Take Action, Stand Up Toolkit
In order to improve culture and climate, patients, staff, physicians, and learners must all feel safe in the workplace. Often, it is not overt instances of bias and discrimination that undercut feelings of safety and inclusion, but rather it is the small, daily microaggressions. Microaggressions are brief and mundane verbal, environmental, or behavioral slights that communicate bias, hostility, and/or prejudice toward any group. They treat people not as individuals, but as a stereotyped identity. Microaggressions diminish confidence, reduce productivity, and contribute to burnout.
Examples of microaggressions include:
“There have been patients who have said ‘I would be full code if you are doing mouth to mouth’ and attendings that just laugh because they are not sure what to say.”
“During outpatient clinic my preceptor asked if it was ok for her to sit in during the visit and the patient said 'ok, on my lap'—I’m not sure what to do in that moment.”
“When I was an R2 working with a new R1 who was not white and I walked in and the patient said ‘finally an American doctor’ and I didn’t know what to say.”
“One question I am asked frequently is, ‘Where are you from,’ and when I answer New York City, then getting the follow-up question, ‘No, but where were you born?’ When I answer, New York City, then being asked, ‘Where are your parents from?’ When I say China and Taiwan, then getting the response, ‘Yes, I thought you were Chinese,’ or a similar response as if that solved the ‘issue.’”
- Professional Undercutting
“The one that stands out is coming in and introducing yourself as the doctor and the patient says on the phone ‘I have to go the nurse is here,’ and then the nurse calls later and the patient was upset that no doctor had seen the patient.”
“Another microaggression I have experienced is being called, as if by default, by my first name in front of patients, with one person even telling a group of people outright in front of me, ‘I don't call anyone who was in training here, Doctor.’ The fact is, though, that even during our training in residency and fellowship, we had already graduated medical school and so are doctors.”
As the above testimonials demonstrate, microaggressions often catch the target off-guard. Without tools to respond to microaggressions and/or bias, many people freeze or attempt to minimize the incident. The person targeted is also put in a vulnerable position and may feel threatened if they do respond. In these instances, witnesses of the event, or bystanders, can step in and address the harm caused. This card offers strategies for doing just that.
Download and Print Microaggressions Cue Card (PDF)
- “Eliminating Microaggressions: The Next Level of Inclusion:” https://www.youtube.com/watch?v=cPqVit6TJjw
- “Addressing Microaggressions in Racially Charged Patient-Provider Interactions: A Pilot Randomized Trial:” https://rochester.primo.exlibrisgroup.com/permalink/01ROCH_INST/173n3b8/cdi_doaj_primary_oai_doaj_org_article_4ce329c228f0414e845e551facca9b55
- “The GRIT (Gather, Restate, Inquire, Talk It Out) Framework for Addressing Microaggressions:”10.1001/jamasurg.2019.4427
- “Recognizing and Reacting to Microaggressions in Medicine and Surgery:” 10.1001/jamasurg.2019.1648
Acts of discrimination, violence, harassment, and hate unfortunately occur on a daily basis in hospital settings. These events are traumatic, but that trauma is compounded for the target when others witness the attack and do not react. For example, imagine being groped by a patient in a room with colleagues who witness the act, but stay silent and do nothing.
Oftentimes, bystanders fail to intervene because they do not know what to do or say. This bystander intervention cue card addresses this knowledge gap by offering strategies for (safely) taking action.
Download and Print Bystander Cue Card (PDF)
We are all responsible for the safety and wellbeing of our community. We all have the power to take action.