When health care professionals unintentionally do harm

The Hippocratic Oath, which is taken by physicians and implores them to ‘first, do no harm,’ is foundational in medicine (even if the nuances of the phrase are far more complex than meets the eye). Yet what happens when doctors bring about great harm to patients without even realizing it? In this article, we define microaggressions, illustrate how they can hinder the equitable delivery of healthcare, and discuss why the consequences of microaggressions are often anything but “micro”.

What are microaggressions?

Microaggressions can be defined as actions, gestures, or even environments that subtly and often unintentionally harm members of marginalized groups. Some examples include when a healthcare professional speaks slowly and loudly to an elderly patient (who is neither hard of hearing nor cognitively impaired) and when medical clinics don’t have hospital gowns or blood pressure cuffs that fit people with larger bodies (or furniture that they can comfortably use).

In response, you might think that in the first case, it’s just an honest mistake committed by a well-meaning individual; and in the second case, it’s not a big deal since it’s nobody’s fault—there’s not even a specific individual to hold responsible.

So how and why are each of these examples microaggressions? And what kind of harm do they cause?

The healthcare professional who speaks loudly and slowly to an elderly patient, based on assumptions and stereotypes about what elderly people are like, might be thinking that they are acting in a way that can benefit the patient. Their reasoning (conscious or not) might be something like this: “elderly patients tend to be hard of hearing and suffer from cognitive impairment and thus the louder and more slowly I speak, the more it will help the patient hear and understand what I’m saying.” However, this elderly patient is not hard of hearing or cognitively impaired. In fact, the loud, slow speaking lands quite differently from their perspective. It might make them feel as though the healthcare professional has not taken the time to get to know them. This can lead to the patient not feeling properly seen, heard, or understood. And this, in turn, can result in the patient not feeling comfortable around the healthcare professional and not trusting them.

With regards to medical clinics not having hospital gowns or blood pressure cuffs that fit patients with larger bodies, or furniture that can comfortably accommodate them, one might think that given the relatively small number of patients who might need to make use of these resources, the impact is relatively low. But the Hippocratic Oath and the imperative to “first, do no harm” applies to all patients—some patients should not be excluded from proper care simply because their bodies fall outside of a normative ideal of what bodies ought to look like. All patients deserve recognition, respect, and the means to receive comprehensive, high-quality care. To be denied this sends the message that one is abnormal, that they do not belong, or that they are not respected enough to be treated fairly in healthcare spaces.

How do microaggressions hinder the delivery of healthcare?

As we can see from these examples, the harms of microaggressions are only “micro” from the perspective of the one committing them. From the perspective of patients, the harms aren’t “micro” at all. Microaggressions can result in the immediate harms of feeling disrespected or invisible. But they can also contribute to long-term harms. For the elderly patient, even though the microaggression was committed with no ill intent, the healthcare professional failed to treat the patient as a dignified human being, worthy of respect. As a result, the patient’s sense of self is undermined and the stigma associated with being elderly in an ageist society is worsened.

The same is true with pervasive anti-fat bias both within and beyond medical contexts. People with larger bodies are disrespected, degraded, and pathologized. When they enter medical spaces only to find that their larger bodies literally cannot be contained by the furniture, that medical devices cannot be used on them, and that medical gowns cannot cover their bodies, their sense of self and self-worth is harmed. This can worsen anti-fat stigma and bias, making fat patients feel shame and hesitant to seek medical care at all.

The consequences of microaggressions are anything but “micro”

Trust is the cornerstone of high-quality medical care. Yet microaggressions can corrode the trust of patients: both their trust of individual providers but also their trust in the institution of medicine more broadly. Distrust in practitioners and institutions can contribute to delaying or foregoing medical treatment, missed or incorrect diagnoses, prolonged illness, and sometimes even unnecessary death.

The upshot is this: when one’s health, well-being, and in many cases one’s very life is at stake, it’s imperative for there to be a trusting, positive relationship with those in charge of the treatment and care. Experiencing microaggressions in medical contexts, however, can undermine this trust. Thus, we must bring attention to microaggressions that arise within medical contexts in order to work to diminish them as much as possible. Doing so can be one important step in building a more just and equitable healthcare system.

_{Feature image by Online Marketing via Unsplash, public domain.}