#48 - LGBTQ+ and Healthcare: What you Need to Know With Phillipa Oakley, Part 2

Factor, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents, serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to digest with actionable information that you can implement into practice right away. Let's get started. Hi guys, welcome to The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thanks for listening. Today we wrap up part 2 of our 2-part training on LGBTQ+ and healthcare. What You Need to Know. In today's episode, we dive deep into the issues and intersectional challenges behind the health inequalities that LGBTQ+ patients experience. We'll gain a solid understanding regarding the key considerations that practitioners need to be aware of when providing hands-on care to LGBTQ+ people, and we'll also learn some practical steps to create an actively inclusive business. Our guest speaker is Philippa Oakley. the clinical director of Acorn Health, an award-winning interdisciplinary clinic based in the United Kingdom. Through Oakley Coaching, Philippa enjoys working with practitioners to help them develop their soft skills and improve their outcomes from care with coaching and motivational interviewing skills. Philippa graduated from the Welsh Institute of Chiropractic. She holds an SFEDI Level 5 Diploma in Personal Performance Coaching with distinction, Is a professional member of the European Mentoring and Coaching Council, and is a coach and mentor with the NHS Leadership Academy. Let's cue the intro music and get started.

So let's look at the key considerations and why all of this is relevant to us as chiropractors, which I think is really the big question that we've got here. There is the obvious clinical impact of not knowing a patient's transgender status, and this can have an impact on their management, on their diagnosis, their treatment, referrals that they might make, their outcomes from care, and so on. We've already discussed the fact that LGBTQ+ people are at higher risk of certain health conditions. So anal cancer, cervical, colorectal, endometrial, breast, prostate, and lung cancers. We also know that sexual traumas are high. We've talked about that and the established links between trauma and the risk of chronic health. But also the risk of physical health components of trauma. So cardiovascular health, developing chronic pain, developing autoimmune disorders, and so on. So we see a higher prevalence of fibromyalgia, for example, in the LGBTQ+ community. And from the perspective of someone who is working hands-on with patients, we need to think about the fact that if someone, for example, presented to my clinic with chronic lower back pain, and I was unaware that they were transgender, that they didn't feel safe enough to share that information with me. In a transmasculine patient, so someone who was assigned female at birth, I could miss out polycystic ovarian syndrome. We can miss out endometriosis. We can miss out cervical cancer, or fail to refer that patient for a cervical smear test, for example. And for transfeminine patients, so someone who was assigned male at birth and has transitioned to female, that could be the prostate referring into the back. So you can see how transgender status does have a really, really important impact on the clinical information that we require from our patients. And it's also really important to note that many of us, on our intake forms, for example, I see a lot of clinics that have sections on their intake forms that are marked as women only. And underneath that, it says, could you be pregnant? Now, we know that transmasculine patients can get pregnant. We know that in one study that was in 2014, I think it was, 24% of transmasculine patients had an unexpected pregnancy while still taking testosterone. Now, I know for a fact that most people, when I talk about this and I say, would you know to ask a transmasculine patient if they could be pregnant? They say, no, I wouldn't. And we know that actually many, many transmasculine patients retain all of their natal organs. So they retain their cervix, they retain their uterus, and they are perfectly capable of becoming pregnant. And in fact, many of them do when they come off testosterone. So there are certain questions that we need to be asking of the transgender community. And we also need to know how to ask the questions sensitively so that we don't miss important clinical information. And in terms of building your confidence in talking to the LGBTQ+ community, one of the things that I'm often asked is, well, how do I ask this in a sensitive way? How do I ask this in a way that isn't upsetting, that isn't challenging or disturbing to patients? Do I ask, what surgeries have you had? Are you transgender? The way that I always recommend people to ask is to ensure that your intake forms, that any of your clinical notes, Have the option for patients to self-describe. So we need to do away with tick boxes in intake forms, for example, because so many people now, if you're on that LGBTQ+ spectrum, you simply aren't going to fit within a box. And it's a very heteronormative thing that we do in society where we still want people to fit within a box because that helps us make sense of, of the person in front of us. And actually, we simply can't do that now. We also cannot guess at how somebody might describe themselves based on how they look. So just because they present as male doesn't mean that they are. So doing away with it, with tick boxes on your intake