Research In Action

Research In Action

healthcare
Addressing Microaggressions in Healthcare: Lessons From Intervention Studies
Share  
By Rui Fu and Stephen Leff
  • Santiago, a Hispanic patient, is described by his doctor: “You're so well-behaved for a child your age.” 
  • Aria, a pulmonary physician of Chinese heritage, is asked by her patient: "Do you really eat cats and dogs?"
  • Jamal, a Black physician fellow (trainee), is described by his supervising physician: “Wow, you did that really well for someone of your background.” 

These are just a few common examples of uncomfortable interactions, identified as microaggressions, occurring among patients and healthcare providers. Microaggressions are those verbal, behavioral, and environmental indignities, intentional or unintentional, that communicate hostile, derogatory, or harmful slights and insults directed toward individuals of marginalized backgrounds. Despite their intentions, microaggressions perpetrated by healthcare professionals undermine patients’ trust in providers and the healthcare system, reducing treatment adherence and increasing risks for physical and mental health issues (e.g., hypertension, cardiac disease, depression). On the other hand, patient-perpetrated microaggressions can lead to emotional exhaustion, burnout, and suicidal ideation among providers, especially racial-ethnic minorities and early-career professionals. For minoritized trainees, repeated microaggressions by preceptors (teaching or supervising physicians) can undermine confidence, productivity, and retention in the field. 

Microaggressions in healthcare have been found to impact approximately 30% to 50% of patients, 30% to 80% of professionals, and 54% to 80% of trainees. Considering the prevalence and impact of healthcare-based microaggressions, our team recently published a review of the existing microaggression-focused interventions and programs in healthcare settings over the past two decades. Over 40 interventions (i.e., trials, evaluations), training programs (i.e., curricular, workshops, activities), and standalone tools (hereafter interventions) were identified and evaluated by different program characteristics and quality indicators. 

Opportunities for Expanding Intervention Strategies 

We identified various opportunities for improvements in program targets and disciplines: 

  • Healthcare providers were the exclusive target of the patient-provider interventions and programs. This suggests a missed yet important opportunity for interventions to empower patients who are victims of microaggressions by teaching them strategies for improving communication and collaboration with healthcare professionals. 
  • Trainees were the primary audience of the preceptor-trainee focused interventions. More programs or tools developed for and implemented among preceptors would provide timely training on recognition of their inadvertent acts of discrimination. 
  • Interventions were predominantly associated with physical health-related rather than mental health-related disciplines. Considering the strong association between microaggressions and mental health problems, implementing microaggression interventions among mental health providers and patients with mental disorders is needed.

Intervention Effectiveness and Strategies 

Over 60% of the identified interventions reported significantly improving participants’ recognition and understanding of microaggressions or their confidence in how to respond to microaggressions. Yet, the majority of the interventions did not employ a randomized controlled trial design which compromised the credibility of the established causality in the studies. Most of the interventions aimed to build awareness of the harm of microaggressions and to teach behavioral strategies for responding to microaggressions. The two most frequently used strategies were 4Ds/5Ds (Direct, Delegate, Distract, Delay, & Display Discomfort) and Open The Front Door (Observe, Think, Feel, Desire)/ OWTFD (Observe/Why?/Think/Feel/Desire). Both sets of strategies reflect a mix of approaches: confronting the source of microaggressions (“calling-in") and inviting them to reevaluate their actions (“calling-out”). 

Implications for Healthcare Settings 

Here are some key implications for clinicians and policymakers in addressing microaggressions within healthcare settings: 

  • Integrating microaggression training into clinical practice can help providers become more culturally competent and aware of their own biases when interacting with patients and colleagues. 
  • Since patients commit of microaggressions, effective interventions and training are necessary to help providers appropriately address and manage such behaviors and patients/guardians recognize when their behaviors represent microaggressions. 
  • Interventions should increasingly focus on supporting individuals who commit microaggressions. 
  • Healthcare leaders should leverage their power and privilege to set clear policies and procedures for addressing microaggressions. 

Below are links to additional reading about microaggressions, particularly in healthcare settings: