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