forms, and simply allowing people to self-describe— how would you describe your sexual orientation? How would you describe your gender identity? It gives them the opportunity to self-describe or to not self-describe as well. They do not have to fill in that information. And it's important to recognize that they need to feel safe enough in your clinic in order to share that information. And if they don't, then they probably won't. And we need to build the rapport with our patients. and build the rapport with them so that they feel safe and they feel confident in sharing that information. Diagnostic differentials are going to be very, very different for transgender patients, for LGBTQ+ patients. And one of the biggest issues that we see, for example, is at what point do we stop looking at the hormone markers, for example, or the blood test markers for the person's sex that they were assigned at birth? At what point of the transitioning process do we start to look at what would be normal in the, the sex that they now identify as. So that's one of the, the things. There's very, very little information available over here in the UK about that. It might be different in the US because I know that, that there are certain factors where you're significantly more advanced in that, but that would definitely be something that we really, really need to consider. Other things that we might encounter in our clinics in the transgender community are physical experiences, physical conditions. that are closely linked with the LGBTQ+ community. So many transgender patients, for example, undertake what's called binding. So it's compression of the breast tissue or tucking. So where they're placing their scrotum inside the body and tucking the penile shaft between the legs. I'm sorry, this is a topic for— it's quarter to 8 in the evening here. I know it's lunchtime over there, but it's important to talk about this information. And we know that around 50% of the trans community are engaging in daily binding, and 97% of those will have one negative side effect from the practice. So we see An increased likelihood of brachial plexus injuries, of thoracic outlet syndrome. We see difficulty in stabilising intra-abdominal pressure. We see adverse musculoskeletal conditions. We see neurogenic symptoms from binding. And a very, very small percentage of the trans community, only 14%, will be able to access the healthcare that they need in relation to that. And so we can see how being aware of the likely pathologies that will present in LGBTQ+ people, and particularly in transgender people, can significantly impact on our diagnostic differentials and what we might be looking for in them. So that's definitely something to bear in mind for your transgender patients. When we look as well at some of the other clinical considerations that we need to think about, to talk a little bit about phalloplasty, so where we're creating— a transgender person might undergo surgery to create a penis. One of the most common techniques for creation of a penis is an anterolateral thigh flap phalloplasty technique. So it's called an ALT. This typically takes, as you can see on the left, we've got an image of the lumbar spine, well, the lumbar nerves, and we can see the lateral femoral cutaneous nerve in that. They take the lateral femoral cutaneous nerve to innervate the neophallus. So they take a motor nerve to innervate the phallus. We need to think, if a patient presented to you in clinic and they had undergone that type of surgery, what would be the impact on the nerves and the sensation in the area? What would be the protocol for supporting a patient with a neurological injury like this? And what would be the impact of scarring and skin grafts as well? Skin grafts, for example, are very, very sensitive to mechanical shearing. So if a patient presents to you and they've got this enormous skin graft over their anterolateral thigh, and they present to you with leg pain, the way that we examine that would be different. The likelihood of them developing neurological problems in the lower leg, is going to be significantly higher. Similarly, another technique can involve taking donor skin, fat, nerves, and arteries from the radial forearm, and they perform a radial forearm free flap. And this has a significant impact on the function of the arm. It's associated with worse outcomes from the surgery, and we see challenges with healing of the graft site and movement of the arm and the wrist and the hand. So not only will we have considerations for the care and the management of the surgical site and the pelvis, And the impact of being in an 8-hour surgery, in stirrups, as they often are. But we're also going to have things that we need to consider in terms of the management of the hand. So we see prolonged hand swelling. We see lymphoedema developing in the hand. So these are all the clinical considerations that we need to be aware of when caring for LGBTQ+ people. So, I'm just conscious of the time to make sure that if there are any questions, that we have time for those. So, I want to very quickly talk about active inclusivity. And I've included this picture of our lovely new 50p coin that we have coming out for Pride in the UK, which has caused a bit of uproar in the community because over here they haven't banned conversion therapy for transgender people, but they have given us a shiny new 50p piece, which is what we would term Pride capitalism, which is where we see people around Pride Month, we see