[00:00:00] Hello, and welcome back to the pulse check podcast. My name is man. I’m hehe. Hey, y’all welcome back. And we’re really excited to get into this topic with Dr. Chrissy. Sheer is our guest today, and we are talking about the language gap in medicine, on the path to trauma informed care. That title was written by Dr.

[00:00:16] Sheer. She is a family practice family medicine practitioner, and she will do a little bit of intro inside of this podcast episode, but, oh my gosh, hehe, I am thrilled. I met Dr. Shelor on Instagram and DM. Can you believe. I can’t, I’m so excited. So I have not met Dr. Christy and I hear really good things about her.

[00:00:38] I’m stoked about this conversation from what I understand, she really centers patients. And I think that is going to be such a pivotal conversation for so many of our listeners. Yeah. So I I’m gonna disclose I’m recording this after the episode, because we literally just got into it. We just got into it.

[00:00:55] So she is so this is our little intro, so fast forward 10 seconds, but she’s going to actually give you examples of non-threatening language to use, to start changing your practice. And we talk about, we got into like a pretty heated discussion in our DMS that we share with you about using different language.

[00:01:12] And she came in and wanted to correct me on my language and. I was like, oh my gosh, we’re talking about stir ups. Here we go. So I encourage you to listen through to the end. She gives a lot of good resources and her pronouns are she her? And she has also asked us to call her Chrissy. So that’s why we referred to her as Chrissy, but she is Dr.

[00:01:30] Sheeler as well. Thank you for joining us and we’ll just get into it. 

[00:01:33] ask a quick question. Are we keeping this topic specifically related to 

[00:01:37] birth? So I was really hoping not actually okay. Because a lot of, at least in my experience with, with people who undergo reproductive care, a lot of the gap comes from the fact that how they’re treated in the office and how they’re treated in their birthing space are different and they’re not expecting such a wide chasm.

[00:02:01] Right? Yeah. And that’s getting more and more noticeable when it comes to trauma informed language because different providers are. in different spaces when it comes to their own journey with trauma informed care. And so birthing folks or people who undergo pelvic exams or, you know, stuff like that.

[00:02:20] I’m, I’m seeing this kind of disconnect between why does this doctor call it this, or talk about this or do this and this doctor doesn’t. Yeah. And that’s really becoming noticeable as I practice here in Canada because in Canada, the way we do prenatal care is a little bit different. Mm-hmm family doctors will oftentimes do their prenatal care until like 28 to 32 weeks.

[00:02:46] And then transition to have you transitioned to an OBGYN. If that family doctor doesn’t have privileges at the hospital. And so at like 28, 32 weeks, all of a sudden the entire it’s like someone speaking a different language, sometimes mm-hmm mm-hmm so, 

[00:03:01] and that’s your connection because you are in family.

[00:03:05] Yes. And I, through my training through residency I did a lot of prenatal care reproductive care. Like that was my jam in residency was like sex ed adolescents and, and reproductive care. So I was very fortunate to get really great education. Yeah. And then it became very noticeable. Like the more you’re trained, the more you realize that some people aren’t and now I’m in a very different space and kind of recognizing that this is not maybe as widespread as I had initially presumed, 

[00:03:37] but yeah, yeah, yeah.

[00:03:38] Yeah. And, and patients and clients and consumers recognize it 

[00:03:43] very quickly. Yes. Because even even colleagues. so I am currently in private practice and hired nursing staff. And they are phenomenal. They’re excellent. They’ve also have limited experience in like family medicine. Mm-hmm uh, so when we were started talking about reproductive care, like specifically pap smears and pelvic exams one of the first things that we kind of started doing was talking about trauma informed care.

[00:04:11] And what language do you use and what kind of things do you say to a patient versus what do you write in the note versus what do you tell me? Cuz they all are sometimes very different mm-hmm and it was a little eye opening that like these women who I work with who are medical professionals had also never been talked to like this before.

[00:04:30] So they didn’t even think to say it from personal 

[00:04:33] experience. Right. It’s never been modeled. No, it’s never been taught. It’s never been said it’s never been modeled. and so they wouldn’t have any idea that there’s an alternative, unless someone like you, a leader or their facility, or they found a peer group.

[00:04:57] Right. Right. That’s how we would kind of find that out, read a book, get onto social media and start being like, what is going on? What is this 

[00:05:04] exactly. 

[00:05:05] This reproductive health, what is this, why are we 

[00:05:08] saying this? Right. Exactly. And it is, it always blows my mind that the, the spectrum, right. There’s some people who go, Hmm, whatever.

[00:05:20] And then I have patients who are survivors of sexual assault, or have had really traumatic experiences with healthcare and to watch their entire, like, almost being open up the minute they are, are hearing this language is. Amazing to see. And the more you see that the more you recognize, oh my goodness, this type of language is so important for so many people that I would never have thought had I not started speaking this way or heard someone else speak this way?

[00:05:55] Cause you can see how it literally makes a safe space versus doesn’t make a safe space. You can see it, you can feel it. You can, it’s just the energy. It’s the way that your patient looks and talks to you and confides in you. It’s what they share. And don’t share. That is huge. Can I ask who is initiating these conversations?

[00:06:17] It started out sounds like just, you kind of bring in this, but do you ever have nurses and colleagues that come to you and say like, Hey, I noticed you said X, Y, and Z. I’m wondering why, or I wanna start using this language or I’ve never heard that before. 

