Implicit Bias and Microaggressions in Medicine

microaggressions in medicine

Though they practice in different cities and clinical areas, Dr. Fatima Cody Stanford and Dr. Tamika Cross have four things in common. First, among the 5% of American doctors who are African American, Stanford and Cross are among 2% of America’s Black women doctors. Second, in 2018, both physicians participated in a Massachusetts Medical Society panel about gender and bias in medicine. Third, in two separate incidences and two years apart, Stanford and Cross were passengers on a domestic airline flight where they each tried to help another passenger in distress. In an apparent act of racial and gender bias, flight attendants questioned both physicians’ medical credentials. 

Dr. Stanford and Dr. Cross are not alone. In an August 2020 New York Times article on microaggressions in medicine, more than a dozen of the physicians interviewed said that their credibility and authority are often questioned by the public, colleagues, patients, or patients’ families. In the article, Dr. Onyeka Otugo, an emergency medicine attending physician, reports: “They ask you if you’re coming in to take the trash out — stuff they wouldn’t ask a physician who was a white male.”  

Microaggressions in Medical and Dental Practices: Definition and Scope

The term “microaggressions” was invented in the 1970s by Chester Pierce, the first African-American psychiatrist to join the faculty of the Harvard Medical School. Unlike acts of overt discrimination or prejudicial treatment,  microaggressions are subtle, stunning, often automatic, and nonverbal exchanges which are ‘put downs’” of someone who belongs to a different socioeconomic, religious, racial, religious, ethnic, gender, or sexual orientation group than our own.    

 “Ask anyone about their bias and very few will admit to it,” says Stacey Gordon, MBA, a diversity, inclusion, and career strategist who consults with companies to recruit, hire, and engage women and professionals of color. 

Victims and perpetrators of unconscious bias and microaggressions in medicine include providers, patients, and patients’ caregivers or families. 

For example, in a University of  Albany School of Public Health study, many physicians and nurses anonymously self-reported their belief that Black and low-income patients were less intelligent, more likely to engage in risky health behaviors and less likely to adhere to after care plans. 

Meanwhile, during a cultural competency training for pre-clinical medical and dental students, 77% of the learners had witnessed or experienced microaggressions in medicine, and those who identified as female reported a higher incidence than their male counterparts.  

One study of first-year medical residents found that, among nearly 400 respondents, 93% had experienced “disruptive behavior” (from patients or their families), including abusive language, and overt gender or racial bias. 

Whoever is the source or target, there’s nothing “micro” about the fallout or impact of microaggressions in medicine. 

Among the Black women physicians interviewed for the August 2020 New York Times article, many reported diminished self-confidence, a sense of isolation in the workplace, fear, stress, and burnout which, in turn, can impact patient care. 

Patient care (and the related health disparities) are also impacted by provider-patient bias, as documented in the University of Albany studies and other findings. Many African Americans, Latinos and Asian American patients believe that they would receive better healthcare if they were of a different race or ethnicity.

Looking Within: What Are Your Unconscious Biases? 

Many medical institutions, including the Liaison Committee on Medical Education and the American Association of Medical Colleges, have expanded their cultural competency curricula to include modules in which clinicians or medical students self-reflect on their unconscious biases and how those biases impact their care delivery.  

While this is promising, experts posit that true cultural competency is a lifelong process of self-awareness, skill building, humility and education.  

So in addition to your formal medical trainings, you can consistently build your own self-awareness and cultural competency. 

Looking Within: 5 Steps to Examine Your Implicit Biases  

  1. Implicit Bias Test: Take the Harvard University’s Implicit Bias Test to assess your beliefs and attitudes about race, gender, sexual orientation and other topics.
  2. Workplace Behavior: In her no-cost online training on unconscious bias, diversity expert Stacey Gordon explains how our unconscious biases and thoughts can drive our workplace behavior. A mindfulness practice such as meditation or expressive writing can help us to analyze our daily or situational reactions and, if needed, to self-correct our thinking and behavior.
  3. Language use: Listen to and check your own language use, particularly in describing certain patient groups. The ADA, the Hogg Foundation for Mental Health, and the Recovery Research Institute provide free online resources on de-stigmatizing language use around disability, mental health and addiction.   
  4. White Coats for Black Lives: How does your current or target medical academic center rate in terms of equity and inclusion? Find out by visiting the White Coats for Black Lives website to download the Racial Justice Report Card.
  5. Free training: The Diversity and Resiliency Institute of El Paso offers no- and low-cost provider trainings, workshops and webinars, including modules on self-assessment and cultural humility.

Check out these 3 Steps to Deliver More Culturally Competent and Accessible Healthcare.

Áine Greaney Ellrott, M.A., is a former health communications leader and award-winning writer living in the Boston area. She has led communications initiatives for a large health system and has written features, blogs, web content, physician and clinician profiles. She has also written consumer guides on topics such as mental health, addiction treatment, integrated primary care treatment, teen health, population health, technology-supported care models, palliative medicine, psychiatry, end-of-life care, advance care planning and narrative medicine. Her bylines have appeared in The Boston Globe Magazine, The New York Times, World of Psychology, Salon, Huffington Post, KevinMD, Edutopia, WBUR/NPR, and other publications.

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