May 2023

By: Jubilee Ahazie & Robert Trevino, MD

Microaggressions transcend socioeconomic boundaries and inflict pain in everyday life. While it’s broadly defined as “a comment or action that subtly and often unconsciously or unintentionally expresses a prejudiced attitude toward a member of a marginalized group” from Merriam-Webster Dictionary, it was first coined by Dr. Chester M. Pierce, a psychiatrist explaining negative commentary and actions directed towards Black people by non-Black people. 

It’s important to understand that various marginalized groups may experience microaggressions. While it is common to focus on racially motivated microaggressions, they can materialize in many shapes and forms, even in the healthcare sector. They can exist in different forms, such as microassaults, microinsults, and microinvalidations.

From my viewpoint as a Black, Nigerian-American woman (JA), I provide below examples of microaggressions that pertain to race, gender, and national origin. Again, I emphasize that these categories are intersectional, and thus one individual may experience microaggressions from each of these perspectives.

On the basis of race, an example that a Black healthcare worker may experience is that they are too loud or that their natural hair is “unprofessional.” People sometimes feel emboldened to even touch the hair of Black healthcare workers without their consent.

Based on gender, female healthcare workers may be automatically assumed to be nurses when they could be surgeons, oncologists, etc. The inverse can be said for men – automatically assumed to be physicians rather than nurses because of the bias that being a nurse is a woman’s job.

On the basis of national origin, immigrants may experience microaggressions about how they speak–either the accents they may have or for making grammatical mistakes while speaking English. The reverse can also be true–an immigrant healthcare worker may also hear a comment such as, “You speak so well for people like you.” This one has been personally directed at me (JA).

Although microaggressions may be deemed “subtle” or “unintentional”, the impact of these comments and actions can be felt deeply and can even negatively influence a person’s health. Specifically, it has been studied that microaggressions can lead to “high blood pressure, depression, sleeping problems, substance use disorders, eating disorders and post-traumatic stress disorder.” For this reason, it is essential to know how to notice and define microaggressions and take action if you experience it or see it happening around you in the workplace.

There are many examples and frameworks for responding to microaggressions, either as the individual experiencing them or as a witness or ally to the offenses. We share one framework, so you may explore others that suit your communication style. Also, you may recognize that different frameworks work for various aspects of your life. For example, in this framework from Harvard Business Review, regardless of whether you are the one experiencing microaggressions or are the bystander, you need to first recognize how you might react: let it go, respond immediately, or respond later. These each have their own emotional and potentially professional impact, but it is an individual decision on how to react. If you choose to respond, here is a framework to help navigate the conversation. Remember, you are not responsible for their feelings in this conversation, but your tone and approach can have an impact.

Discern: determine the level of investment you want, which includes considering the importance of the issue, your relationship with the party, your feelings, & how you want to be perceived

Disarm: you need to be ready as it may be uncomfortable for both you and the individual as sometimes people become defensive

Defy: challenge the individual to clarify their statement with questions like “what do you mean” as this allows individuals to reassess their statement for themselves

Decide: you control what this means for your life and work, including what you take away

Additionally, this resource from Women in Engineering through the University of Illinois offers other statements that could be used to navigate the conversation when addressing microaggressions. 

In health care, we recognize that microaggressions may come from your clinical colleagues or patients and their families. While we need to respect personal boundaries and possible clinical relationships, the impact of microaggressions can take a toll. Institutions often have outlets for sharing both macro and microaggressions.