All right.
Welcome to Hands On, Hands Off.
Today,
we are diving into a topic that's
often overlooked but deeply impactful,
and that is the role of
gender in OMPT practice.
I'm your host today, Moyo Tillery,
and joining me is Dr. Sarah Shaver,
whose work and insights are
helping us rethink how
gender dynamics shape
patient provider
interactions in manual therapy.
Dr. Shaver, welcome to the show.
Thank you.
I'm excited to be here to
talk about gender and physical therapy.
Outstanding.
It's great to see you.
So let's start with a little background.
Can you just briefly
introduce yourself and your
journey into orthopedic
manual physical therapy?
Yeah.
So my name is Sarah Shaver.
I use she her pronouns and
I've been practicing for
about nine years now.
I did my DPT at Husson
University in Maine.
I went on to do an
orthopedic residency and
become OCS certified.
I did that out in Oregon.
And then I gleefully moved
back to the East Coast to
Boston University where I
did my fellowship in
orthopedic manual physical therapy.
And I am currently at the
tail end of my SCD program
at Bellin College.
But in the meantime,
I am working full time
treating in a clinic in
Providence in an outpatient
orthopedic setting,
working with a lot of young athletes,
predominantly female or of
the LGBTQIA plus community.
But this topic of gender in
practice is one that is
near and dear to my heart.
And I feel pretty passionate
about its involvement and
consideration in the role
of health care in general,
but even more specifically
to physical therapy and LMPT.
Yeah, I mean,
I think you've queued us up
perfectly with your
background and your current
work environment to dive
right into this topic.
So let's do it.
What inspired your interest
in exploring gender
dynamics and then gender
dynamics specific to OMPT?
And perhaps before we even
go deeper in our discussion,
can we just level set for the listeners?
Can you help us define
gender in this context and
perhaps why it's important
to distinguish gender from
sex when discussing clinical care?
Yes.
So, yeah,
I think it is really important
first to differentiate
between gender and sex.
For the majority of this podcast,
when we refer to females
and males and men and women,
we're going to be referring
to the cis female and the cis male.
And that is those assigned
female at birth and those
assigned male at birth.
Right.
That is their sex.
We're going to speak in this
way largely because of how
research has been conducted
up until this point.
Research today is still
grossly and overwhelming
lacking for the transgender,
gender fluid and non-binary community.
I fully recognize and
validate that community.
I'm a member of the LGBTQIA
community myself,
but for the purpose of this podcast,
because of how research has
been conducted,
we'll be using male and
female to talk about the
cis male and the cis female.
So the sex assigned at birth
by the provider.
That's awesome.
Thank you so much for grounding us there.
I know that when you and I chatted before,
we talked about some of the
things that maybe
catapulted you into this
line of research and work and practice.
Some of them involving
existing discrepancies,
gender-related discrepancy in
medicine and healthcare,
but in PT specifically,
and maybe some of your
personal experiences,
meaning you've observed
some powerful antidotes in
your clinical work,
particularly around maybe
female providers feeling
somewhat misunderstood or
invalidated by their patients.
And again,
that patient provider relationship.
And, you know,
leaning into your presentation at AOMT,
you reviewed a large
retrospective analysis with
a huge number of cases,
over three million.
So can you tell us a little
bit about maybe what you took from that?
What did the data reveal
about patient provider
gender discordance?
And how does it compare to
maybe what we see in
broader health care literature?
Can you just kind of take us
into your world there?
Totally.
So there were so many things
that contributed to me
heading down this road of
interest and passion.
And the first is that overwhelmingly,
especially when entering my fellowship,
a huge overwhelming
majority of my direct mentors were male.
I really actually had to
think deep into this to
realize I had one mentor
early on in my residency that was female.
But overwhelmingly in the world of OMPT,
My official mentors were male.
I didn't have a lot of
female representation from
the mentor side of things.
And it feels kind of similar
when you walk into the AOMT conference.
Sure,
there are females walking around and
they're there.
But overwhelmingly,
we see a male presence.
And we often see that even
reflected on the stage in our presenters.
So I think that that is
improving with time.
Um, so that was, that was the first thing,
just feeling like,
even though I'm technically
or theoretically in a field,
female dominated field,
then when we look at OMPT,
we see a much more male dominated,
dominated specialty,
but even more so than that,
even more meaningful to me
is that whether it's a
result of internalized bias,
internalized sexism or overt bias.
