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Episode 5 Transcript

Preferred Gender Pronouns with Michelle Sariev, NP

Erin Everett: All right. Welcome back to Exclusively Inclusive. I’m your host, Erin Everett, nurse practitioner. Today’s show is going to be a little bit more special because I have one of my favorite people ever here on the show with us tonight and her name is Michelle Sariev. So say hi, Michelle.

Michelle Sariev: Hey Erin. I’m so happy to be here. Thank you so much for having me.

Erin Everett: Michelle is a wonderful asset to the community and not only to her patients but her colleagues. So we’re very excited to hear from her today and she’s going to be introducing herself here. So Michelle, if you wouldn’t mind giving us a full intro, your name, your preferred pronouns, that type of thing.

Michelle Sariev: Absolutely. So again, my name is Michelle Sariev. My pronouns are she and hers. I am a family nurse practitioner. I’m in practice here in Atlanta, Georgia at a private practice. We do internal medicine and endocrinology. I am an HIV specialist and I also specialize in HIV prevention as well as treatment. I have a focus in transgender health and have since I’ve been in practice as a nurse practitioner when I started in 2012.

Michelle Sariev: Like I said, I live here in Atlanta with my husband in Reynoldstown. We’ve been here since 2008 so we’ve seen a lot of changes around here and we live here with our two dogs, Oliver and Ruby. Oliver’s a German shepherd rescue and Ruby is our little beagle mix that we got from the Atlanta Humane Society. I came into nursing as a second career. I was already well into my 30s when I went to nursing school and I wanted to become an RN basically for the schedule. I really liked the idea of three twelves a week and I was a writer and so I thought that would be a good way for me to foster my writing career.

Michelle Sariev: And then I went to nursing school and decided I wanted to change the world and go into health policy. I had idea that nursing was going to hit me like such a bomb and I worked in emergency medicine for five years. I wanted to kind of be on the front lines of everything that was “wrong with the system.” And about six months in I realized I did not want to be involved in policy and it was a little too much. So I worked in emergency medicine and got a very, very healthy appreciation for prevention and a wellness as part of health care.

Michelle Sariev: So I decided what would make sense would be for me to go back, get my master’s degree, become a nurse practitioner so that I could focus on primary care prevention, healthcare and wellness. I think it was a very natural progression for me to get into transgender care because I really do think that it is all about wellness and it’s not a disease state and it’s all about helping people achieve their wholeness and their real selves and I love that. I think is the ultimate thing that we can do in primary care for anybody really.

Michelle Sariev: So it was a natural progression, like I said, I am a member of the American Academy, HIV medicine like Erin. So, my specialty is through them and I serve on their national board of directors. I’m also the co-chair of the NP committee for the organization nationally, and I sit on the Georgia steering committee. We do a lot of work, not only HIV medicine, but also we’re kind of moving into looking at sexual health and transgender health and wellness as well.

Erin Everett: That’s awesome.

Michelle Sariev: Yeah. Thank you.

Erin Everett: So now we know a little bit more about you professionally and personally. What is one fun fact that not everybody knows about you?

Michelle Sariev: One fun fact, I think… Well, the thing I always love to say when people ask me this question is to brag maybe a little about how I was in an all girl band in Athens, Georgia in the early 90s.

Erin Everett: That’s amazing.

Michelle Sariev: We were one of the first all girl bands around, so that was really fun.

Erin Everett: That is awesome. Michelle’s credentials are obviously extensive and amazing, and so we’re really excited to have her here and to learn a little bit more about what she has to offer the community. So basically the way that I met Michelle is we used to work together at our previous practice and Michelle became a fierce mentor of mine and really helped me jump into HIV care in transgender medicine. So I wouldn’t be here today if it were from Michelle. And even if I was, I definitely wouldn’t be half of the provider that I am. So I’ve learned a lot from her.

Michelle Sariev: Thank you.

Erin Everett: Of course.

Michelle Sariev: Right back at you.

