July 19, 2021

Microaggressions: How to deflect unwelcome commentary and stay focused on patient care

Bruce Peyser, MD, FACP
Director of Education and Teaching, Duke Primary and Urgent Care
Provider, Duke Primary Care Pickett Road

Professor of Medicine, Duke University School of Medicine

I recently read a valuable article online from Medical Teacher, a journal published in England that I access through Duke University Medical Center Library. My favorite teaching articles usually are found in the journal’s “Twelve Tips” series. The particular article that resonated with me was written about microaggressions, overt discrimination, and instances when patients or their families might offend a learner. Here’s the link to the article: “Twelve tips for responding to microaggressions and overt discrimination: When the patient offends the learner” by Daniel Wheeler et al. in Medical Teacher.

Originally, I thought these unpleasant events happen infrequently to our learners, but in fact, that is not the case. It turns out almost every trainee has experienced at least one form of harassment or discrimination during their education. Not surprisingly, microaggressions significantly affect our trainees and can lead to burnout, self-doubt, and moral distress.

Patients and families are the sources of many of the inappropriate and/or discriminatory comments shared with learners. These microaggressions can tend to disproportionately affect learners from underrepresented minority groups, which can include those related to race, ethnicity, gender, and sexual orientation.

The authors encourage teachers to create a communication toolkit so that they can react quickly to situations that might arise. It’s especially helpful to rehearse some responses, and the authors present very helpful tips that can be used dependent upon the given circumstance that arises.

When I first thought about highlighting the microaggressions article, I planned to interview some of my previous students to ask about their experiences. But then I reflected upon my own experiences, and I can recall times when patients or families have made inappropriate comments to me. I have not appreciated when my ethnicity, my two to three pounds of weight gain, my greying hair, or some other smallish item was the focus of their attention. Unpleasant comments happen, and it takes practice to learn how to deflect unwelcome commentary and stay focused on our primary job, which is to take excellent care of our patients.

A very recent article in another journal focused on inappropriate comments from patients and is worth a review as well: “Discriminatory and sexually inappropriate remarks from patients and their challenge to professionalism” by David Alfandre et al. in American Journal of Medicine.

I hope to discuss this topic in more detail at our next faculty development session, which will take place Wednesday morning, April 8 at Duke Integrative Medicine in Durham. (You can sign up now with Kelly Trousdale.)

In closing, be aware of this problem with microaggressions, and think about how you might address it when it affects either your learner, your colleague, or yourself. Knowing how to assess the situation is key, as is being aware that a private debrief with a trainee is so important afterward.