[00:06:34] Yeah. So it’s kind of a mixture of both, depending on when you, I guess start the story and my own learning.

[00:06:40] So unclear if, you know, listeners will know, but medical training requires medical school and then residency and residency is several years, depending on your specialty where you are supervised to various levels of intensity by physicians who have, you know, completed their training, they’re called attendings.

[00:06:59] So when I was a resident and was in my first year, we call it our intern year. We, my program started by giving us a certain level of reproductive and trauma informed training before we ever saw a patient to ensure that our skills in terms of pap smears and other kind of sensitive exams were there.

[00:07:17] And that we were doing things in a I don’t wanna say supportive, but I guess respectful. Respectful way. And I was incredibly fortunate that my attendings, my essentially leaders in residency were very young, like only a couple years outta residency themselves and had an incredibly diverse sphere of specialties.

[00:07:38] So like I had one who was very involved in LGBTQ and HIV care. I had several who were incredibly knowledgeable on reproductive and women’s health. And so they were very forward and very took the initiative to make sure that when they watched you or when they were involved in you providing this care for a patient.

[00:08:01] They flat out told you, don’t say that, do not say that this is a better option or, you know, she looked really uncomfortable. I don’t know if you picked up on it, but you might have heard me say this and this, and this is why. And you kind of picked that up by osmosis a little bit. When I got into my second and third year and it became obvious that I was I had a knack for reproductive care and that I liked this stuff.

[00:08:23] I really wanted to kind of push that forward and made sure that my interns, so the first years in the program, when I was a third year in chief, that they knew why I was doing what I was doing and was very specific. If I was gonna send an intern into a room, look, this is what this is gonna look like.

[00:08:43] I like to say this. I like to say that Later on. It became much more because I had gotten in the habit of it. And now with my, with my current staff, it’s much more learner led where they’ll ask me, you know, why do you say this? Or you were in there for a really long time. Like, what did you guys talk about?

[00:09:01] And, and stuff like that, which gives me the opportunity to say, you know, yes, absolutely. You’re gonna do the P, but I just wanted to make sure that there wasn’t anything in their history that was gonna make this really difficult. And so we could kind of talk it through and, and see if there was some strategies that we could come up with and stuff.

[00:09:18] And that has been really eye opening that change in the last couple of years where people are more open to asking why people are having these conversations. 

[00:09:29] One half a step back. That phrase is one of the phrases. I think that is Contributes to this confusion or like kind of like code switching almost.

[00:09:43] And I know that’s that’s not technically code switching, but it is right. Like code switching. My understanding would be in the African American black indigenous communities having right. A vernacular language. Yes. Right. A cultural way of speaking that is culturally appropriate. Yes. In their families friend group.

[00:10:08] And then changing when they speak to white folks or predominantly white spaces. 

[00:10:15] Yes. Is that because they feel like 

[00:10:17] they have to, because white people have made them feel like they exactly it’s way. Not because they want 

[00:10:22] to. Right. And I, so I think that that’s probably the biggest example of code switching.

[00:10:30] Okay. But I would hazard to guess that as women in medicine, you both probably code switch fairly regularly. How you talk to, you know, your 60 year old male colleague is probably different than how you talk to, you know, people within your own peer group. We even code switch when we talk to our parents versus our friends.

[00:10:52] Right. And it’s, it’s a protective mechanism, right? It’s, it’s how you can yeah. Fit into that space. I think the biggest differences is that for a lot of folks, when they code switch, they do it for their own, I guess, comfort level versus like black folks. From what I understand from speaking to people within that community, yes.

[00:11:14] Is more. Driven at least in part by, by safety and recognizing that they actually will not succeed if they 

[00:11:22] there’s comfort 

[00:11:23] levels. Yes. Not their own. Yes, absolutely. 

[00:11:27] So, okay. So thank you to clarify. So maybe it is code switching, but you saidto the resident.

[00:11:34] You’re gonna do the pap. I wanted to see if there was anything in the history or parts of the story that we could understand better in case that would make this pap 

[00:11:44] more difficult. Yeah. So I, I guess the exact line that I typically use is, is there anything that you need me to know about in your history that would make an examination or like this more difficult for you?

[00:12:01] Right. And it is a very open ended question in order to try to get to see if somebody is comfortable. Talking about their past medical racism or sexual assault or yeah, uncomfortable PS or yeah. Anything like that. And their answer then is reflected by what we do as a decision. If they go, this is yes.

[00:12:26] And they give me an answer. A lot of times I will end up doing the P a so they don’t have to disclose twice. And B, because I know that I have more experience mm-hmm and so a lot of times that’s kind of but I try to open it like that. So I don’t kind of buck someone into a corner. 

[00:12:42] Yeah. Love the way that’s question is phrased.

[00:12:46] That makes me feel good. If someone were to ask me that and I’d be like, yeah, I actually kind of have a laundry list of how this could be more difficult for me. Do you care to hear? Or what, where are we in that? Right. right. And then the response would, would make it so that I either tell you, or I don’t tell you yes.

[00:13:07] The language, the word difficult caught me because I had a feeling that, that and I’ll explain to the listeners in a second, why I had a feeling that that was what you were gonna say. And I’m, I really love, and thank you for sharing that your language was to the client. Mm-hmm and you used the word difficult, which is funny to me because that language is used outside of a patient’s room about patients centering healthcare providers and their difficulty level in performing the exam.

[00:13:41] Yes. So that’s a one, two punch right there. You’re using the same language. Yes. But you’re not saying to make this exam more difficult for you to perform. You’re not saying that to your peer or your resident, right. You’re saying more difficult for the client to experience and how can we alleviate any of that?

[00:14:04] Yes. Reduce barriers and, and continue. Consensually is ultimately what that is, 

[00:14:10] right? Because at least for me, my level of difficulty in performing a pap is irrelevant. Right? Like if I decide to completely cross boundaries, I can get the P done. I’ll be committing obstetrical violence as I do it, but I can certainly get the pap done.

[00:14:30] The question is more like I’m never gonna leave an exam room thinking, wow, that exam absolutely traumatized me as a provider. I’m never doing another path. Like nobody has ever said that, but my patient or the. The person who’s having it performed. Mm-hmm could very well at the end of this go, that was a completely traumatic experience.

[00:14:51] I am never having that done again. So why, why center? My, like, it’s it doesn’t it doesn’t matter. Yeah. I also use the word difficult because it’s vague enough that it doesn’t let somebody think I’m only talking about their physical issues, right? Like it’s, I, I want them to kind of look at the breadth of their experiences and, and decide what they’re comfortable sharing with me.

[00:15:19] Because what makes a pelvic exam difficult for, let’s say a 65 year old postmenopausal women, which is anatomical, right? Like a lack of lubrication and, and the resulting anatomical issues is very different than my 22 year old. who was involved in intimate partner violence and is having flashbacks when I, you know, show them what a speculum looks like.

[00:15:47] It’s also the last question I ask in my kind of spiel. We, we go through several minutes of talking first, where we go in detail about what a pap is gonna look like before we ever do it. So, no, one’s surprised by the instruments. Nobody’s surprised by anything. We sit the back of the table up and we comment that we do it so that they can lay eyes on me and I can see them.

[00:16:11] So if they’re not comfortable saying words, we can have that, you know, body language conversation. I let them know that I will tell them everything that I’m doing before I do it. So they’re never surprised. And I’ll do that through a combination of verbally and. With hands so they can feel if they’re not able to process.

[00:16:27] Well, we talk about, is there someone you want to bring in with you? Do you want to be your support system? Do you want to listen to music? And if you do, how do you want me to communicate with you? And then we always finish it with, if you say, stop, we stop. There’s no ifs, ands or butts. We’re just done.

[00:16:44] We’re just done. If you wanna stop and ask a question, I’ll answer it. If you wanna stop and be stopped, that’s it. And we don’t have to worry about it. Mm-hmm and so, because we kind of go through that whole thing beforehand, mm-hmm, it relays the it relays to them that this is really trying to center you and get you to be empowered in this moment.

[00:17:05] And so if you think there’s something extra that we need to know about, then let’s talk about it before we do anything, since we’re already in the conversation, right? Like, let’s talk about it now. 

[00:17:14] Cause they’re thinking that. Yes, this is bringing that up already. And you’re anticipating that because you are the provider, you’re the professional.

[00:17:22] You do. I don’t know, 20 of these a day more or less. So you should be in, we, we should be anticipating that the next thought is going to be, but why do I have 

[00:17:36] to have my top off? Right. What’s gonna make it difficult. 

[00:17:39] Is that my chest is yes. What’s gonna make it difficult. Is that my last thought personally?

[00:17:45] And I shared this publicly was a whole new thing for me, was going for the recent path and I was facing the door. So my thought, oh no, no, my ch is facing the door. I have a problem with that. I’m not asking you to move the bed, but I I’m just bringing into, into the space, cuz it is definitely within me right now.

[00:18:09] And they might be like, I can’t, I can’t literally move the bed for you, but here’s what like, oh, okay. I didn’t even think about that. Thank. because they’ve, you know, you’ve already proven. Hopefully the goal would be like, you’re here. Your, your difficulty is well above the things that I’ve said, because I’ve already said, how do you want this?

[00:18:33] How do you want that? How do I can stop all this work? We’re done. It just, it’s literally, you are literally up here and I am supporting you and to have this experience. And so then I might be able to tell you, 

[00:18:47] yes. And that statement about, if you say, stop, we stop. That’s it. And it’s said with, and I say it like that with short language and without explanations and just being done to convey a level of ease of, I am, don’t really care if we don’t end up doing this, right?

[00:19:06] Like, I want you to get good help. Like, I want you to get good healthcare. I want you to get adequate screening, but like. in the grand scheme of things. I have no motivation to like power through a difficult exam for the sake of a difficult exam. So, and that’s kind of why I say it like that so that they convey like, oh, like Dr.

[00:19:26] Sheila really doesn’t care. If this is hard for her, like she’ll just stop or we’ll go slow or whatever. Like, she’s cool with it. We’ve already sat there for 

[00:19:36] 15 minutes. It’s already been 15 minutes, which is already longer than any of my appointments ever my life, except my last 

[00:19:45] path. 

[00:19:47] you are three people behind now with that appointment.

[00:19:52] and everyone knows it because we’ve been told, okay, you have any questions you’re already gone. 

[00:19:59] That’s. Exactly, exactly. But it’s BEC very few people that I’ve ever spoken to about like, why I’m late to my next appointment has ever been upset by me saying we were doing an, you know, we just had, had to spend extra time talking about an exam to make sure that folks knew exactly what was going on.