Erin Everett: So that takes us to what we want to talk about today. Some things that we’ve heard back from the community. Looking on the Instagram page and the Facebook page, we’ve had some questions and one of the questions… Whereas, as somebody who’s not involved in the community directly, how could they make sure that they are asking people their preferred pronouns appropriately and how could they interact with people who are gender diverse or in the trans community both in the workplace and out in the general public. So I was wondering Michelle, if you could help people navigate that a little bit. Because it is a little bit different when you’re not in the community.

Michelle Sariev: Absolutely. Sometimes in my clinical setting, I don’t know what people’s pronouns are walking into the room. So usually when I’m trying to ask somebody about their preferred pronouns and I’m not sure if they go by pronouns that are congruent with their gender expression as I perceive it.

Erin Everett: That is a super important that you mentioned that. I’m really glad you did. So we can get into that in a little bit too.

Michelle Sariev: Absolutely. So what I will do is introduce my pronouns and I’ll say, “My name is Michelle Sariev, I’m a nurse practitioner and my pronouns are she and her. I think it’s interesting from… I just thought about this as a nurse practitioner, I think society thinks most NPs or a lot of NPs are women. So I come in and I think people perceive me very much as a cis woman and they kind of oftentimes look at me like, “Well, duh.” So it’s a really nice way to sort of break the ice and get people talking about it. And one of my favorite things is when I encounter someone who’s never been asked what their pronouns are and never really thought about it. They are never offended and they’re usually either really grateful that I’ve asked or kind of enlightened by the question.

Erin Everett: So when you ask them, are you literally saying to them, so, “Hi, my name’s Michelle.” They obviously will then go ahead and, “Hey, I’m Sarah, or I’m Jim, Jack or Bob,” whatever the name is. Do you say, “And what is your preferred pronoun,” or do you segue into it differently or how do you kind of approach that?

Michelle Sariev: I usually say my preferred pronouns are she and her and what are your preferred pronouns? Usually, I just ask it straight forward, I believe.

Erin Everett: Yeah, I think that’s great.

Michelle Sariev: I had somebody… I have a little pen that has my pronouns on it and I had someone in clinic the other day kind of look at it, because it’s really small. It’s pretty subtle. She was looking at it and saying what does that say? I explained it to her and she kind of looked at me funny, like she didn’t know what I was talking about and I said, “Not everybody goes by pronouns that are what I perceive as their gender expression basically.”

Erin Everett: So what does that mean? For somebody who doesn’t know what that means? What’s the best way that we can kind of get them to understand?

Michelle Sariev: One of the ways that I explain it is sometimes when I’m teaching nursing students or nursing graduate students, and I talk about how in the field of nursing we used to have to wear all whites way back when we had to wear dresses. Nursing truly was an all just cis female, very gendered profession.

Erin Everett: Very, very binary.

Michelle Sariev: Yes. The way that I present wearing pants and button down shirts sometimes or a jacket would have been perceived as very, very masculine back then. But now it’s seen as normal for a cis woman to dress that way. So I kind of break it down that way, to give that really extreme example. And then I kind of move further by saying, some people choose to express themselves in a very feminine way. Some people in a very masculine way. Some people in a very, what I would say non-binary way where it’s neither, and just kind of explain it that way. Does that make sense?

Erin Everett: Yes. Because I think what you’re saying is that basically for someone who is cis female, identifies as female, may not be into dresses, may not be into flowers and pretty things. But so they might be more androgynous and not have actually have a female gender expression. So maybe just plain pants suits and that’s totally fine. But people might want to ask them what their pronouns are because the gender expression isn’t necessarily what they identify as.

Michelle Sariev: Right. Right. And –

Erin Everett: It’s really important.

Michelle Sariev: I just realized, I’m not sure if you’ve done this on our previous podcast, but we didn’t explain what cis means. So cis and trans. A lot people.

Erin Everett: Yeah, let’s revisit it.

Michelle Sariev: A lot of people don’t know what that means. So it comes from chemistry and so cis is basically the same and trans is inverse. I was assigned female at birth and I identify as female. So I am a cis female versus someone who was assigned female at birth, but their gender is male or masculine. That means that they are transgender or a trans man or trans masculine. So just to explain that real quick.

Erin Everett: Yeah, no, that’s awesome. I appreciate that because I’m sure listeners are wondering.