I'm not sure.
It's probably a combination of both,
but overwhelmingly I've
personally watched so many patients.
I have personally experienced,
I have seen and felt the
collective experience of
the female of walking out
of a healthcare appointment
and watching that patient
feel invalidated, misunderstood,
belittled, gaslit.
Oh, maybe it isn't that bad.
It's, it's, it's, I, um,
isn't as bad as I thought it was.
I'm not, it wasn't taken seriously.
My tests were negative.
I was dismissed.
I'm not sure I got to say
everything I wanted to say.
I'm not sure they understood
what I was saying.
I just overwhelmingly was
watching females feel
invalidated and
misunderstood when they
left a patient appointment.
And we see this reflected
quite frequently when
females intentionally go
out of their way to request treatment.
another female provider
they're seeking someone
that they think has the
capacity to understand
their perspective a little
bit more and who perhaps
will listen to their
perspective a little bit
more and listen I fully
believe that physical
therapists are in this
field with good intention
but this collective
experience is so broad that
it's impossible to ignore
I mean, when we look at the ED,
we see that men's pain is
taken more seriously.
They're triaged more quickly
than the female.
We see that female patients
are interrupted more
frequently than the male provider.
We have all this data to say that somehow,
for some reason,
females aren't quite
receiving the same
treatment or response when
they're seeing their healthcare provider
And we can maybe perhaps
extrapolate that to physical therapy,
and we'll talk about that later.
And then really what was the
straw that broke the camel's back,
if you will,
is the study that you alluded to,
which was by Wallace et al.
And it was one point three
million patients.
It was a retrospective
analysis looking at patient
outcomes between surgeon
and patient based on sex
concordance or disconcordance.
So whether or not the
surgeon and the patient
were of same or differing sex.
And what was found, again,
a retrospective analysis of
over one point three
million patients is that
when the male surgeon was
male and the patient was female,
the patient within thirty
days of surgery was at a
statistically significantly
increased risk for death,
worse overall
post-operative outcomes and
readmission to hospital.
And that was the first
peer-reviewed paper that I
had read that truly just
validated and almost
slapped me in the face of
this is happening.
It is undeniable and it is real.
And that kind of cascaded my
interest and my involvement, I think,
in this area of physical
therapy and OMPT.
Yeah, that's scary.
That's really scary.
And anyone listening,
you know at least one cisgendered female,
right?
You know at least one.
And so if you're feeling
separated or not connecting
to this topic,
you know at least one person, right,
who could be the person who
experiences these negative
outcomes because of a lack
of conversation around this topic.
So this is serious and this
is very scary and everybody
has to be thinking about this.
So I'm thankful to have, you know,
clinicians and leaders and
innovators like yourself in
this space to bring us all
to a level of practice that
we should be at the level, obviously,
of a fellow of manual therapy,
but any clinician, even at entry level.
So this is a crucial conversation.
And you said something, Dr. Shaver,
about kind of what led to this,
the things you were hearing
female patients say,
and the female experience.
And at the foundation of
that is seeking concordance
and seeking understanding.
And I think that part of it,
just to contextualize it
again for the listeners,
if you're feeling separate
from this topic, any human being, right,
regardless of sex and gender,
race and other identity differences,
most people just stop.
speak concordance and understanding.
That's just human nature, right?
So just trying to frame this
work contextually in different ways,
everyone has to connect to
this topic because it is crucial, right?
And we don't need our
patients to suffer and outcomes,
like you mentioned,
be perpetuated because of a
lack of knowledge, awareness,
or tools to kind of right the ship,
right?
I know that in your work as well,
Dr. Shaver,
you have specific clinical
examples to further help us
connect to this data and
this topic and this work.
You and I talked a little
bit about maybe more common
trends that we've heard of
as physical therapists.
ACL injury, tears, female versus male.
You know,
I think most of us know it's
maybe more common for some
reasons that we're kind of
taught in a narrowed focus way.
Q angles increased, right?
But there's more.
Let's talk about that.
Can you give us some
clinical examples that
you've seen in your
practice or that you've
read about in your research
that helps us parse this
out a little bit further?
Sure.
Totally.
Um,
so there's kind of two parts there and
I'll start with the more
broader question here.
Um,
and then I'll dive into the little bit
more PT and ACL side of things.
Um,
so I would like to zoom out because I
don't know that we can
analyze where we currently
are and figure out how to
go forward without looking
left and right and without
looking backward.
Um, and by that, I mean,
I wanna talk about a couple
examples where there's
clear differences in sex
based outcomes in physical
or in healthcare.
And it goes all the way back
to nineteen ninety three
because it wasn't until
nineteen ninety three that
women and minorities were
required to be included in
a medical research.
So we have this huge body of
data that is really was
done on men patients,
male patients that
researchers and health care
have just chose to assume
perfectly extrapolates to
the cisgendered female patient.
And the truth is, is that it doesn't.
And that's starting to
become more and more clear.
And unfortunately,
we're seeing it come out in our outcomes.
We can talk about the world
of pharmacology,
where women are nearly
twofold greater risk of
experiencing an adverse
drug reaction across all
drug classes and are
significantly more likely
to be hospitalized as a
result of these adverse drug reactions.
We can talk about females in
the emergency department,
where a female is more
likely to be wrongfully
discharged from the ED with
symptoms of unstable angina
or myocardial infarction.
That risk increases if the
patient is not white.
We can talk about how a
female presenting to the ED
with a myocardial
infarction is two to three
times more likely to
survive when being treated
by a female provider.
We can get away from the ED
and we can talk about
non-alcoholic septohepatitis or NASH,
which is
experienced,
fifty percent more likely by females.
However, men,
despite controlling for all
sorts of variables,
are eleven point nine more
likely to receive a liver
transplant plant and women
are more likely to die
while waiting on the wait
list for their liver transplant.
They're more likely to be
removed from the wait list
altogether due to
deterioration from condition,
and they're more likely to
just remain on the wait
list indefinitely and
unfortunately experience death.
we can again we can zoom out
even farther we can look
farther left or farther
right we can look at a
retrospective analysis by
doria rose looked at over
fifty five thousand
individuals and looked at
the performance of
sigmoidoscopy is right and
whether they're performed
adequately or inadequately
and we see females
significantly more likely
to have a procedure that
was performed that was
deemed inadequate and of
those that had an
inadequate seizure they
were three times more
likely to go on to develop
colorectal cancer
And you mentioned earlier, right,
this is scary.
This feels terrifying to me
as a cis woman that has
health needs just like any other human.
And I know in physical therapy,
we're unlikely to be
detecting on the regular
colorectal cancer or heart attacks,
right?
And when I give this information to people,
what is most commonly said
to me by other therapists is,
But physical therapy is different, right?
We see our patients often
two to three times a week.
We see them for extended periods of time.
We form relationships in
ways other healthcare
professionals don't.
And listen, I hear you.
But it is really difficult
for me to believe that
somehow we see these
discrepancies in the rest of healthcare,
and somehow we as physical
therapists are immune.
It's really difficult for me
to believe that somehow,
given our current society,
that these biases haven't
permeated or affected physical therapy.
And it's really difficult
for me to hear you dismiss it so easily.
I think that brings us to a
couple more PT specific examples.
And the ACL is a classic one.
It's commonly talked about
how women are more likely
to tear their ACL.
They have wider childbearing hips.
They have estrogen that
makes their ligaments more lax.
They have a greater Q angle, right?
This is, I would say,
probably commonly known and
accepted language.
However,
when we look at that a little bit
more closely,
there's several variables
that really should make us
question that women are
inherently more likely to tear their ACL.
And the first is that we've
watched over time the rate
of male ACL tears decreasing.
decline and we've seen the
rate of female ACL tears
either incline or stay the
same kind of depending on
what you're referencing.
So why do we have this graph
that doesn't match,
especially when we have
known and cited and
researched ACL tear prevention protocols
that have been designed for females,
like the PEP program that the IOC,
the International Olympic
Committee put out.
We have these known programs
that can decrease ACL tears
by the right of sixty to eighty percent,
depending on the literature
that you're looking at.
And they're not being used.
And again, my question is,
why is that ignorance?
Is that overt sexism?
Is it subconscious bias?
But inherently female ACL
tears don't have to be at
the rate that we are.
And truly we could even back
up even farther and we
could look at studies of
dancers that started when
they were young.
And the unique thing about
these young dancers is that
men and women often start
dancing at the same age and
they train for years.
And what we see in dancers
is that there's very little
difference between males
and females between their
jumping mechanics.
their landing mechanics
between their quad to
hamstring ratio and their
ACL tear rates are about the same.
You contrast that to something like soccer,
where females are largely
starting playing in their
post-pubescent years.
Males are starting to play
in their pre-pubescent years.
And we zoom out even farther
and we see difference in
strength training and kind
of cultural upbringing in
based off of gender, right?
My brother was asked to
stack wood and carry the groceries in.
I was asked to sweep the ground, right?
So even from a really super young age,
we are strength training in
a really gender segregated way,
our males and our females differently.
And then we're starting our
sports at different times
based off of women,
females go through puberty
one to two-ish years before males, right?
So males are strength
training and doing their
sport at the peak of their puberty,
at the peak of the time
where their muscle building
and bone density mass is
most influential.
females are starting after their puberty.
And then we're socializing
and training them
differently and not
initiating and providing
them with the same
resources and knowledge to
strength train and work on
these mechanics, right?
So I really like to
challenge the idea that
women are just inherently
more likely to tear their ACLs.
And maybe this comes down to
societal expectations,
how we are gendering tasks
that we give our children and even
um,
the information that we're giving them
in sports and in physical therapy.
I feel really frustrated.
It happens all the time.
Females come into the clinic
and they're like, oh, you know,
it's just like women are
more likely to tear their ACL.
I'm the fourth person on the
soccer team this year.
That's torn their ACL.
Like it's just going to
happen to the other side.
You know, it's just more likely a woman.
And there's this inherent
sense of I'm weaker.
I'm frailer.
I'm been defeated.
I'm probably going to tear
the other one next year
because that's what
happened to women in soccer.
Um,
I would really like to
challenge that notion.
Yeah,
you're challenging it right now in
real time.
It's happening.
And it starts with increased awareness.
I sincerely appreciate your zooming.
You're zooming out and taking us back to,
you know, where the yardstick is off.
If we're measuring something
against something that is not accurate,
everything from there is
going to be inaccurate.
And that's
essentially,
it sounds like that's what we're seeing.
And that is really powerful
to kind of back it up and say that.
And, you know,
I've never thought about
what you just said,
which is we're training
kids, right?
I've never thought about the
biomechanical implication
of boys do this and girls
do that and gendering and
roles and things like that.
I mean, that is really powerful.
Maybe others have,
but I find that really
insightful within the
context of this conversation,
but of course, after that, beyond that.
And continuing to zoom out,
you said something that I
find also really powerful, which is
It's an excuse.
We as physical therapists
are part of the health care system.
And so whenever, you know,
and I think in the company
of fellows in this
community of practice where
I think we tend to think
outside the box by default,
which is sometimes why we
pursue fellowship training is.
whenever I hear something is
inherent or like you're
predisposed to something
especially when it comes
with um the context of
something really narrow
like gender or height or
age or race or upbringing
or it just it's a red flag
for me so I I appreciate
that you're pushing back
and challenging this this
well you know she's gonna
be more lax because she's a
dancer or she's gonna be
more flexible because she's
good she's a dancer
Maybe not.
Maybe there's more.
And what I'm hearing you say
is that there is more.
But the research to support
that is lacking,
at least specific to physical therapy.
I have so many things...
you know,
that I want to ask you about and
chat with you about.
But for the sake of time,
can you bring us into maybe
where you are now,
some of your parallel
collaborations and maybe
others that you've
networked with and talked
to who have worked in or
around this space?
What are those conversations like?
What are you finding,
whether it's in certain
groups of athletes or certain ages?
Can you just talk to us a
little bit about the
research side and the
scholarship side of what's happening,
what's developing,
maybe where you see things
going as far as your
specific work in this area?
Yeah, I mean...
the scholarship in this area
and the progression in this
area is in a really really
fun time um one of my
favorite places to network
and discuss with other
clinicians and providers
interdisciplinary is the
female athlete athlete
conference I'm going to
give a little plug here
female athlete conference
happens in boston
massachusetts every other
year and it's an
interdisciplinary conference
full of physicians, orthopedics,
physical therapists,
nutritionists that are
coming together to overall
discuss physiology, pathology,
and the treatment of truly
the female patient,
but a little bit more
specifically the female athlete,
and where I get to hear and
talk to a lot of really
cool researchers and hear
some really novel research in the area.
