. Social workers are [01:05:00] gonna be your best friend.
Lee Westgate helped me get started on some of these. And then the communities in which you serve, do you serve members of the queer community that you know about? Then go to them. As I said in the beginning, inclusivity isn’t just about your LGBTQ status, but the language group you’re in, the income level that you’re in.
So make sure that you engage your community. We’ve had patient advisory groups that tell us how we’re doing, how we can do better, what we’re missing. I strongly advise having patient advisory groups anytime you have a group practice. And yeah, I think I would leave it like that. not on your own.
Nicole: Well, thank you so much, Mary Kathleen.
Stephanie: Thank you.
Mary-Kathleen Haber: You’re welcome. It’s such a pleasure. Thank you for having me.