Michelle Sariev: Now, on the same note I would like to add that I don’t think that it’s necessary to always introduce yourself with your pronouns. People trip over, do I need to introduce myself with my pronouns in every single setting because that can get really awkward and be off putting. So I think it’s important to be able to read social cues and understand when it’s important to you.

Erin Everett: Yeah, so I think you know the distinction there is for what you’re doing on the daily, you’re going into patient rooms, you want to make sure that you’re creating a safe space and then you acknowledging them and affirming them. So it’s really important that you introduce yourself with your pronouns and allow them to let you know what their preferred pronoun is. However, if you’re going to the coffee shop and you’re going to order a cappuccino not everyone needs to know your preferred pronoun because it can come on a little too strong and sometimes people just want to be stealth and carry on.

Michelle Sariev: Absolutely. Which I think leads into a good segue into thinking about if people who aren’t in the community or don’t have a lot of interaction with the community but want to know how to sensitively interact with the community or if they ever have questions, how to approach the that.

Erin Everett: So one of the other questions Michelle was addressing is that people want to know if they’re out in the general public, how can they be respectful of their gender diverse community members?

Michelle Sariev: I think looking to the community as a lead to not only the LGBTQ community, but also allies of that community. I really try hard to model the activities and behavior and language, especially for people who may not have that much experience with it. I think asking questions and remembering how important it is to ask very respectful questions and not intrusive questions.

Erin Everett: So what would be an example of an intrusive versus a respectful question?

Michelle Sariev: If you’re meeting someone… Say you’re meeting a trans woman for the very first time, you’ve gone through introductions, you’ve shared your pronouns with each other and you just want to know a little bit more about what it means to be a transgender woman. And this person has told you that they’re an open notebook, ask me anything. I want to help you understand what this is all about or whatever.

Michelle Sariev: Maybe not asking about their genitalia. That’s exactly what I mean. I think you probably knew I was coming to that because I think that’s what everyone goes to. I remember when early on in my career, I started doing talks in a human sexuality course and Emily and I used to always kind of pause about that because I’d be like, there was a huge separation between sexual orientation and gender identity. We really tried to keep them separate. But I had this moment where I was like, “Until we are comfortable talking about sex and thinking about sex, we are never going to be comfortable talking about gender and gender identity.”

Erin Everett: Absolutely.

Michelle Sariev: So that’s where the two kind of came together. But that’s not to be confused with it’s all about sex because it’s absolutely not.

Erin Everett: Right. Right. I think it’s really important that you made that distinction that it’s not appropriate to ask about somebody’s gentalia or whether they’ve had surgical genitalia reassignment, whether they’ve had phalloplasty or vaginoplasty because a lot of patients don’t go on to have that surgery, but it doesn’t make them any less female or any less male.

Michelle Sariev: That’s exactly right.

Erin Everett: The general public are often hung up on that and whether or not they’ve had surgery, if they pre-op or post-op and blah, blah, blah.

Michelle Sariev: Absolutely.

Erin Everett: It’s just not that important.

Michelle Sariev: It’s not. I think it gets sensationalized when you start talking about that and I think that unfortunately transgender health and the trans community has been politicized and so we have to be very, very careful to not be led down that road into a trap of sensationalization.

Erin Everett: Right. Absolutely. Well, I think that was some very good information on how to… So the rest of our listeners can be sensitive to the gender diverse community. So one of the thing I wanted to talk to you about was since you are a healthcare provider yourself and you and I practice in very similar offices. However, you have a lot more experience in the social movement, politics, and civil rights and just trying to make sure that people gain rights who don’t have them. So as a health care provider and with your special interests, what do you see is one of the largest areas of disparity in our healthcare as far as it pertains to the LGBTQ community?

Michelle Sariev: That’s a great question and I think it’s very complex and I think we can think about this in terms of the general population at large, really. I think about when we talk about Ryan White programs and what a really quite extraordinary job they have done with helping people who are living with HIV who may be uninsured or under insured. How that whole program just really, really sets people up for success and really serves the community in a good way, Ryan White clinics.

Erin Everett: For sure.