large corporations suddenly sticking up a rainbow flag and calling themselves allies. And inclusivity, as I've said here, I use the term active inclusivity because I think inclusivity is an ongoing practice. We need to be considering the steps that we are taking as clinicians and as practice owners. For example, signposting within the clinic, having an inclusivity statement on our website, making sure that any materials that are within our clinic are inclusive, that they don't simply show pictures of straight, white, healthy cisgender people, but are perhaps reflective of a wider demographic. So ensure that people can see themselves represented on your clinic materials, on your website, for example. And that in itself will help the LGBTQ+ community go to your clinic. As somebody, for example, who lives with a food allergy, I research a restaurant before I go out to eat there. I will look at the menu on the website. I will potentially call them and say, hey, do you have an allergy menu? Am I safe to eat at your restaurant? And that's simply for eating out at a restaurant. It's not for choosing what could potentially be my long-term healthcare provider. So the LGBTQ+ community are likely looking for cues on your website, on your social media, on your marketing to Determine if they are going to be safe in your hands when they come to your clinic. We need to consider the assumptions that we make. So it's really important to do away with any sort of Mr. So-and-so is here for his appointment. Mrs. So-and-so is here. My dentist, for example, once said to me, oh, I've got your sister in next. And I said, no, you definitely don't have my wife. So those kind of heteronormative assumptions that we make perhaps without thinking can be really damaging. And it's really important to use reflective language as well. So if a patient says to you, my partner, just because the patient appears female, avoid, try to avoid saying, what does he do? And giving him a pronoun that perhaps isn't the correct pronoun. And avoid the patient being put in the position where they either have to out themselves to you or perhaps struggle with their partner being misgendered on a regular basis in your clinic. Now, another really important factor, sanitary bins in male and female bathrooms. This is really, really simple, but make sure that we have sanitary bins available if you have male and female bathroom facilities in your clinic. This is important not only for transmasculine patients who still menstruate, but for example, if you've got a male patient who's got a stoma or has to self-catheterize, to make sure that they also have somewhere to dispose of that. So there are parallels between cisgender healthcare and trans and LGBTQ+ healthcare that we need to consider. Some patients have stated in feedback that seeing a doctor or a nurse who's a member of the LGBTQ+ community might mean that the practitioner is less likely to make assumptions around sexuality and gender identity. I'm very lucky. I feel very safe to be out at work. It's something that took me a long time to do, but I am, and I'm now very public about it on social media, and I've received a lot of support, or a lack of negative comments, I should say. Some clinicians won't feel safe to do that, but perhaps if you are a member of the LGBTQ+ community and you do feel safe to state that you are an LGBTQ+ member of the community, that, that might encourage your LGBTQ+ community to engage more with your clinic. And more medical and practice education is really the most important thing. So attending seminars like this, training your front of house staff, training your CAs, for example, to build and develop understanding. Because one of the main factors, and the point that I'd really like to end on before we hopefully move into a little bit of conversation about this, is the fact that positive experiences with care for LGBTQ+ people didn't involve seeing practitioners who had enormous levels of knowledge in hormone therapies, in understanding the LGBTQ+ community, in understanding what they need to do in referral pathways and things like that. The main factor involved 3 elements. So it was care that was appropriate, was responsive, and that treated the patient holistically. So considering the patient as a whole person and not simply saying, you've got back pain because you are transgender, not chalking everything up to somebody being transgender, for example, but really considering them holistically. And I think This is something that we as chiropractors are very, very strong on. I think we're very good at looking at our patients holistically. And so I really do believe that we have a massive opportunity to be enormously impactful in the care and the support that we provide to LGBTQ+ people. And I would really love to see practitioners and chiropractors around the world leading the way in this. The most common factor in positive experiences for LGBTQ+ people in healthcare is a willingness for healthcare providers to see what is possible. So doing their research, if you are presented with something that you're perhaps unsure of how to support, is saying, I don't know the answer to that, but I'm going to find out. That is the main thing, is a willingness to see what is possible. And a point or a fact to leave you on: being an ally is a sustained and persistent pattern of action, so not an idle or stable noun. It is an ongoing commitment, so it is active inclusivity. and being a sustained ally to the LGBTQ+ community in your area.

