Microaggressions in Medicine

Brittany Feaster, MHS; Lynn McKinley-Grant, MD, MA; Amy J. McMichael, MD

Disclosures

Cutis. 2021;107(5):235-237. 

In This Article

What are the Effects of Microaggressions?

Although microaggressions may be unconscious and unintentional by the offender, the negative ramifications are notable. Recent studies report that women and under-represented minority (URM) medical students, residents, and physicians experience microaggressions and implicit bias at a higher prevalence and frequency compared with their male and non-URM counterparts.[7,9] Repetitive microaggressions are harmful to the health and safety of women and URM medical students, residents, physicians, other providers, and patients. The Table provides example scenarios of microaggressions in medicine categorized according to Berk.[10]

Microaggressions negatively impact physical, mental, and emotional well-being. Current data support that medical students and residents who experience microaggressions are more likely to report associated symptoms of burnout, depression, and suicidal thoughts.[11,12] Subjection to persistent bias can lead to minority status stress and racial battle fatigue, creating feelings of invisibility, isolation, exclusion, and loneliness for those impacted.[13,14]

Consequences of Microaggressions in Medicine
Example scenarios in medicine Berk's law: consequences of microaggressions10
Exclusion from a monthly meeting of colleagues with superior or department chair Creating feelings of isolation, exclusion, loneliness, and tokenism
No administrative assistance while other colleagues have assistance Lowering the individual's work productivity and problem-solving abilities
Repeatedly not having a resident or medical student assigned to you Devaluing the individual's research, scholarship, and teaching contributions
Being asked to provide more letters of recommendation than other colleagues; assuming a female or URM physician is a nurse or maintenance worker Undermining and questioning the individual's qualifications and credentials
Being labeled as disrespectful by staff or superiors for not using "ma'am" or "sir" when speaking to patients Subjecting the individual to biased and unfair reviews for performance appraisal, tenure, merit pay, and awards
Being told that only 1 person can apply for a grant and that another faculty member has already been selected Excluding the individual from grants, research projects, team teaching, mentoring, guest lectures, and professional conferences
Being singled out for comments or asked to lead by colleagues or superiors whenever issues concerning race or diversity arise; given excess responsibilities on department and university committees for diversity Committing the individual to excess service on diversity, task force, department, and university committees as the face of diversity
Having a suggestion not recognized when presented at a meeting with colleagues but acknowledged when presented a few minutes later by male or non-URM colleague Resulting in feelings of being ignored, overlooked, unappreciated, underrespected, undercompensated, overworked, misrepresented, and devalued
Faculty, residents, medical students, and physicians experience burnout, depression, and PTSD due to repeatedly experiencing and witnessing microaggressions in the academic setting and workplace Producing physical and mental health problems, such as depression, frustration, anger, rage, low self-esteem, stress, PTSD, anxiety, substantial weight gain, high blood pressure, and cardiovascular disease
Staring or not turning around to speak when a woman or URM provider walks into the office; overhearing a receptionist say to a patient, "I want to warn you, she is Black" Creating an unwelcome, hostile, and invalidating climate that is alienating, stressful, polarized, and risky
Abbreviations: URM, underrepresented minority; PTSD, posttraumatic stress disorder.

In the book Black Man in a White Coat: A Doctor's Reflections on Race and Medicine, Damon Tweedy, MD, reflects on race in medicine. Tweedy notes his experience as a medical student when a professor mistakenly assumed he was a maintenance worker in the classroom. Tweedy describes how he internalized the exchange and, despite his success throughout the course of his medical training, combatted feelings of anxiety, self-doubt, and implied inferiority.[15]

Although microaggressions are harmful to one's health, they also undermine the learning and teaching experience for students, residents, and faculty, and they detract from the larger goal of providing care for patients.[11] Frequent devaluing and questioning of an individual's contributions, qualifications, and credentials based on identity can lower productivity and problem-solving abilities. These behaviors cultivate an unwelcome and hostile work/learning environment that is stressful and polarizing for the recipient.

Despite the heavy burden of microaggressions, most students, residents, and faculty physicians do not report incidents to their institutions and feel that training, resources, and policies to respond to bias adequately are lacking.[7] As a result of implicit bias and microaggressions, women and URM medical students and providers are unable to focus solely on the practice of medicine. They are tasked with the additional burden of shouldering the emotional and cognitive complexities that microaggressions produce.[16]

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