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“...but where are you really from?” : A Guide to dealing with Microaggressions in Medicine

The term microaggression has found its way into discussions about racism over the past few years. Microaggressions are behaviours that originate from implicit bias. Implicit bias stems from negative stereotypes, prejudices and assumptions about a person’s identity. Being on the receiving end of racial microaggressions is an experience that is sadly very familiar to the Black community especially within medicine; from medical school to speciality training. Microaggressions can happen in the form of backhanded compliments, non-verbal disregard of a person, questioning of credentials or behaviour, inquiries into ethnicity and racially-based generalisations.

Examples of microaggressions that may be familiar to current medical students and doctors:

  • “...but where are you really from?”

  • “You don’t look like a doctor”

  • “You don’t look like a medical student”

  • “Wow! You’re so well-spoken”

  • “How do you get your hair like that?!”

The gravity of being the subject of microaggressions should not be brushed aside as these experiences often lead to feeling demeaned, uncomfortable and powerless and result in the questioning of our self-worth. These feelings can be heightened when there has been no tangible guidance on how to deal with these matters. The medical profession holds the notion of ‘professionalism’ in high regard meaning the idea of speaking out and opposing microaggressions may be the antithesis to common working culture. As a result, those on the receiving end are often conditioned to internalise these situations which in turn allows for feelings of inferiority and imposter syndrome to fester.

We have put together our tips on how to go about challenging microaggressions within medical school and in the clinical environment.

1. Assess the situation and pick your battles

Assess the situation and pick your battles. Was the comment from a consultant midway through teaching? Perhaps it was a fellow student during placement? Or is it a patient making a passing comment whilst you try to take a history? It is important to evaluate the situation as this could determine possible outcomes that may arise from addressing the microaggression. It could lead to a student becoming newly educated on their prejudices and assumptions or it could result in a defensive response, thus inhibiting your ability to build a rapport with a colleague or patient. This is the unfortunate reality of making steps to overcome implicit biases held by those in our society. Consider the potential consequences of addressing the microaggression and decide whether it is better to deal with it at that moment or at a later, more appropriate time.

2. Dissect and disarm

Ask the person what exactly they meant by their comments. This provides them with the opportunity to explain and provide a healthy space for any misunderstandings to be cleared up. Asking for clarification also opens the door for a candid conversation in which the aggressor doesn’t feel under attack and this enables a learning experience to take place instead.

3. Remain calm

Challenging microaggressions can be a scary encounter especially if you are uncertain about what could happen after doing so. Maintaining a calm manner may help to prevent the situation from escalating negatively.

4. Look after yourself

In the situations you can't address and in the ones you do address, there will be an element of internalising and processing. Whether you can address the microaggression or not, it is natural to internalise the situation and bear the need to process any negative feelings about self and self-worth. This is why it is important to have people around you with whom you can discuss these experiences and share any stories of overcoming. Studies have found that the shared communication of experiences amongst ethnic minorities can help in the process of coping - so try to avoid managing these ordeals by yourself but speak to your community around you.

5. Tips for bystanders

The challenge of microaggressions shouldn’t just be left to those that are experiencing them, but bystanders should also take up personal responsibility to demonstrate solidarity. Bystanders should validate the experience of the person who has experienced the microaggression and if possible, speak up against the microaggression in unison with the person who has undergone the experience. This transition from being a bystander to an upstander is an exhibition of true allyship.

Opposing these implicit biases should not solely be the role of the person on the receiving end and we must acknowledge that everyone has a role to play in overcoming microaggressions - victims, perpetrators and onlookers.

Written by Oyinda Adeniyi

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