[00:20:17] Or I spent a little extra time educating or, you know, because that next person has gotta come in for their P too mm-hmm right. Or I’ll book, extra space. If I know it’s gonna be difficult or, you know, I’ll have nursing staff say who who’s fantastic will say like, Hey, you know, we’re just Dr. Sheila just finishing up.

[00:20:36] Someone had some extra questions so that they know that they can ask their extra questions. Mm-hmm mm-hmm but like, do you wanna know? What’s gonna make me way more behind is in three years when my traumatized patient comes back and this exam now takes 30 minutes because they’re hyperventilating mm-hmm, remembering what happened the last time.

[00:20:53] Mm-hmm and you spend two appointments, actually not doing the exam. 

[00:20:58] Yes, because I also had to come in 

[00:21:01] exactly and yeah, see the space and it wasn’t necessarily you, but that definitely is the reality for folks right now is they were like, I’ve been hurt every time I’ve come in. Right. I’ve been hurt for 15 years.

[00:21:13] I’ve been hurt for 20 years. Every time I come in and you’re like, well then is today the best day to do an exam? Or is another day, the best day you made it in right 

[00:21:22] goals. And that’s, and that’s what I tell people. When it comes to pain, as I say, you know, app pelvic exam is probably not gonna be comfortable.

[00:21:30] Both physically like mentally, emotionally, it’s probably not gonna be comfortable. You’re in a very vulnerable space. And I understand that, but it shouldn’t be painful. And if it is, it typically means that something is, needs to be addressed. And so I need to know about it. Like, I don’t want you to just sit there in silence.

[00:21:48] If a P is truly painful, something’s probably not. Okay. And that’s. That patient’s fault. It’s not something that they did, but is there something else going on that I’m gonna miss, because you are like a classic example of cervical motion tenderness, right? Like it’s a huge warning sign to something going on.

[00:22:09] And if a patient just assumes that a pelvic exam is supposed to hurt mm-hmm and they don’t comment to me, like, I, I don’t want them to think that that’s the goal is you just shut your mouth and open your legs and just let me do this. And we’re done mm-hmm that right there 

[00:22:23] sounds like sexual assault, right?

[00:22:25] Like when you, yes, that literally sounds like sexual assault. And I think a lot of providers really miss that, I think, you know, we get really caught up in checking off our check marks that we need to do every day. And we really it’s missed on us a lot of how this is actually felt and experienced by the patient.

[00:22:45] Right. And it’s well, we see that and I’m so glad that you brought up sexual assault because you see that in. Other aspects of language when it comes to birthing and yeah. And pap, right? Like how many times have you heard a provider say, all right, scoot down to the end of the bed for me, like in a different context.

[00:23:05] Oh my goodness. And so there’s really subtle changes that you can make. And it’s, it’s funny, maybe this is actually how we started talking. That’s right. There’s some really subtle changes you can make. So we say exam table instead of bed, cuz I want to completely desexualize that. Mm-hmm I don’t say for me, I, I slip up of course, but I’ll say can you bring your bottom to the end of the table as far as is comfortable for you?

[00:23:34] And, and say like, this is for you, right? Or I’ll explain, you know, it’s to make this more comfortable. It, sometimes it usually helps to have you come to the end of the table. Can you come to the end of the table? I call them footrests instead of stir ups. I call it a drape instead of a sheet stuff like that.

[00:23:52] And it’s actually the stir ups thing. Okay. Yeah, man. And I talking so Mandy, 

[00:23:57] right. Chrissy dropped in my DMS recently. This is how I told the story to hehe. I was like, I was like, Chrissy drops into my DM and I was like, who is this person? Cause you know, people on the internet get feedback. And I, I, and I know that and he, he knows that.

[00:24:20] And so I was like, someone’s coming into my DMS, giving me feedback about what I said and I, you just have to like be in a place for it. And then I read this message and let me read this message to you. Oh, dang it. I didn’t even put that part in here. It was, 

[00:24:37] hold on. I probably have it in my, you have it. I probably have it like flat out in my Instagram DMS the very first.

[00:24:46] All right, let me see. Okay. It 

[00:24:48] wasn’t clear what it was kind of clear, ready, 

[00:24:51] dramatization. And for listeners, my Instagram does not make it abundantly clear that I’m in healthcare or a physician and that’s for my own kind of safety, is I? Yeah. Whatever. So it’s privacy. So it 

[00:25:06] was just like part of a name 

[00:25:09] and then your picture and then like a dog or something.

[00:25:11] right. It’s some brand random brunette who’s like messaging Mandy says, hi, I love your account, the info, the advocacy, honestly, the whole vibe you’re doing fantastic things. Are you open to a constructive suggestion in regards to some of the language that you use often? And I sent it at like lunchtime on 

[00:25:27] a random, and that’s what, and that’s what I got.

[00:25:31] And I was like am I, and you know, like I am trying to run a very trauma aware like facing business, internal business, we’ve done so much work this year on like timing and white supremacy pillars and things like that. And like, how can we really be critical about, about it and, and how can we feel good in ourselves?

[00:25:54] And usually when we feel good in ourselves, we’re doing something different than a white supremacy pillar, different than we’re, we’ve been shown different than we’ve been told to do. And I say that because the folks listening are learning a language from you right now, that’s different than what they’ve seen.

[00:26:10] Yes. That’s different than what they’ve learned and said before. So we can rattle something off. In 15 seconds. Do do, do, do, do you want this? You want, that you want this and intake is done and boo boo, boo. But it’s not like it’s going to feel different when they start using different language. And so it feels good inside.