It was at this conference a
couple years ago that my
perception of very similar
kind of concept, the ACL,
my perception of
concussions was challenged.
I think really similarly to ACLs,
providers often think about
concussion and think, ah,
females have worse outcomes
when it comes to concussion.
And I, you know what,
I'm sure there's data that says that.
But Christina Masters
presented at the Female
Athlete Conference and
specializes in concussion
and works for the NFL and
the National Women's Soccer League.
But she put out a paper in
looking at over a thousand
concussions from thirty
different institutes and
really challenged the
notion that females have a
worse prognosis because she
found that within these D one schools,
when time to concussion to
referral and first seeing
the provider was the same,
the prognosis between the
sexes was the same.
She then went on to look at
the same thing with the
pediatric population and
found the same outcome.
This is just another topic
where I constantly hear
presented and talked about
how women have worse outcomes.
I mean,
it's been drilled into my head for
a really long period of
time to really be
questioned and not
supported by this research
that Christina Masters is doing.
It's just another area where
we're letting preconceived
beliefs and notions
have a strong influence on
our practice because we
haven't taken the time as a
society or healthcare to
really look at this sex specific data.
But other,
so Christina Masters did that
work on concussions,
and I'm sure she's
continuing to research that.
But also in this area, I mean,
you can find references
through the Australian Sport Institute,
FASTR, F-A-S-T-R, through Stanford,
where there's
constantly updated research
about female physiology and pathology.
And it's one of the places I
go to kind of look for some
new female specific
research or an area that
I'm trying to learn more about.
Yeah.
Thank you for sprinkling
some of those resources for us,
for all of us.
Appraising the evidence I
think is something that we
all as in this community of
practice can really
appreciate and bridging the
gaps in where we are as
individual practitioners
relative to some of the
topics that we talk about on this podcast,
but obviously in clinical practice.
I think you and I had
another discussion where you, you know,
provided some insight and
really enlightened me on
something that I think
clinically I sort of
witnessed and just
uncomfortably brushed away as well,
which is the use of manual
therapy in chronic pain.
And, you know,
the impact of this being
more negative towards women versus men or,
you know, female versus male.
Do you mind just telling,
retelling that story from
your perspective and just
any other nuggets that you
have around the topic of, you know,
the maybe inconsistent use
of or inappropriate use or
disuse of manual therapy to
address chronic pain,
which has that influence on women?
Yeah, so a couple of things come to mind.
Women, anything can be disproven,
but women often have more
chronic pain than males.
We see higher rates of
things like cervicogenic headache,
autoimmune diseases, right?
So I think if I was to ask
you to close your eyes and
picture the chronic pain patient,
I don't love that language,
but picture a patient
you've had with chronic pain,
most providers probably picture a female.
And a really recurrent motif
I've seen in the clinic,
it's kind of one of two
things that more commonly
are providers being like,
this is a chronic pain patient.
This is not someone we do
manual therapy for.
We need to do X, Y,
and Z to address their pain,
but we shouldn't do manual
therapy for a chronic pain patient.
And first I really want to
challenge the notion that
any one diagnosis,
no one should have something.
Similarly to every one of
your patients shouldn't have one thing,
right?
We don't,
we need to be individualizing our care,
but this concept of, Ooh,
hands off for chronic pain
patients is
disproportionately impacting
female patients.
It starts off with a tone of
I'm inherently making a
judgment and deciding you
don't get this treatment.
It's belittling.
And doesn't allow for a
thorough assessment because
you've already made a
decision based on a
diagnosis and what
treatment this patient is
or isn't getting without
considering their history,
the other health care that
they've received, other personal,
socioeconomic,
racial things that might be
going on that we might need
to consider with this patient.
You've pre-decided based on
a diagnosis what is going on.
and what you need to do and
not do about it.
Again,
we see this with autoimmune conditions.
We see this with chronic
pain and the cervicogenic headache,
where we've pre-decided a
treatment route based off
of maybe an area
that I think most therapists
or a lot of therapists
prefer not to treat even
and have decided they're
not going to receive manual therapy.