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So that's my, my slides finished, and I'd like to thank you for listening. As I have talked very briefly about just at the beginning, we do have a clinical LGBTQ+ healthcare course that is available, and we've provided a little offer there for you to access. This goes into significantly more detail in hormone therapies, in pain patterns, in the neuroplastic changes that take place in the brain, and more detail and more resources for you in your practice. We also have one that is Canadian specific, so has stats and figures that are relevant to the Canadian population. And we have one that is aimed at front of desk health and CAs, so doesn't involve the clinical information that perhaps we as clinicians need to know, but provides communication support and guidance for your front of house staff so that they can help contribute to a positive experience for your patients in clinic.

Wonderful. Thank you so much, Dr. Oakley. This has been informative and has definitely taught us some great things. I have a few questions here I'll kick off with, but again, guys, if you are watching this either live or even if you're watching this later in the recorded replay, if you do submit your questions through the chat feature, Dr. Oakley will either receive an email if you are watching this as a replay and she can follow up with you there, or of course, if you're here in our live audience, certainly ask those and I'll be sure to ask them out loud. I really love how you were talking in the end about ways that practitioners can make their office more inclusive and publicly display that we are an inclusive office. You mentioned having an inclusivity statement on your website.

Mm-hmm.

Where would someone find that language? Where would you, do you have any resources or recommendations on where to find those appropriate statements?

Yes, absolutely. What I think might be really helpful, we have a resource on LGBTQ+ inclusive language, sort of dos and don'ts. I'm going to hopefully try and upload that in here if I can. No, it doesn't look like I can. So, Jessica, what I'll do is make that available to you to share with attendees, if that's okay. We have a sample statement as well that's available on the Oakley Coaching website, which I am more than happy for people to plagiarize, to copy and take and use as your own, because I think sometimes getting the language right or feeling confident that the language is right can be a factor for people. So that's where you could definitely access an example and then tailor it to what feels suitable for you.

Absolutely. And we can certainly— what we can do, everyone, is we can send that out in the email with the recorded replay. So if you're watching this live, or if you registered and weren't able to catch the live broadcast, you'll receive an email here in a few hours with the recorded replay link, and we'll be sure to include that attachment there for you as well. Another thing that you mentioned was the need for sometimes practitioners to have a referral network so that you know the appropriate providers to refer your patients to. How important is it to make sure that those other providers in your referral network also are inclusive and are welcoming to the LGBTQ+ community?

It's absolutely vital. The, the challenge that we have in the UK, for example, is that the LGBTQ+ community really lack trust in the NHS. And just as an example, Ray, who shared his story with us, Ray shared an Excel spreadsheet with me that listed every transgender-friendly doctor that was available within his local area. And that was provided to him by other members of the LGBTQ+ community, and it was stored within a central area. So we know that the LGBTQ+ community will share information about who is and isn't an inclusive practitioner in their area. And so we have that challenge of we might be missing out on providing care to an entire demographic of patients if we aren't signposting that we're inclusive. I also make sure that I have conversations with the practitioners within my network who I'm referring to, because the last thing that I would want to do is to damage that relationship that I have built with my patient by referring them to a practitioner who isn't inclusive. So I think that's perhaps not necessarily just the LGBTQ+ community. You know, for, for myself, I always want to know the practitioner that I'm referring to. But it's a conversation that I make sure that I have with anybody that I do refer a patient to.

