Microaggressions in Healthcare

A discussion on what microaggressions are, examples of what they look like, and how we can address and prevent them in healthcare and community settings.

"Did you really just say that?"
How to Confront microaggressions.

As you navigate down your journey in healthcare, you’ll encounter a wide range of people of different races, ethnicities, religions, sexualities, etc. Whether these individuals are fellow healthcare professionals or patients, amongst the interacting and communicating you’re bound to come across someone who will comment on your skills or even your appearance. And while it is very commonplace at times, “microaggressions” — subtle prejudicial comments or actions — should not be tolerated in healthcare or any other field. With this being said, conversations must be had in order for us to successfully tackle these implicit biases.

There is often a divide when it comes to discussing the concept of microaggressions. On one end, the concept has aggravated some people who believe microaggressions describe situations where people are just being overly sensitive. On the other hand, many people feel as though they are walking on eggshells due to the growing aim to be politically correct. With the lingering fear of being called out or the frustration of having their feelings invalidated, nothing is being said at all, resulting in an ongoing silence. And because microaggressions are continuously going unchecked, they are becoming more damaging than the outright “-isms”. We cannot expect ourselves to advance the discussion on derogatory injustice and the potential solutions for it if we are afraid of having honest conversations with each other and admitting to our mistakes. Microaggressions don’t seem to be going anywhere anytime soon, so it’s worth understanding what they mean and how they affect others.

What are microaggressions?

It’s important to understand that microaggressions are not just subtle insults and insensitive comments; they’re something more specific and destructive. Microaggressions are the harmful remarks or actions that attack a specific identity of a person’s being in a way that it is discriminated against or subjected to stereotypes. A key part of what makes them so disconcerting is that they happen so casually, frequently, and often without any harm intended, in everyday life. The people who are most commonly affected by microaggressions are people of color, women, the LGBTQQIA+ community, or those who are otherwise marginalized. And while unintentional, they affect people of all races, genders, orientations, and cultures.

Here are some examples of microaggressions that have been said within healthcare settings and day-to-day life:

  • “I’m not a racist. I have several Black friends.”
  • “Oh, you’re in dental school? Are you planning on becoming a dental assistant?” (Minority women aren’t assumed to be the doctors)
  • “You want to become a doctor? Won’t that be hard? Why not look into nursing?”
  • “Where are you from?” (When Asian or Latino Americans are assumed to be foreign.)
  • “Your English is very good.”
  • “You want to be an orthopedic surgeon? Wow, girls aren’t usually into that.”
  • “You are so articulate!” (Assigning intelligence to a person of color based on their race).
  • “Are you sure you want to be a surgeon? Don’t you want to have a family?”
  • “Everyone can succeed in this society if they work hard enough.”
  • “When I look at you, I don’t see color.”
  • “As a woman, I know what you go through as a racial minority.”

 These are just a few examples, but we can go on and on. Fortunately, there are ways to make sure coworkers, leaders, and even patients are more aware of their behaviors and biases.

How microaggressions affect healthcare

Unlike overt expressions of racism, sexism, or homophobia, microaggressions can be more difficult to identify and address. As a result, microaggressions can create a hostile and invalidating environment that is not conducive to proper learning. As a healthcare student, microaggressions can be prevalent throughout all years of training and can come from classmates, patients, and even clinical doctors. And even though the comments may be targeting your race, ethnicity, gender, or sexual orientation, you may be led to feel that you are overreacting if you question this behavior. Oftentimes, there is uncertainty about how to respond to these microaggressions because of a disproportionate power dynamic or not having a direct person to go to. And because most healthcare institutions are dominated by white male culture, many people believe microaggressions don’t exist, but they do. Repeated often enough, they accumulate and can impact every area of one’s life, including one’s health.

Beyond the classroom setting, the impact of bias and discrimination on minority patients is also present in the clinical environment, and they have been shown to strongly impede diagnosis and treatment. Patients can pick up physical and verbal cues from physicians, feeling liked or not by the physicians and comfortable or not in their care. When healthcare professionals allow microaggression culture to fester in the workplace amongst patients, not only are we harming patient-professional relationships, we are also destroying patient health and contributing to the growing health disparities seen in marginalized populations.

How we can combat microaggressions

While you’ll never be able to predict or control what someone else says, you can choose how you react to it. Microaggressions can be difficult to confront, but we as healthcare professionals and students need to be open to being corrected when found guilty of using microaggressions and willing to correct others. This is the only way we will be able to create a space where all people feel comfortable, safe, and accepted in our care.

Here are some structured suggestions moving forward when combating microaggressions in healthcare:

Take A.C.T.I.O.N.

Ask: Present clarifying questions to assist with understanding the microaggressor’s intentions. You can try something along the lines of, “I want to make sure that I understand what you were saying. Did you mean…?

Carefully listen: If they disagree with your paraphrase and clarify a different meaning, you could end the conversation there. If you suspect they are trying to “cover their tracks,” you may consider making a statement about the initial comment. If you choose to address the comments, you can say something along the lines of, “I’m glad to hear I misunderstood you, because, as you know, such comments can be…”. If they agreed with the paraphrase you gave them, explore their intent behind the comment: “Can you tell me what you were hoping to communicate with that comment?”.

Tell others: Express that what you observed was problematic in a factual manner. You can present this in a manner of, “I noticed that…”. Don’t contradict yourself with “I think” or “I felt” statements. Share the harm that was caused as a concrete concept. 

Impact consideration: Ask how such a statement or action could impact others. Say something along the lines of, “What do you think people think when they hear that type of comment?” or “what message do you think such a comment sends?”.

Own your response: Share your thoughts and feelings around the impact. Start the conversations by addressing the impacts of the microaggression. “That comment can perpetuate negative stereotypes and assumptions about…”. Take note of your delivery as well. It can be easy to get angry and upset, and your feelings are definitely valid. However, try to use some emotional intelligence here and don’t allow your emotions to overshadow the educational moment this needs to be for the offender.

Next steps: Request appropriate action be taken. State what you want to happen moving forward (ex. “I’d like you to stop making those kinds of comments because…”) and check in with the target of the microaggression if you were a bystander. If you  yourself were targeted, continue to build your network of mentors who you can go to in times such as this, remind yourself that you have value, and practice self-care.

Ganote, C., Cheung, F., & Souza, T. (2016). Micro-aggressions, micro-resistance, and ally development in the academy.

Desmond-Harris, Jenée. “What Exactly Is a Microaggression?” Vox, Vox, 16 Feb. 2015, www.vox.com/2015/2/16/8031073/what-are-microaggressions.

Ganote, Cynthia, et al. “Microresistance and Ally Development: Powerful Antidotes to Microaggressions.” University of Nebraska Omaha, 2016, www.unomaha.edu/faculty-support/teaching-excellence/microaggressions.php.

“Microaggressions in Medicine.” School of Medicine, som.georgetown.edu/diversityandinclusion/microaggressions/.

Wilcox, Lindsay. “How to Deal with Microaggression in Healthcare.” RNnetwork, 18 Sept. 2019, rnnetwork.com/blog/microaggression-in-healthcare/.​