Just like not everybody
needs manual therapy.
We don't get to say, hey,
this diagnosis doesn't get it at all.
That's really
disproportionately impacting
female patients.
Yeah.
And that brings me kind of
to the thought process of
really similarly therapists saying, oh,
like,
I'm not biased.
I treat everyone the same.
This is a really similar concept.
And I hear that you saying I
treat everyone the same has
really positive intent.
I don't think it has
positive outcomes and does
not play out the way you want it to be.
Equality and equity are not the same.
And if we are treating
everybody in the same capacity,
I treat everyone the same, right?
That sounds so inclusive.
What you're doing is
fundamentally excluding and
not considering certain
factors that may impact one
individual or a group of people.
And it leaves us a lot more
susceptible to practicing
with bias and unconscious
or internalized sexism or
racism or other discriminatory ism.
We have to consciously and
intentionally consider the
things that are different
from ourselves in order to
give our patients the best treatment.
Yeah, no, this is so good.
There's so many things in
what you just said that
boil down to why this matters.
Previously,
we talked about even delayed
access to care, right?
Like maybe female injured...
young females are not
getting sent out for care.
And of course,
that's going to impact outcomes, right?
But then more concerningly, maybe,
or equally concerning is the topic of
these preconceived notions
that still serve as a
barrier once these
populations are in our care.
Oh my gosh, that is really scary.
So it's one thing to not get the care,
but then to finally be in a
position to get it,
but the practitioner with good intention
The outcome is still negative.
The impact is still negative.
I mean, who wants to be that clinician?
Not me.
So I want to be enlightened
to not treat everyone the same.
I mean,
I feel like maybe some of us
listening are uncomfortable
with that because now I
think historically we hear, well,
don't focus on the differences.
Focus on what we have in common.
In this case, right,
equitable care and
equitable clinical decision
making and practice,
the distinguishing factor
is what helps you individualize the care.
So we can't ignore that.
I mean,
that it seems like an
oversimplification of a
pretty complicated concept.
thing,
but we have to pay attention to what
makes each patient different,
specific obviously to this
topic of gender.
So thank you for kind of
going there with us and
really shedding light on
maybe when our intention
doesn't match our impact
and that sort of ongoing reflection.
That needs to happen, you know,
with clinicians from
patient to patient and
sometimes with the same patient.
We've got to step back and reassess,
you know,
what worked last time may not
work this time because they
have experienced something
in the health care system
that is now challenged
their thought of where they're going,
their recovery patterns.
That's something else that I
think we chatted about.
Please go ahead.
Yeah.
Good intentions only go so
far because you can't see
or address what you're not looking for.
I'm thinking of a paper by Stenberg et al.
This was twenty twenty one.
It's entitled Gender Matters
and Physiotherapy.
Please go read it.
But this paper looked at men and women,
cis men and women, and found that
this was in a study,
this was kind of a collection of review,
but that men often viewed
their pain as proof of hard labor,
where women were more
likely to feel shame and
self blame for pain.
This was after leaving a
primary care appointment
and that men tended to
place blame outside themselves.
They tended to blame their
pain on external factors.
Women were a lot more likely
to internalize feelings of
guilt and see causes within
themselves for pain, right?
At face value, your patients,
cis men and cis women,
are coming to you likely in
a very different place.
They have different health
care experiences.
They might even feel fearful
of what you're going to say
or fearful of how you're
going to perceive them or
fearful of being judged.
They're foundationally
coming to you at a different place.
And I treat everyone the same or, oh,
I just treat the patient in
front of me leads us for so
many blind spots.
Because, again,
we cannot see what we're
not looking for when we're
treating our patients.
And I always kind of come
back to this thought process,
this like gut check.
Right.
Like if I'm sitting here and
saying this and your gut
reaction is I'm good, I'm not biased,
then truly I'm very
specifically and directly talking to you.
Right.
If your internal dialogue is, oh, well,
I don't think I'm biased,
but how could I assess
where there is something
that I'm doing impacting my care?
How can I dive deeper into this?
Then I support that.
That is what your internal
dialogue should be.
But if you're hearing this
and you're thinking, that's not me.
I'm not biased.
I treat my patients great, right?
I'm not letting this seep into my care.
Then truly, I'm directly talking to you.