Absolutely. And I think what was very enlightening for me was your discussion about some of the specific musculoskeletal and even neuromusculoskeletal complaints that if you didn't understand the patient, if you didn't understand maybe some of the surgeries they've had, maybe even some of the binding practices, which again was not something that I think many practitioners think of off top of head, you may miss something. You may miss a crucial diagnosis or a crucial, even a differential diagnosis that you wouldn't even have considered beforehand. And when it comes to having those initial intake conversations, obviously nowadays with technology, practitioners do as much as they can to get intake information before a patient comes in so that they know their medical history, they have a better idea About any medications they're on, any hormone treatments, et cetera. What are some tips or pieces of advice you can give about that first patient encounter, making sure that you understand correctly? Let's say, for example, if you have a patient that's in the midst of transition, gender transition, and you wanna make sure that you ask them appropriately what phase they're in so that again, you know, those markers in the blood for specific hormone levels or different things they might be dealing with. How do you ask that in a way that is sensitive and that lets them feel comfortable enough kind of sharing the details of where they are in that process?

That's a really— it's a great question. It's a really challenging one, because sometimes when we're working with transgender patients, they simply do not have the trust in healthcare providers to share that information. So this is why it's so important to have this visual signposting on your website, on your socials, on your intake forms, or any Materials that you send out to patients before they come in so that they feel safe to share that information in that first appointment with you. When I talk to patients about surgical interventions that they might, may have, I don't say, what surgeries have you had? I say things like, what surgeries are you comfortable talking to me about today? That gives them the opportunity to talk about what they feel is relevant or to not talk about it, and so on and so forth. The same, sometimes we have practitioners who the patient has had a radial forearm free flap and they've got an enormous scar on their arm, I think it's really important to not just go, what's that from? But say, do you feel comfortable talking to me about that surgery? For example, so that we aren't inadvertently forcing them into a situation where they don't feel comfortable. There are some tips in terms of inclusive intake forms, like the mere fact that you ask someone's pronouns on an intake form is another signpost that you are inclusive because you know to ask and you respect using someone's pronouns. Sometimes we see intake forms that say, what are your preferred pronouns? And we just say ditch the word preferred because it's not preferred. They are their pronouns. That is the pronouns that they use. And it's not simply, this is the one I'd like you to use, but you can also use this one. So the language that we use can really reflect both how inclusive we are as a practice, but also can go a long way to supporting that patient in feeling able to divulge that important information to you in the clinical setting.

I love that. And I really love what you said about ditching the word preferred. I think that is just another way to kind of affirm That you are an inclusive practice and that you welcome everyone. And when it comes to really looking at these initial conversations, I think what you said is important there, not only for the LGBTQ+ community, but really for any patient that may come in your office. When you see a scar, when you see something of that nature, because that could be related to a trauma, that could be related to an accident, that could be related to something that they're just not quite ready to discuss. And The interesting aspect of being the clinician is I know oftentimes with patients, especially dealing in musculoskeletal care, that you have, may have a patient that they rolled their ankle when they were 5 years old, but it's affecting their hip now.

Yeah.

And a lot of times for the patients, they don't always know if it's relevant. They don't always know that this one thing may be related to some pain they're experiencing.

Elsewhere.

How do you combat that in these circumstances? Do you just essentially make note of the things that they do provide you with? And then if you end up kind of hitting a plateau with care or things don't really quite add up to giving you the diagnosis that you're trying to figure out for this patient, how do you then address that conversation later on if they were not comfortable speaking about it in the beginning?