Michelle Sariev: Why can’t we put that model to all of healthcare?

Erin Everett: Sorry to interrupt you.

Michelle Sariev: That’s okay.

Erin Everett: But for people who aren’t familiar with Ryan White, what kind of population do they mainly serve?

Michelle Sariev: So Ryan White clinics are HIV clinics that serve people living with HIV who are uninsured or underinsured.

Erin Everett: So Uninsured, no insurance. Underinsured, meaning their coverage is really not covering most of their care.

Michelle Sariev: That’s correct. Yes. It’s federally funded, Ryan White was a young man, young boy actually who got HIV from a blood transfusion in the 80s, and he was a total hero. He stood up for people living with HIV and so the program is named after him. So it’s federally funded and we do a really, really great job in those programs serving a large part of the community. I think though with the general population as well as LGBTQ people, I think there’s a huge disparity in people who may have insurance, what they perceive as good insurance or they don’t have any insurance at all and they’re not living with HIV.

Michelle Sariev: So I think that that can be a very difficult segment of the population to serve and to get into care. Another disparity that we see is the amount of discrimination that the LGBTQ community has seen in healthcare. And so a lot of times they don’t present to care at all because they’re afraid of being discriminated against or they have a lot of health anxiety about going to clinics. So sometimes they haven’t had a screenings that are really, really important. Maybe they haven’t had full vaccination series. So it’s really important to assess health status and wellness and all those things that we do to keep people healthy.

Erin Everett: I’ve said this before and I want to say it again. I really do think that heteronormative individuals walking into a clinic who identify as cis really take for granted how easy it is to gain access to care. They’re not having to walk in and feel terrified and maybe some do feel terrified of pelvic exams for other reasons, but not because they have grave genital dysphoria or wonder if they’re having a prostate issue. Is the examiner really going to be a familiar with a trans woman and be sensitive or are they going to make them feel really uncomfortable and ashamed of their birth genitalia? These are like legit concerns.

Michelle Sariev: Absolutely. One of my favorite things that I do all day is once I build that rapport and let someone know that they’re in a safe space and that they can be their authentic self and that we are partnering in their health, they are absolutely in control at all times. So I love to just let people know I’m going to meet you where you’re at in your health care. And to see the anxiety just float away and it really does happen way more often in the LGBTQ community.

Michelle Sariev: They’ve had to hide their truth. They haven’t felt like they could talk to healthcare providers about anything from sexuality to how they brush their teeth at night. They think that they’re being judged from the moment they walk in and it’s really, really gratifying to be able to offer a very inclusive environment to folks like that.

Erin Everett: Yeah, that’s amazing. I wish there was more of us out there doing that. We could increase access.

Michelle Sariev: I think what people don’t think about too, unfortunately within the community, there’s a lot of shame. There’s a lot of discrimination just within the community. So I think it’s really important just to always be mindful of being as inclusive as possible.

Erin Everett: Yeah, absolutely. And then also just to flutter back a little bit to the pronouns I meant to ask you, when you’re talking to someone and you know that their preferred pronoun, maybe she, her and you slip up and miss gender them, what’s the best way to handle that?

Michelle Sariev: That is a great question. It happens all the time. I tell people this, don’t be afraid to mess up, just go ahead and make the mistake and you apologize. Sometimes I don’t even apologize. I mean, I apologize by correcting myself and I just kind of look them in the eye and say, “I’m sorry, he.” This happens a lot when I’m seeing people who are under 18 and they’re there with their parents and their parents oftentimes by the time they get to my office, the parents are usually fairly supportive of their kid for the most part.

Michelle Sariev: But they inevitably mess up on the pronouns and they really, really get very upset about this. I explained with the kid, they’re in the room, you’re going to make mistakes, you’re going to mess up, just correct yourself and just let him know that you see him for who he is. That’s all you can really do.

Michelle Sariev: It’s really quite as simple as that. That makes me also think about, they, them pronouns. And that’s gotten a lot of attention lately I think in social media and in pop culture and people get really tripped up by the idea of they, them pronouns. What I say to people is you don’t have to understand it. It doesn’t matter if you understand it or not. If you are a binary person, like I’m a cis female, I don’t know what it’s like to be non-binary, to not identify as male or female. But that doesn’t matter. I can still call you by what you want to be called. It’s very simple and it’s not hurting anybody.