[00:26:32] It’s the other things that are going to feel like they’re unraveling, like the timing. Yeah. And someone might be waiting for me and I don’t know how someone’s gonna respond because this is new language for me. But in inside it’s like, I think I can handle the response cuz I think this feels right. So I read it again and I was like, okay, well they didn’t message again, all the things that they need to tell me, they literally, you literally just said that.

[00:27:00] And I was like, well, because that’s what I usually get. And I’m like, okay, okay. Yeah, I’m in a space. But like I get it all the time and I respond I try to be very. Assertive when I respond, because I am not open to getting bitch slapped in my comments without warning and from someone who is like rude or, but it didn’t sound like that.

[00:27:25] So I was just like, can you introduce yourself? 

[00:27:27] I think I said, yeah. Well, you wanted to know if I was some random person or like who I was. And so I think, yeah, sure. What’s up. Do you mind introducing yourself? Your account is private. And so because you had agreed to hearing what I had to say. And then, but I could clearly tell that you really kind of wanted context.

[00:27:49] First. I started by introducing myself and then basically said what I had wanted to talk to you about because you had given me. And opening to do it. Like you had agreed to doing this. And had you not to sure. What up, if you had said, I just want, like, who can you, do you mind introducing yourself?

[00:28:08] Whatever first then I would’ve just introduced myself and yeah, I was needed for you to say, what did you wanna say? Yeah, 

[00:28:14] I was open because I didn’t need you to be a certain thing. I just wanted a little back and forth of transparency, which is my assertiveness, because folks feel like I’ve seen Mandy for three years on here.

[00:28:27] I now can tell Mandy that she shouldn’t be talking about V a because V a is dangerous and deadly. And I’m just like thank you. Not here for it. And also so 

[00:28:35] incorrect, 

[00:28:36] it’s very one sided. Like I’m giving into the internet and people are like, why don’t you teach about this? And I’m like, hold on, hold on, hold on.

[00:28:43] Right. But yes, I was interested in an exchange. I didn’t need you to be a certain person. I needed a little bit of like. Transparency relationship and, and, and I thought, who asks permission? I was like, okay, I’m interested. I’m interested who asks yeah. Permission and it felt it. I was curious. And, and then you said a little bit about yourself.

[00:29:05] Mm-hmm that you’re in Canada and the us. 

[00:29:09] Yeah. So I did all of my training in the states like in the Midwest and then I’m I’m Canadian. And so when the pandemic hit and the city that I was in got absolutely rocked. I ultimately decided that I wanted to go home to practice mm-hmm . So I was board certified in the us and then came and got my license in Canada.

[00:29:28] So I’ve seen kind of both healthcare systems. And I think I mentioned that like what my clinical interests were and that they were reproductive health and all that fun stuff. And then I kinda dove into one of the things that we talked about here and kind of leads into another topic, which is you had made this really great video that was aimed at letting like informing and allowing patients to advocate for themselves in regards to the use of stir ups within the birthing world.

[00:29:55] And you were kind of specific about like during labor and for someone who is very deliberate and intentional on their language, when it comes to that stirs has a certain, it can have a certain sexualized aspect to it. Right, right. Which can be triggering for people who, even if they haven’t, you know, experienced sexual assault can just be triggering.

[00:30:18] Cuz it’s like a weird exam where someone’s like all up in my space and they’re saying words like so I had said, Hey, like, you know, you might wanna consider mm-hmm . You know, using another phrase and, and I had given other examples but it opened up this really wonderful conversation about what I call the language gap, which is you really wanted to make sure that first of all, the way you use stir ups and footrests those length terms in the hospital in a birthing experience are different than what they mean in the clinic.

[00:30:54] So, okay. How so? Okay. So in the clinic anybody who’s undergone a pelvic exam will know this in the clinic, you have the exam bed or exam table, my apologies exam table, and your doctor will pull out these places for you to rest your heels. Right. Right. So you’re, they come out like this and, or like this, I guess, and you rest your heel in both of them, which puts you in, what’s essentially like a squatting position, but with you on your back.

[00:31:20] Yeah. And the reason for that is basically. The bottom part of a speculum, the handle of a speculum comes down and your VVA and your vagina are very close to the exam table. And so to put you into that position or for you to go into that position allows us to be able to maneuver without being hindered and without you being hurt.

[00:31:44] It’s very difficult to do pelvics sometimes without that. And if you’ve ever had a pelvic exam in like an emergency room, you’ll notice the difference, right? They probably put something underneath your, your back end to, to tilt you up a little bit. Those were traditionally called stir ups, right?

[00:31:58] They’re things that you put your heels into to hold your legs. Trauma informed language basically says, maybe stop doing that. And so we call them footrests because it’s a place where your foot rests. And when I was in my training, they called them footrests in the hospital as well, because we had birthing beds.

[00:32:19] Mm-hmm that. We just called them footrests and said it, how high do you want these footrests? Do you want them low, lower? Do you want them up really high? So your knees are like up by your ears. Like, how do you want these your video called them stir ups? Because I think where you guys are, there’re two separate entities.

[00:32:39] There’s a foot risk where you can place your heel and then there’s a higher, like. I guess almost sling thing where your legs get put into, if you’re thinking like old school medical shows, it’s like the thing that people with broken legs would put their leg into to like, hold it up almost. The or Uhhuh.