So the hope is that, with being upskilled in inclusive care, that you will build the rapport very, very quickly with that patient so that perhaps you might get that information at the second appointment. I personally make a note of anything that I see on a patient. So if I note that they've got a scar on their forearm, and they choose not to tell me about it, or perhaps they cover their arm with their sleeve, or example, they try to hide it, those kind of non-verbal clues can indicate to me whether it's something that they feel comfortable about. Similarly, whether somebody feels able to take off items of clothing, for example, if they're really unwilling to take off items of clothing, then perhaps I'm aware that they might be a little bit more in that trauma experience. There's also an opportunity towards the end of a consultation perhaps to revisit and say, is there anything else that you wanted to talk to me about today? But actually, when we look at language, when we ask questions like, is there anything else, we tend to get a yes or no answer. So another important thing to bear in mind with your language in clinic is to say, are there any other concerns? Do you have any other concerns that you would like to talk to me about today? And when we're asking questions in that way, it becomes more likely that we'll get some more feedback from that patient. We'll get some more information from the patient as opposed to saying a yes or no question. So it's something that I revisit time and time again. Are there any other things that you would like to me— like to talk to me about? Are there any other surgeries? Are there any other trauma experiences that you've had? Where they feel able to then tell me what else might be going on. And sometimes just stating the obvious and saying, it might not feel like it's relevant. It might not feel like it's something that you need to talk to me about, but I would be really grateful if you feel comfortable sharing any information with me that you feel comfortable talking about. And we can just encourage them to say, oh, well, actually, this might be relevant. I had a lady today, for example, who stood up, took off her top, and she had completely forgotten that she had had open heart surgery. And I was about to examine her, and she had gone through the case history. We'd gone through her medical history. She had completely forgotten that she'd had open heart surgery. And it wasn't until I saw this enormous scar on her chest that she said, oh yeah, I had open heart surgery. So every— everybody does it, but it's knowing to keep asking those questions and to ask them in such a way that is more likely to generate a response.

Absolutely. And guys, again, please feel free to chat in any questions that come to mind. I know we're a little bit short on time, but I had one other question here regarding The inclusivity, we talked about having an inclusivity statement that you have publicly posted on your website, signage in your office. How important is it to have a policy in place with your internal staff so that the leader pretty much lay the groundwork for this is who we are, this is our company culture, this is how we are representing ourselves to the world and to our patients?

I think it's an important, it's, it's, it's a must-do because your front of Front desk staff, for example, they're the first person that people are going to see when they come into your clinic. So if somebody comes into a clinical environment, and there's a front desk staff who is wearing a name badge, for example, that says my pronouns are, that's a nice visual signpost. I think it's really, really important to try and— I refer to calling people in before we call people out. So it's really important to try and bring people along with it. So I like to encourage people to have a conversation about why this is important, why it matters, why we're doing it, because sometimes it can feel confusing for people to say, well, why do I need to wear a name badge that says that my pronouns are she and her? Why is that important? And having a conversation as a practice and saying, look, this is the ethos, this is the culture of the clinic, this is what we want people to feel, this is part of our patient journey. And bringing your clinicians and your practice staff along with you and helping them to formulate and helping them to guide and say, well, where else could we improve? What else could we do? What more could we do? within the practice. And actually, front desk staff see our clinics in very different ways to the way that we do. So they sometimes are the ones to come to us and say, hey, well, actually, I think we could do away with the signage on our toilets, for example. I don't think we need that anymore. It's those kind of things that perhaps we lose sight of as clinicians because we're looking from one side of things. And having front desk staff who are actively looking for ways to make the clinic a more inclusive environment, They can be a really, really powerful resource to utilize. So, I would really encourage having some kind of policy, both internally to also say, this is what is acceptable and this is what's not, but also to create an opportunity for more dialogue between your team and more opportunity for growth.

Here's another interesting question that came in, and it's something that, as a Southerner myself, I didn't think about before. But in the Southern US, we are very much taught from a very early age that as a sign of respect to someone, you say, yes, ma'am. Yes, sir. That becomes very difficult when you're trying to not assign a pronoun to someone. How do you encourage that front office staff to still speak in a very respectful way, but avoid that habit that we have of assigning a gender to that?

It's, it's really difficult. It's like over here in the UK, the amount of meetings that start with, hi guys. That's something that we see a lot and we really have to work to overcome that and say, hi folks, or hi teams instead. So it's finding a word that feels comfortable. I know that the yes, ma'am and yes, sir is, is something that is ingrained from birth. So it's finding a word that works for you that perhaps you feel more comfortable with, that you could learn to replace that with and to grow from there. I, for example, work very hard to use the words they and them. So when somebody says to me, oh, my partner, I would automatically, my response now would be, what did they do? As opposed to what does he do. But that's something that I've had to work very hard to do because we are often overcoming habits of a lifetime where we're trying to change the way that we've developed these societal norms and particularly cultural norms that you have in, in those areas. Interesting to me that Georgia has a very high level of transgender people because I know that they have that, that similar kind of culture. So it's, it's something again that you can in many ways have some fun with. It's say, well, What other word do we use? Is there another colloquialism? Is there a friendly word that we could use instead where we can say, thank you folks, or that kind of thing and just replace it? But it is something that is going to take time. And it's, it's something that I think is really important to reflect upon is the fact that we're all still going to get this wrong. Everybody does. It's, it's something that we're all learning and we're learning to do better and we're learning to get better at as a society, but we are still going to make mistakes. We are still going to misgender people, but it's then saying, I'm sorry, I made a mistake, and then moving on. And that's something to bear in mind, is that we're not out here to cause issues. We're not out here to upset people. We're all just trying to learn and do better. But mistakes happen, and it's learning how to deal with those in a positive way. And often just acknowledging that you have misgendered somebody and saying, I'm really sorry, I'm still learning, I'm trying to do better, and I will in the future.