Erin Everett: Right. It’s honestly no different from someone deciding to go by their middle name versus their first name.

Michelle Sariev: Absolutely.

Erin Everett: It’s just what they prefer. You don’t have to understand it like you said.

Michelle Sariev: Absolutely.

Erin Everett: So in order to further expand on they, them pronouns, can you explain for me a little bit what it might mean for someone who’s not familiar for the community? What does it mean to be non-binary or gender fluid or gender queer?

Michelle Sariev: If you think of gender identity as a sort of dynamic continuum that where male is on one side, female is on the other, non-binary people exist somewhere in between those two or maybe even somewhere outside that line that I’m drawing. Non-gender identity is a social construct. It is something that we have made a lot of decisions going way back about. I remember reading somewhere that originally pink was not supposed to be the color for females. Blue was not supposed to be the color for males.

Michelle Sariev: That was decided in a marketing room one day. That’s the only reason why we think of blue with boys and pink with girls that was created. This is all kind of created so people who are non-binary I find to be actually quite enlightened and very well aware of the reality of the fact that from day to day our needs of how we present ourselves to the world or how we feel on the inside may change depending on who we’re around, who we’re with, and who our family is. There’s so many different things that basically influence how we feel about ourselves in regards to gender. That I feel like non-binary people are a little bit more realistic.

Erin Everett: Yeah, I think that’s a really great way to describe it. It’s funny because since I think I’ve told you this before, but since working with this community and just being really a lot more educated on the gender spectrum. I’ve also become more comfortable with how I may want to present and just a lot more willing to step outside my box of what I would normally present or where. For the most part I present very female, but sometimes I want to be a little bit more male and it’s fun and not to take away from how people truly identify. But it’s fun to break down those social constructs and tell them no, like, no, I do want to wear this. I do want to wear these male looking boots because they make me feel good.

Michelle Sariev: Absolutely.

Erin Everett: That goes way beyond someone’s actual gender identity. But it also comes back to it in the sense that, yeah, why do we have to do what we decided to do in the 1800s.

Michelle Sariev: That’s what I mean by non-binary, people are quite enlightened.

Erin Everett: Yeah, and you can always kind of empathize a little bit. It’s a different fight. It’s a different journey, but it’s a fight nonetheless.

Michelle Sariev: Absolutely.

Erin Everett: So yeah. I think that’s great. I think it’s going to add a lot of value to our listeners and hopefully we’ve explained that well, but of course if anyone’s listening to this information has any questions, please feel free to email me at erin@exclusivelyinclusivepodcast.com. That’s erin@exclusivelyinclusivepodcast.com. Well, I don’t know about you, but I think we had an awesome episode tonight.

Erin Everett: I think it touched a lot of good subjects.

Michelle Sariev: I loved being here. Thank you so much.

Erin Everett: Yeah, we would love to have you back. Some of the things that I wanted to bring Michelle back on to talk about would be things like reproductive justice and some of the other topics that are near and dear to her heart. She has a lot to offer the community.

Michelle Sariev: I would love that. Thank you so much.

Erin Everett: Awesome. Well, you can find Michelle’s contact information at exclusivelyinclusivepodcast.com. We posted underneath this episode along with some of the resources that we’ve discussed. Michelle is also going to be typing us up some resources if patients or providers or allies alike are listening and wants more information about good quality transgender medicine topics. A lot of the resources that she’ll be listing and posting also have things for people in the lay community and how they can also interact with their gender-diverse community members. These are things that Michelle and I use both personally and professionally to to navigate through life.

Michelle Sariev: Absolutely.

Erin Everett: Yeah, really good stuff. So again, if you guys have any questions, just feel free to email at erin@exclusivelyinclusivepodcast.com and very special thanks to Michelle for coming on and giving us all that wonderful information.

Michelle Sariev: Thank you.

Erin Everett: We look forward to talking again soon. All right. Remember everybody live fierce, speak your truth, and love everybody.