That sense of defensiveness
that you're coming up with,
that tells me that maybe
some bias is seeping into
your care and that you're
unwilling to assess it.
Yeah.
You just said it, right?
You took the words from me,
which is sitting with being
uncomfortable is good, right?
We all sort of know that
that's where growth and
transformation happens.
We tell it to our students.
We tell it to our patients.
And behavior change models is
Are you willing to change?
That means you're willing to
step into a place of discomfort.
And so that obviously
translate into our own
reflections on our practice.
I've never met an orthopedic
manual physical therapist
or fellow who doesn't care
about improving their practice.
And if you're wondering why this matters,
why we're talking about this,
this is because
We're telling you it will
influence your practice.
It will drive your outcomes.
And that awareness is really
exciting to now go back and practice.
what you're hearing, even without maybe,
if you haven't gone into the research,
you know, to the extent that you have,
Dr. Shaver is like,
I am now being fed some
information that should
trigger some reflection.
So I love that.
Thank you for this conversation.
It's so important to
understand how this is
going to influence our
day-to-day practice.
I remember, you know, during
residency and fellowship training,
just really enjoying the
training because I always
walked away with tangible
tools that I could implement directly.
And I think a lot of times
that's what we're looking
for as clinicians is not this abstract,
you know,
study, those are great,
but how do I translate that
into clinical practice?
And that's what you're giving us.
So thank you for that.
And kind of along this conversation,
you've sprinkled
beautifully lots of tools
and resources for us, the listener,
to help us be aware of our bias,
but then to also
start to move the needle a little bit.
This is a continuum and a journey.
And I remember thinking too, you know,
patient to patient,
depending on who the
patient is in front of you,
It's almost an ongoing
within a day of as a new patient comes,
I'm in a different place in
my continuum of growth and learning.
And that's OK.
Patients are supposed to
challenge us to meet them where they are.
And we say that a lot,
but we can't meet patients
where they are if we don't
know where they are,
which I think is where a
lot of what I'm hearing
from this conversation as well.
Dr. Shaver,
I'm always curious about what
people are doing related to
or not related to this topic.
But before we go there,
are there any other things
that you want us to be aware of?
Any strategies or
suggestions just specific
to our topic of OMPT,
gender considerations in OMPT practice?
Is there anything else you
want to kind of just give us today?
Yeah.
I mean,
I wish I could give you one
succinct clinical pearl,
but if there was one thing
you were going to do is to
intentionally and
consciously spend the rest of your day,
your week,
thinking about what biases you
may or may not have,
like to truly take a deep
dive into your practice and say, oh,
did I use language that
happened to set that patient up?
to feel like it was her fault?
Did I skew my manual therapy
practices in a way that was
not beneficial to them
because of their gender or sex?
How do I change this in the future?
How do I better validate and
listen to my patients that
have historically been
invalidated and felt belittled?
Like I want you to truly
take the time to
intrinsically process and
think about that.
And the truth is, almost inevitably,
you've probably let a bias
seep into your practice in
the future or in the past.
And almost inevitably,
it'll probably happen again
in the future.
And that's okay as long as
you're willing to reflect
on it and acknowledge it and grow.
It's when it goes unchecked
that it's a problem.
And reach out to people that
are of different
sexes and gender from yourself,
talk to them,
ask them what works for them,
what they have seen,
like bring this to your clinic,
bring this to your place of work,
bring this to your
university and discuss it
with people and make it an
active conversation.
This can't be a passive,
this can't be a passive
change for the field of
physical therapy or OMPT.
My second recommendation is to read.
It doesn't need to be in the
depths of your university library.
It doesn't need to be
peer-reviewed journals.
Pick up Roar by Stacey Sim
and learn about female physiology.
Pick up
Unwell Woman by Eleanor
Klanghorn and learn about
the history of gender
discrepancy in the
healthcare in the United States.
Pick up He, She,
They by Skylar Baylor and
learn about non-binary and
transgender individuals and
like intentionally read
even outside of your field,
and learn about the
collective experience of
the people that are most
different from you so that
you can best help them when
they're in front of you.
I love that.
Those are outstanding resources.
Once again,
you're giving us things we can use,
and I love that.
And I want to take a second
to just hopefully everyone
can see the parallel
between what you said as
far as refining your
practice and ongoing reflection.