Absolutely. And I think the important first step is having conversations like this, attending trainings, and educating ourselves as healthcare providers in how can you truly give the best care possible to each and every person that comes in, because everyone is an individual and everyone has different needs, whether that's just their needs coming to you to get out of whatever pain or, or whatever injury they've had, but then going further into really treating the, the patient as a whole and, and treating all the biopsychosocial.

Of course.

Components that are involved there. Thank you so much. This has been incredible. A ton of great information. You can click on that little green button that says offers and Dr. Oakley does have a link there with a discount. It sounds like 5% off of the course. Could you tell us a little bit about— Yes. So everyone please certainly take a little click on that green button. How many hours is the course and it's fully online, correct?

Yes, it's fully online. It's 10 hours. It's structured CE. We are working to get it approved for CE over in Canada. Over here in the UK, it's approved for 10-hour CPD. It's online, it's self-directed, and it's lifetime access. So it's, it's there as a resource and it's something that we continually update anytime there's new information or guidance that comes out. So it's really going to be something that I hope will grow and evolve as this conversation does around the world, basically.

Absolutely. Well, thank you so much. I really appreciate the training today. And of course, if you will send over the information you had about the inclusivity statement, we will be sure to include that in email to everyone that is registered today. And again, everyone, thank you so much for joining us. We look forward to seeing you next month. Thank you so much, Dr. Oakley. Have a wonderful rest of your day, and thank you everyone for joining us today.

Thank you, Jessica. Take care, everybody.

That's it for today's episode. Be sure to tune in for episode 49, where we kick off a new 2-episode training titled Healthcare in the Digital Age: Leveraging a Virtual Platform to Scale Your Practice and Improve Patient Outcomes. We will be talking all things tech and patient care. And hearing from 2 docs who successfully leveraged a virtual platform for explosive practice growth during COVID and beyond. You won't wanna miss it. Episode 49 drops in 2 weeks. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Give us a 5-star rating to help us grow the show. Every little bit helps. And guys, if you enjoy the content that you're receiving, if you've learned anything and had some value that's been provided through our trainings, Please share our podcast with some friends. You can always click the subscribe button, but then you also have an opportunity in each one of those podcast platforms to hit that share button, post to your social media channels, or email or text it to a friend. If there's someone out there that you know of, a friend or colleague that could benefit from this information, we'd be eternally grateful if you shared that with them. If you'd like to subscribe to our Patreon channel for special discounts and member perks on Factor products, live trainings, and online course offerings, you can visit our Patreon link in the show notes. You'll also always find a link to download the PDF presentation from our training featured in each episode in our show notes, along with a link to view the full video webinar recording if you're a visual learner. So be sure to check those out each time. And last but certainly not least, we invite you to join us for a live hands-on factor training in a city near you. Next month, we'll be in Mesa, Arizona on March 11th and 12th, and Bayamón, Puerto Rico on March 25th and 26th. All of our hands-on courses offer CE credit for chiropractors, athletic trainers, massage therapists, physical therapists, and PTAs, so be sure to visit factoreducation.com— that's F-A-K-T-R education dot com— to view our full course schedule, including international course dates, and take advantage of any special discounts and offers you might see there. We'd love to meet you in person sometime. That's it, guys, for today's episode. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.