Psychologists are teaching health care teams to identify and address microaggressions

As public awareness of systemic racism has intensified since the murder of George Floyd in 2020, psychologists are seeing increased openness in clinical care teams to learn about microaggressions—subtle statements, actions, or incidents that are unintentional or intentional forms of discrimination against members of a marginalized group.

Microaggressions are common in health care and can cause team members to feel less valuable and less inclined to share clinical input. Many do not feel comfortable expressing concerns about slights related to race, sexual orientation, socioeconomic status, or gender. That, in turn, can harm patient care. “Important clinical information can be lost when team members feel degraded and uncomfortable interacting with colleagues and patients,” said Veronica Shead, PhD, a clinical psychologist in the VA St. Louis Healthcare System who conducts team trainings on microaggressions.

By leading discussions about different types of microaggressions, the impact on patients and team members, and how to address the incidents, psychologists are pioneering culture change in health care systems. “Microaggression education is not focused on dismantling systems but improving them,” Shead said. “And providers want to feel equipped to deliver the best care possible.”

While taking time for microaggression training may seem difficult in a hospital’s fast-paced environment, research suggests that delaying these discussions can have significant effects on patients and providers. According to one review paper, studies conducted from 2007 to 2020 showed that microaggressions in the United States and Canada were associated with anxiety, depressive symptoms, low self-esteem, and suicidal ideation (Spanierman, L. B., et al., Perspectives on Psychological Science, Vol. 16, No. 5, 2021). “If patients are coming to treatment for an ailment and they experience a subtle microaggression, this could compound the presenting problem,” said Lisa Spanierman, PhD, a professor of counseling and counseling psychology at Arizona State University who studies microaggressions. In the studies, microaggressions were also linked to back pain, hypertension, insomnia, and stomachaches among targets of the discrimination.

For health care providers, studies suggest that workplace mistreatment such as discrimination increases the risk of burnout and suicidality (Ehie, O., et al., Current Opinion in Anesthesiology, Vol. 34, No. 2, 2021). One study of more than 7,000 surgery residents showed that roughly one-third reported discrimination based on their self-identified gender and 16% reported racial discrimination (Hu, Y., et al., The New England Journal of Medicine, Vol. 381, No. 18, 2019). Factors such as depression, job dissatisfaction, and physician burnout have been associated with suboptimal care practices, including medical errors.

While much of the literature on microaggression intervention focuses on helping the target respond, this sends a message that the target is solely responsible for addressing harmful behavior, said Roxanne Upah-Crenshaw, PhD, a clinical psychologist in the VA Greater Los Angeles Healthcare System who provides training related to microaggressions throughout the Veterans Affairs (VA) system.

“This can create heaviness and stress for targets, which can lead to burnout,” she said. “This ultimately affects productivity and staffing turnover.” By teaching a team about microaggressions, colleagues who witness the incidents learn to support patients or team members who are targets. Discussions about these subtle forms of discrimination are often eye-opening for team members, and the benefits have a positive ripple effect on the work environment, patient satisfaction, and the quality of care.