It's sometimes something
that I feel like we drill
down when we talk about
psychomotor skills.
And again,
we're orthopedic manual physical
therapists, we're using our hands,
you apply a technique, it didn't go well.
So you take a step back and
you figure out what went well,
what didn't,
get the feedback and then improve.
Can we just apply that to
what we're talking about here?
You know, it's the same framework.
It's just a different thing
at the center of that practice.
And so I love that.
For me,
that is a parallel that I really
connect with.
You know,
refining my skills goes beyond my
hands-on skills, right?
It's more than that.
There's so much more to that.
So thank you for those tips.
That's awesome.
And as we're kind of closing,
I want to talk about maybe
some hot topics.
You talked to me about a
course that you're involved in,
a female athlete course
that touches a little bit
on transgender athletes as well.
Can you tell us more, some takeaways,
maybe some things for us to
consider related to that work?
Totally, yes.
So I teach a course to some
sports residents entitled
The Female Athlete,
but I have basically an
entire lecture dedicated to
the transgender athlete or
treating the transgender individual.
And when I talk about this,
what I hear so commonly is, oh,
that's such a small
percentage of the population.
That's not really entry level material.
I really want to challenge
that here and now, because first,
in the United States,
there's an estimated one
point three million transgender humans.
Right.
That is a huge percentage.
That's a huge amount of the population.
And in my clinic,
it's an overwhelming amount
of the population,
a large amount of the population.
So
And truly, like in DPT school,
I did sharps debridement on an orange,
okay?
If that is entry-level information,
then learning about the
musculoskeletal rib and
chest pain that an
individual may acquire if
they are improperly using
their chest binder,
that's entry-level too and
should be in our residency programs.
If my learning how to use ultrasound-
as entry-level material,
then so is learning about
shoulder mobility and pain
after top surgery, right?
Deciding that an entire
minority of the population
is not entry-level material
or is not enough of them to
teach the material in your
residency or in your DPT
program is an example of discrimination.
I think this material is not
difficult to teach,
but should be in our curriculum,
both in residencies and in DPT programs.
And you've probably treated
a transgender individual
whether you know it or not also.
That's powerful.
That's really powerful.
We talk about inclusive practice.
This is what it is.
This is what it looks like.
And you're preaching to me, right?
Because I do feel like I
have a sense of awareness
about some of these topics.
And yeah, I practice inclusively,
but I can tell you that
I have work to do.
After speaking to you and
learning about there are
still gaps and how
inclusive are we truly in our practice?
Now, granted, we are, you know,
subspecialists in the world of OMPT,
which is why I was really
interested in chatting with
you about this is, you know,
gender topics spans OMPT practice.
It goes way beyond that.
But if we're going to be
specialists within a specialty practice,
we have to consider the
minority population, right?
Like fellows, we do tend to,
I can speak maybe for
myself and a lot of my
colleagues in OMPT practices,
you might get that complicated patient.
They tend to give you that
complicated patient because
you're the fellow,
you're going to figure it out.
And so even within our subsets of
of patients,
we have to consider the
minority patient because
they may be more likely to
come and see us because no
one else could figure out what was wrong.
So that is, I mean,
I think what a great
representation and picture
of inclusive practice and how to do that.
So thank you again.
I mean,
so many nuggets I think that you
have given us and tangibles.
I have to now poke you a
little further and say,
What's next for you in this
space or in other spaces?
Maybe in your career trajectory,
are there studies or
initiatives you're excited about?
Tell us a little bit more
about that and then we'll wrap it up.
Sure.
My future is a little bit
vague at the moment.
I'm currently finishing the
DSC at Bellin and I would love,
my ultimate goal is to kind
of transition into academia
and then very intentionally
dive into the world of research,
of researching both gender
discrepancy and working and
researching the LGBTQIA community.
Enough said.
Nothing to add.
That's amazing.
And there's a lot of work ahead for you,
so get ready.
As you can see, in your own work,
you've discovered this.
Thank you, Dr. Shaver,
so much for joining us and
for challenging us to think
really critically about gender in OMPT.
For those of us listening,
those of you listening,
we will be sure to get
these resources out to you
And until next time, everyone stay curious,
stay reflective,
keep your hands on and your minds open.
Thank you, Dr. Shaver.
Thank you.