“I thought you were African,” said the attending physician to Dr. Amira Mohamed when he called on her to ‘interpret’ for a patient who was from Senegal and she was unable to (she is Sudanese). Dr. Mohamed has also been told many times that she ‘does not sound African.’
These are microaggressions – the everyday, subtle (and often not so subtle), verbal and nonverbal actions directed at underrepresented and marginalized groups.
The term was first coined by the Harvard University psychiatrist Dr. Chester Pierce in the 1970s to describe the regular insults and putdowns he saw non-Black individuals using against Black individuals. This was solidified into public consciousness by Dr. Derald Wing Sue, a professor of psychology and education at Columbia University, nearly four decades later, who, with a team of social scientists, studied microaggressions and how they also affect religious groups, gender identities, those living with disabilities, and the LGBTQ+ community.
In addition to what Dr. Mohamed experienced, an example of a microaggression is when a doctor of a different race or ethnicity is told that they speak English well (a form of microaggression known as a microinsult), the presumption being that they were not born in the U.S.
Though “micro” is part of the word, microaggressions have macro effects. Certainly, where the common refrain, “Don’t sweat the small stuff,” does not apply. Ask Dr. Alyson Myers. “I was told that I could take a food tray when doing rounds on hospitalized patients. When I identified myself as a physician, the patient did not even apologize; this is something I doubt a white physician has been asked,” says Dr. Myers. “It’s one of many things coming at you – from clinician colleagues to patients – that pile up over time and it wears you down. Those of us who are physicians of color have experienced microaggressions from childhood through medical school and well into our careers as doctors.”
It's exclusionary. It’s demoralizing. It’s exhausting.
And it can also be difficult to confront, especially among young doctors who may be concerned about its effects on their careers – and that they will be labeled “difficult.”
Among some medical students, an experienced microaggression is credential-questioning – the assumption that they were only accepted to medical school because of affirmative action or quota (a microinsult). It’s devaluing and stressful and it affects learning.
Doctors from other countries practicing in the U.S. experience the microaggression of being perceived as less competent than their U.S. counterparts (a microinvalidation).
There is no shortage of examples of microaggressions based on race, gender, sexual orientation, religion, or ableism.
Types of Microaggressions
Microassaults: a deliberate, derogatory, verbal or nonverbal action. Examples include clutching a handbag when around darker skinned individuals, telling a racist joke, posting offensive content, or using racial epithets.
Microinsults: are subtle, insensitive, disrespectful snubs. For example, a white person who says that they don’t see color or a colleague with workplace privilege asking an employee of color how they got their job (the underlying assumption being that they only were hired as a result of a minority hiring action for which they would otherwise be unqualified). Another example is a backhanded compliment of telling a person from a marginalized group that they are articulate, calling a woman “honey or girl” in a professional setting, or telling a person of a different ethnicity raised in the U.S. that they speak English well.
Microinvalidations: are actions that exclude, diminish, or discount the experiences of others. Examples include deliberately not using a transgender person’s preferred pronouns, mixing up people of the same race, speaking over a woman or other marginalized individual in meetings.
So how should microaggressions be dealt with in the workplace (and everywhere else)? “It’s frustrating that the onus is often on us to teach our colleagues about what microaggressions are and how people can address their implicit biases,” says Dr. Mohamed.
It’s incumbent on all of us to educate ourselves.
As an Ally
- Do your homework (e.g., read books, blogs, and listen to podcasts about a historically marginalized person’s experiences).
- Learn about the different types of microaggressions and call them out (see below).
- Recognize your everyday behaviors, biases, and prejudices.
- Speak up when you witness microaggressions in the workplace.
- Be open to feedback without becoming defensive when a colleague confronts you about an action you have taken (acknowledge their distress, don’t minimize their concerns, take the conversation seriously).
- Be cognizant of the language you use. The CDC offers this helpful resource, Preferred Terms for Select Population Groups & Communities.
Interrupting Microaggressions
There are several ways to interrupt microaggressions in several settings. For example:
- When asked: “Where are you from?” the response could be “I’m just curious. What makes you ask that?”
- When someone says that everyone can achieve success in society through hard work, you can ask the person to provide examples.
- For a woman who is talked over, she can respond that she would like to finish her thought. An ally could say that they want to hear what their female colleague has to say.
- When someone says, “When I look at you, I don’t see color,” ask them to explain their perspective.
Please see more examples of tools to employ to interrupt microaggressions.
Additional resources:
MedEdPORTAL: The AAMC Journal of Teaching and Learning Resources. Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students, Rhonda Graves Acholonu, MD; Tiffany E. Cook; Robert O. Roswell, MD; and Richard E. Greene, MD, MHPE. July 31, 2020.
American Psychologist. Racial Microaggressions in Everyday Life: Implications for Clinical Practice, Derald Wing Sue; Christina M Capodilupo; Gina C Torino; Jennifer M Bucceri; Aisha M B Holder; Kevin L Nadal; and Marta Esquilin. May-June 2007.
JAMA Surgery. Recognizing and Reacting to Microaggressions in Medicine and Surgery, Madeline B. Torres, MD; Arghavan Salles, MD, PhD; and Amalia Cochran, MD; July 10, 2017.
The Commonwealth Fund. Confronting Racism in Healthcare: Moving from Proclamation to New Practices, Martha Hostetter and Sarah Klein (authors).
Medical Care. Addressing Structural Racism in the Health Workforce, Randl B. Dent, PhD; Anushree Vichare, MBBS, MPH, PhD; and Jaileessa Casimir, BS. October 2021.
Posted on: Friday, May 05, 2023
