There’s Nothing 'Micro' About the Impact of Microaggressions


August 12, 2019
by Katie Smith

What is a microaggression?

A white woman walking home crosses to the other side of the street as she approaches a black man. A physician assumes that a person who appears to be homeless and says she is in pain is seeking narcotics. A professor compliments an Asian American medical student’s perfect English, even though it’s his first language. These are microaggressions: small acts of prejudice that insidiously reveal the speaker’s bias and impact the lives, careers and health of the recipients.

“Microaggressions are seemingly harmless to outsiders because of the assumptions we make,” says La-Rhonda Harmon, PsyD ’18, who specializes in curriculum development and workplace training in social service settings. “In school or the workplace, microaggressions are dangerous because they marginalize and ultimately underutilize talent, impair recruitment and retention, erode an individual’s performance, stifle innovation and growth, inhibit teamwork and collaboration, and adversely affect business growth.”

Columbia University psychologists define microaggressions as “brief and commonplace daily verbal, behavioral or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory or negative slights and insults.” In contrast to overt racism, microaggressions are smaller, baked into daily conversation and often passed by without notice or bystander intervention.

Do microaggressions happen in health care?

While many microaggressions in healthcare settings are similar to those experienced in every part of life, the power dynamics are drastically different for patients.

“Healthcare microaggressions occur when clinicians make unfair judgments and assumptions about individuals from minority groups,” says Dr. Harmon. “Invariably, these experiences compromise patient-centered care and inhibit the potential for mutually respectful patient-clinician relationships.”

Dr. Harmon offers as an example a clinician who berates a patient for noncompliance without acknowledging systemic factors such as financial or familial stressors. In response, the patient feels judged and may avoid future treatment. “It is imperative for healthcare settings to provide ongoing cultural competence training and supervision to improve patient engagement and healthcare outcomes for individuals from minority groups,” she adds.

  • A study from the University of Washington’s Surgical Outcomes Research Center found six common microaggressions reported in healthcare settings: mistaken identity, mistaken relationships, fixed forms, entitled examiner, pervasive stereotypes and intersectionality. Read more.
  • Of the 150 American Indian patients surveyed by the University of Minnesota, over 36 percent reported experiencing microaggressions in health clinics. Read more.
  • A study from the University of Colorado Boulder finds that “clinicians’ implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, clinician bias may contribute to health disparities.” Read more.
  • A 2014 study in the American Journal of Preventive Medicine found that racial microaggressions accelerate aging at the cellular level. Read more.
  • In 2015, researchers from the University of Tennessee “found that microaggressions can trigger intrusive memories of traumatic racially related incidents. This supports that for some, microaggressions are experienced as traumatic events, which is of serious concern. Many of the same principles used to care for survivors of abusive trauma might be adapted to explore and intervene on effects of racial microaggressions, referred to as trauma-informed care.” Read more.

What can healthcare providers do?

In response to evidence indicating that negative relationships between patient and provider lead to adverse health outcomes, there has been a push toward culturally competent care that places the patient at the center. Service providers are encouraged to see “through the patient's’ eyes.” Hallmarks of culturally competent, patient-centered care include services that meet patient needs and preferences; healthcare facilities that are convenient to the community; documents that are tailored to patient needs, literacy and language; and data on performance available to consumers.

Ven diagram of patient-centered care and cultural competence


Taking action

The A.C.T.I.O.N. Method by Cheung, Ganote and Souza (2016) suggests that microaggressions be addressed in six steps:

  1. Ask clarifying questions.
  2. Carefully listen.
  3. Tell others what you observed that was problematic.
  4. Impact consideration for yourself or potential others.
  5. Own your response.
  6. Next steps.

What is the impact of microaggressions?

A 2013 article in the Journal of LGBT Youth called microaggressions “death by a thousand cuts.” One discriminatory experience is horrible. How can you measure several, every day, over the course of an entire life? For some, the impact can be deadly.

  • Research suggests that experiencing microaggressions leads to elevated levels of depression and trauma. Read more.
  • A study of 405 young adults of color links microaggressions to suicide risk. Read more.