Microaggressions in Medicine

By Fisayo Aruleba, Medical Student (University of Alberta)

Read time: 3 minutes

At 16, I held a job as a retail associate in a clothing store. I was the only Black employee and as a result, every Black shopper that walked in was directed towards me. I was provided with rationalizations such as “I don’t understand their accent,” “they never spend money” or “they’re always returning things,” “they can be very loud and sometimes rude,” or my personal favourite: “Black people sometimes have a weird smell.”  Many of these comments were made by my supervisor. The same supervisor would ‘praise’ me by saying that I was “not intimidating or ghetto like other Black women.” I would be reprimanded by her for looking “wild and unprofessional” when I wore my natural hair out, all while she felt entitled to massage it without consent.

These incidents are not isolated and, for many folks from marginalized communities, receiving remarks like these is commonplace. Most of the time, perpetrators are unaware of the impact of their words or actions on the recipients. The intent is not usually to cause offense or pain. But regardless of intention, these instances of “microaggressions” have very real effects on people’s lives and psyche.

What are microaggressions?

Microaggressions are defined as “everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership”¹. They have been ubiquitous in my daily life, and as a student excited to enter medical school, I had naively hoped these pointed moments would occur less. Instead, they continued, taking on both familiar and new forms in my medical training.

There isn’t enough room on the page to list all of the microaggressions I’ve experienced, but here are some ways in which they have manifested:

• Having to correct my preceptor five times on the pronunciation of my name within the span of a two-hour group discussion—even with the phonetic spelling displayed on my Zoom ID
• Being in a small group session with one of my only two Black classmates and constantly being referred to by one another’s name—even though we shared no similarities in appearance or personality
• Always having questions related to race directed at me
• Being told all about the corruption and poverty my classmates apparently saw during their (one and only) trip to an unrelated African country after mentioning that I am from Nigeria
• Being commended on the way I speak English with almost no trace of an “accent” for someone who wasn’t born here
• Being constantly asked if I plan to go “back to my country” to practise medicine, as if this is not my country

These occurred just in my first year of medical school—in spaces where students and instructors should have a special duty to ensure everyone is respected. At first, these microaggressions may seem trivial, but the repeated interactions day after day have cumulative effects. Over time, they can wear you down, affect your interactions with others, and change your perception of the world. They reinforce the historical and societal perception of being seen as “less than” and highlight differences in power and privilege, further contributing to the feeling of being “othered.”

What can we do?

Although it may be uncomfortable, we as physicians have the responsibility to recognize, understand and address microaggressions. This process starts with doing reflective work to honestly examine our own routine practices. Taking time to critically self-reflect and acknowledge our biases in order to see the ways in which we all commit microaggressions is an essential first step to unlearning and changing our behaviours.

However, simply acknowledging the existence of microaggressions and becoming aware of how these subtle injustices are committed is not enough. A critical second step is to take sustained action to actively dismantle the culture of silence and complacency prevalent in the medical community. In this uphill battle for change, we must champion a community of safety and inclusivity that does not tolerate overt or covert forms of discrimination. I want to speak with passion and energy without being labelled as angry. I want educators and colleagues to address me by my name, rather than not acknowledging me at all.

Until such time, it is imperative that we broaden the dialogue to recognize all subtle forms microaggressions can take, and the resulting indignities affecting the livelihoods of those on the receiving end. While doing so, we must also avoid placing the extra burden on affected individuals to spend uncompensated time being advocates and educators.

In taking the oath to do no harm, we as medical practitioners must prioritize the creation of an environment where perpetuating discrimination—however subtle—is not acceptable.

References

¹ Microaggressions: More Than Just Race. Available: https://www.psychologytoday.com/ca/blog/microaggressions-in-everyday-life/201010/racial-microaggressions-in-everyday-life (accessed 2021 Jul 13)

Fisayo Aruleba is a medical student attending the University of Alberta and a member of the U of A Black Medical Students’ Association. In 2021, Fisayo was a Summer Medical Student at CPSA, working closely with both the Physician Health Monitoring and Accreditation departments.