[00:32:57] Yeah, yeah, yeah. Mm-hmm, so very different. 

[00:33:00] The stir ups that I am talking about, it’s a whole mechanism. Yes. So you pull it out of the bed of the labor bed and it could be a foot rest. It, you put your whole foot there. Yeah. So it’s as long as my arm and you can put your almost as long as my arm, you put your foot there or you spin the nurse would spin the whole thing around, lift up this other cradle.

[00:33:24] Yes. And you cradle your calf in 

[00:33:25] that. Yes. So we call that entire mechanism, a footrest or a leg rest. So we never called it a stir up. It was either a footrest or a leg rest, but the idea being that this is where you rest this body part. Right. That 

[00:33:40] even when you were practicing in the us, you had that or only when you yeah.

[00:33:44] So yeah. 

[00:33:45] So in the us, I had never heard somebody call it a stir up. I knew they did cause from my own experience and from like some older docs, but like everybody called it a foot rest or a leg rest. Mm-hmm because we didn’t use them very often. Like you held your own legs or your support partner did, or nursing asked you.

[00:34:03] And so if you put it there, it’s because you were literally taking a rest. And so we called like, and didn’t wanna hold your leg anymore. So I had reached out to you Mandy and was talking about this and, and you basically said, or the, the thing that kind of hit me the hardest was I never want to feel, I, I don’t want to mislead.

[00:34:25] Patients, I don’t want them to have me say a word like footrest and make connections and then get into a birthing space and be, I guess, I don’t wanna say surprised, but then be hit with this different thing. Like this thing that they weren’t expecting. Cause your ultimate goal was, was advocacy and education.

[00:34:48] And I was just coming from a, from a different space. I was coming at it more from like provider to provider. Yeah, yeah, yeah, yeah. And so we chatted about it and it brought up this conversation about the language gap, which is that we are now at this impetus where as more and more healthcare workers and providers start using more sensitive language, like trauma inform language, gender neutral language like all of these different languages.

[00:35:21] While the rest of healthcare. Doesn’t right. We are now forcing patients into learning multiple languages. Right. They now have to know that a footrest and a stir up might be the same thing. It might not be the same thing. I have to ask my provider. If it’s the same thing, I need to like use context clues about what my provider is, directing, like all of this stuff like is an exam table and an exam bed.

[00:35:46] The same thing, right? Like, is this paper sheet, the drape, or are they gonna put a drape up in front of me? Like in the, or like, do I get a, like, am I gonna get a sheet sheet? Like, what is, yeah. 

[00:35:56] It looks like a bed. It has sheets and pillows, but you call it a table. Right. But it’s actually where I sleep.

[00:36:02] Yes. and it feels like shit. Yes, the fuck is this, is there a table coming in? Do I get on that table? Cause in the office, you call it a table, but right in labor and delivery, the table actually has all of the tools on it. Yes. And no person gets on it. There’s. 

[00:36:19] Right. Like one person calls this a stir up and then so like, am I like standing in it?

[00:36:25] And then someone else calls it a foot rests, but then that other person called this a foot rests and like, do I rest my feet on both? Or, or where do I put my leg? Like, is my leg rest on? Like, it’s actually 

[00:36:34] a leg thing. Right. And then, yes, there’s a whole thing in the, or that’s even more a monstrosity that you are describing, which is like, and I, and I do, and I’m very, I, I don’t know the word colorful and very abrasive, some folks would say, and mostly providers come at me and say, you can’t talk about stirs like that.

[00:36:56] It’s gonna scare people. And so, yeah, I felt my internal body reacted to your message. 

[00:37:06] Right. 

[00:37:07] And I don’t know, I probably, I don’t know. I’d have to look at the timing, but I probably didn’t respond right away. And I usually don’t because I felt I didn’t, I like read it, put it away. 

[00:37:18] And that’s like a totally valid, inappropriate thing to do.

[00:37:22] Right. Like you, and it’s, it’s interesting because, and I, I don’t mean this in any like sort of way, other than exactly how I say it, which is your reaction to that comment is not far off how some patients who have been traumatized have reactions, right. Like there’s a delay in, oh gosh. Cause it’s an uncomfortable, it’s uncomfortable.

[00:37:51] Right? Like they don’t know how to process what we’re talking about. And so there was a bit of a delay of like I didn’t, I, I don’t, I word that made me uncomfortable. I don’t like that. Which is really interesting. So we kind of go further into a conversation about it. 

[00:38:08] Yeah. And. It was a very interesting conversation.

[00:38:15] and I’m 

[00:38:15] so proud of us. yeah. Good job us. You’re so proud of us. Look at us. We’re I 

[00:38:20] am like, I, I am traumatized around stirs and that’s, that’s like very understood personally and professionally, like when you said no, provider’s gonna leave a pap smear and say that was the most traumatic pap smear I’ve ever experienced.

[00:38:38] I’m never doing pap smear again. I actually would believe that even a listener right now would associate a pap smear that they’ve done or witnessed as traumatic as a secondary or vicarious trauma because their client was traumatized potentially or reacted in a traumatized way. 

[00:38:58] Yes. I think I should provide a disclaimer for that.

[00:39:03] Yeah, no person who genuinely cares about. Inflicting trauma or understands that this can inflict trauma is going to leave a difficult path and say that because if you don’t recognize that a pelvic exam can be traumatic, right? You are not thinking about the fact that it was traumatic. You’re just irritated that this took you 30 minutes.

[00:39:28] Right? And like, you’re just not, and you can, you don’t know what you don’t know. Right? Yeah. 

[00:39:34] And you still, you can still feel a dissonance. You can still feel that’s supposed to go this way. We’re all upset. right. Why are we all upset? Why, why are we supposed to be doing it quick? Let’s get it done. Everyone has 11 minute office visits.

[00:39:51] Everyone has 11 minute office. We have to, this is how it goes. Let’s just go. This is difficult. They made it difficult for me. But in reality, what might actually be difficult is their difficulty is hard to see or. 

[00:40:04] I love what you just said. You said they left going. They made it difficult for me. Yeah.

[00:40:10] That’s where that owner like no ownership, right? Yeah. Yeah. And that’s why people don’t. And that’s why I say it doesn’t matter as much to certain providers because they’re leaving the room going. I did everything. What I was supposed to, I was, I don’t wanna say flawless, but this was not my problem. This was not my fault.

[00:40:29] I don’t need to reflect, I don’t need to think about it. I’m not gonna let this sit into me. I did it right. They were difficult. They were hysterical. They didn’t cooperate. They were non compliant. They didn’t listen to a gosh thing thing I said, and all of that onus gets put on the patient. Yeah. And the provider will leave the room.

[00:40:48] Not all, definitely not all. But some providers will leave the room and go, like, not my problem. They made it complicated. And so it’s. Without any ownership or recognition, it’s it just doesn’t hit you the same way 

[00:41:05] for sure. I think the folks listening to us are in the, in between space. Absolutely. I think they’re like 

[00:41:12] they’re listening to us 

[00:41:12] is, Hey, welcome Hank.

[00:41:14] So glad you’re here. Hello learning. Hello? Hi. Oh, glad you’re here. It’s messy here. PS. It’s messy. but they’re in, they’ve never seen you work. They’ve never shadowed you. Someone like you, nurses have never been in, you know, L and D nurses are very separated from each other. You know, they come in in emergencies when it’s almost the worst kind of experience to share with each other, right.

[00:41:40] These traumatic mm-hmm like, you know, innately traumatic, but also the language and all of the autonomy and all of the consent is out the window often. And that’s what we kind of like share. And so we’re like, okay, this is just what everyone’s doing in the room, but they don’t actually see us do an intake that takes an hour and a half.

[00:41:57] And we’re. Wear your own damn clothes. Right? I got a bra and you wear a bra. I don’t care. Yes. So they’re, they’re kind of like trauma aware, curious, they’re like reaching, like how do I do this? How do I find this? And I, I do wanna talk about that in, in a minute. I have a lot of folks coming at me who are, who are in the, in between mostly they, their professionals never would a parent has a parent ever come out and said, I hate that.

[00:42:20] You talk so blatantly about stirrups, because I think we should all be in dark in the dark about ’em mm-hmm, it’s healthcare that says I’m offended. I’m angry that you talk like this because I’m not trying to do harm. I thought potentially when you were like, I’m a doctor, I was like, oh, okay, sure. Yeah, yeah.

[00:42:41] Yep, yep. I’m sorry. I offended you because I talked tos, but really you’re like, how do we help the language? How do we grow this team of trauma aware professionals? Because it is our responsibility to be trauma aware. Is it our responsibility to be doing this work behind the scenes, even though I really love that.

[00:42:59] We’re kind of doing it, not behind the scenes. Yeah. How are we gonna change this language? Or how, how is it supportive language to clients and how do clients not have to do all the heavy lifting on it? 

[00:43:12] Right. And it’s, I think you can be intentional about having those conversations with other providers and other members of the care team without necessarily being, you know, overtly teachy.

[00:43:29] And so Like something as simple as, you know, Mandy, if I’m, if I’m the physician and, and you were the, and you were Ellen D nurse, and you said the word stir ups just even as we were popping outta the room saying, Hey, when you said stirrups, which part were you referring to? And you tell me, and I go, oh, we’ve always called those blank.

[00:43:48] We kind of find it’s a little bit more it’s less triggering for some of our assault patients or some of our, whatever, and basically leaving it at that. And if you want to ask more and, and have a deeper conversation then fantastic. And if you, don’t also totally fine, you’re not quite there yet in your journey, but at least you’ve heard the term, you’ve heard the other term.

[00:44:10] And then when I say the term multiple times, going forward in the birthing experience, we are on the same page. Mm-hmm and you know why I’m saying it? And you might wanna ask more questions. You might not The, but at least you have now recognized. Oh. Like, but that implies like that is dependent on somebody within the sphere of the experience.

[00:44:35] Prerequisite having the knowledge. Yeah. And in a lot of spaces they don’t. Yeah. And so to the point that like I have spent time with, with folks and explained things to provide them with advocacy, to go into other spaces. Right. So like I’m referring you to, so, and so, you know, you might want, like, you can probably expect them to do blank, blank, and blank.

[00:45:04] Right. Or, you know, you might hear some different language from them when they say this. They probably mean that. Or if you, if you’re cur, if you haven’t heard something before, ask them and I’ve even said, like, if somebody. Because I’ve, I’ve had this experience. I’ve told patients before, if you don’t understand a term and they look at you as if you are dumb for not knowing what that term is, put the onus on me say, blame me for that say, oh, my physician has always said blank.

[00:45:36] Yeah. Because it’s not your problem that we speak in a language that you don’t understand. Yeah. It’s not on you. And I have no problems taking that, cuz I will take I’ll have that conversation with, with the other person down the road. Sure. Like that’s 

[00:45:49] that fun? It’s actually a great opportunity. right.

[00:45:52] Excellent. 

[00:45:52] Yes. 

[00:45:54] The opportunity. I would love this conversation because I’m actually sending people to you and I’m like a little wary. So if we just open the 

[00:46:02] delightful, grab the coffee, take a seat, let’s have a conversation chat. Cause 

[00:46:06] I’m gonna talk. I’m gonna listen a lot and you’re gonna talk a lot and then I’m gonna flip it and be like, Or we could step into 20, 22 and understand that the majority of folks that we’re working with need a unique individualized experience yes.

[00:46:21] And the way you say it feels really good, like it is not anybody’s fault that we speak this language. Oh. But ours we’ve decided to like, speak, speak in ways that speak in our medical terms, right? Yes. And like you said, in our conversation, we’re not getting clear for ourselves, for each other in the healthcare professional space on these words, which is a really exciting opportunity because you and I specifically spoke about stir ups and I specifically used the term stir up.

[00:46:54] Yes. Because of the intention behind its use at the majority of the time and the country that I’m in at this time. Now everything I say on the internet. If you hear something on the internet and it does not apply to you, then that means it does not apply to you, right. Everything on the internet, but often more often than not.

[00:47:17] And I can back it up with receipts of tens of thousands of comments, clients, students that the intention behind the stir up is not a footrest and it’s not an option. 

[00:47:29] Right. And that was a, and I think I said in our, in our texting conversation, I basically had to pause and stop because that had not been my experience.

[00:47:43] Like I knew about it. I like we had talked about it extensively in my training in regards to obstetrical violence and consent and informed consent and what that looks like and trauma informed language and all of this stuff. And I was like, my co-chief did her major research on obstetrical violence. And she was a close friend of mine.

[00:48:04] Like this was not. You’re in a 

[00:48:06] unique container here in the 

[00:48:07] middle, wherever you are. All of our 

[00:48:10] listeners are like, where’d she go to school? Yeah. 

[00:48:14] no, I very much was. And that was fought for, right. Like it was to the point that, you know, residents would come back from certain experiences and be like, what did I just witness?

[00:48:23] That was so not okay. And we had to have older and more experienced attendings go. Yeah, you’re gonna have to get used to seeing that more often. It’s the norm. But no, no older attendings. It shouldn’t be, it shouldn’t be, get used 

[00:48:37] to seeing that you should get used to advocating for, against your colleagues and stepping up and being like colleague to colleague.

[00:48:42] That’s some bullshit 

[00:48:43] right there. Right, right. Exactly. In residency it’s difficult. Yeah, for, for listeners, we, we briefly touched on what residency looks like. You need to understand the hierarchy and medical education is like military style hierarchy. You. As to certain levels, depending on the, what we call malignancy of a program, or like how bad a program is, it’s like a, you speak when spoken to type of picture the first year.

[00:49:12] Doesn’t talk back to the second year who doesn’t talk back to the third year, who doesn’t talk back to the attending. Like it’s like, yeah. And you can be reprimanded and punished essentially for doing it. I was very fortunate to not be in that space. My program worked very hard to cultivate a culture that eliminated that to as much as they could, but the concept of me as a resident, even as a third year, chief as a resident speaking back to, you know, a specialist for how they did not gonna be a thing, like was not an applicable So it was surreal.

[00:49:51] Like, I, I totally understood where you were coming from. Once you had kind of laid it out, I just needed the, the space to be laid out. But you actually brought up another really interesting fact, which is that most of your content is geared towards social media and social media has time and space limitations.

[00:50:10] And this is a very nuanced conversation and topic. And social media doesn’t really allow you the opportunity to be nuanced. Like you can’t, you’re trying to get a lot of information out there in a digestible, you know, relatable, relatable space. Like that video would not have been nearly as impactful if you had spent the first 30 seconds explaining that what a foot rests and a leg rest in a stir is in these different.

[00:50:43] Like spaces. So we’re dealing with this, like it’s almost like clients and patients and providers are speaking two different languages and social media is another dialect. It’s like French versus English versus, you know, Southern. And it’s like, yeah, you’re saying the same words, but the context, like, unless you are in that space, the context is like lost on someone from Michigan you know what?

[00:51:13] Yeah. Which was kind interesting to 

[00:51:17] me. 

[00:51:17] I have had to learn how to speak the social media language 

[00:51:21] You’re really good at it. like you’re fluent, a lot of lies. 

[00:51:28] It’s really hard to be this bridge between two different languages and try and impact people so that they feel empowered when they go 

[00:51:37] in and then sit there and have, if we’re gonna relate it back to language, it’s like, You’re you’re bilingual, you’re trying your best.

[00:51:47] And someone is always screaming at you going be better at this. Yeah. Why aren’t you fluent? Why don’t, you know, this obscure term that like, why aren’t you using it? Or we don’t use that. And it’s like, you would never accept that in real life. Right? Right. Like no southerner, no southerner is gonna sit in Michigan and be berated for not using a specific term.

[00:52:07] I’m going to cut off Dr. Sheeler right here and see you all in part two of the language gap discussion in medicine. Where we give a lot of examples. A lot of scripts, we continue this. Very emotional conversation in part 2. See you there!dy