Microaggressions can seem harmless to some, but they create a hostile environment for people in marginalized groups — especially in the healthcare industry.

Microaggressions are actions, statements, and other behaviors — unintentional or intentional — that discriminate against people in marginalized communities. They can take many forms, from subtle insults and invalidation of people’s experiences to overt assaults on someone’s identity.

Healthcare is one of the most common settings for microaggressions, for both patients and healthcare professionals. From the discrimination Black women face during pregnancy to the lack of support neurodivergent folks experience when seeking emergency mental health care, these behaviors affect millions of people in marginalized communities.

To better understand what microaggressions look like in a healthcare setting, it can be helpful to know the different types of microaggressions. When we break down these behaviors, we can see that there are three types of microaggressions: microinsults, microassaults, and microinvalidations.

Microinsults

Microinsults are rude and insensitive comments, made either unconsciously or intentionally, that are disrespectful to a person’s identity. These comments are often related to aspects such as gender, ethnicity, language, and appearance.

Here’s an example of what a microinsult might look like in a healthcare setting:

An Asian American woman is seeking prenatal care from a new doctor. It’s her first pregnancy, so there are several concerns she wants to discuss. During her initial visit with this doctor, one of the first things he says to her is, “Your English is great! Where did you say you’re from, again?”

Other possible examples include commenting on the attitude of Black patients, discussing the physical appearance of trans patients, and making assumptions about a doctor’s experience because they are a woman or are Black, Indigenous, or a Person of Color (BIPOC).

Microassaults

Microassaults are a more deliberate type of microaggression, and they typically involve behaviors that intentionally harm the marginalized person. These behaviors are usually obvious forms of discrimination or prejudice, but they can be either subtle or overt.

Here’s an example of a microassault someone might experience during a healthcare visit:

A man with Tourette syndrome who experiences both vocal and motor tics arrives at a busy urgent care center. After he visits the front desk, the nurse asks him to take a seat in the waiting room. Several people in the waiting room become nervous about his motor tics and decide to sit on the other side of the room.

Other examples include male healthcare professionals making “accidental” physical contact with female patients, healthcare professionals refusing to accommodate disabled patients in waiting or exam rooms, and patients loudly refusing service from BIPOC doctors.

Microinvalidations

Microinvalidations are comments or conversations that ignore or invalidate the experiences and identities of people in marginalized groups. This type of microaggression is extremely common in the healthcare world, for both patients and professionals.

Here’s an example of what a microinvalidation can look like in healthcare:

A woman visits her busy doctor’s office because she has been experiencing frequent abdominal pain and bloating. When she arrives, her doctor, an older man, enters the room in a hurry. He barely listens to her concerns, prescribes her medication to take for the bloating, and tells her to book a follow-up in 2 weeks.

Other possible examples include professionals invalidating disabled patients who have difficulty finding transportation for appointments and white doctors discounting the hard work it took for their Black co-workers to get into medical school.

Microaggressions in the healthcare industry have a hugely negative impact on people in marginalized communities — and there’s plenty of research to back this up.

For example, racial and ethnic microaggressions can significantly affect healthcare outcomes for BIPOC individuals. This is especially true in areas such as pregnancy care and chronic disease care.

In one study published in 2019, researchers explored the impact of racial microaggressions on prenatal care and found that Black women who experienced racial discrimination and microaggressions were more likely to delay important prenatal care.

Sexuality- and gender-based microaggressions can also have a significant impact on healthcare outcomes for members of LGBTQIA+ communities.

In another study from 2019, researchers surveyed 489 LGBTQ adults in the United States about their experiences of discrimination.

The researchers found that 53% of the participants reported experiencing microaggressions due to their gender identity or sexual orientation. This type of discrimination is so impactful that 18% of those surveyed said they avoided seeking out healthcare for themselves or a loved one because of anticipated discrimination.

Microaggressions can also negatively affect the physical and mental health of people in other marginalized communities, such as disabled people and neurodivergent people.

It’s crucial that we address microaggressions in the same way as overt prejudice and discrimination because these behaviors are not just present in healthcare spaces — they’re also present in schools, workplaces, and every other area of society.

Here are some steps we can take to begin addressing and preventing these behaviors in healthcare:

  • Ensuring equity and diversity in roles: An overwhelming percentage of healthcare professionals are white, and diversity in healthcare roles is often lacking. It’s important that we provide equitable opportunities for people in marginalized communities to enter the healthcare space.
  • Maintaining an open dialogue on diversity: Before we can start to change these behaviors, we have to be able to openly talk about them. Diversity, equity, and inclusion (DEI) initiatives and diversity-themed programming are some ways we can open the floor for discussion.
  • Creating and upholding codes of conduct: Another important step toward tackling microaggressions is being able to document and address these experiences. Institutions should not only have clearly outlined policies but also be strict in holding people accountable if they break them.

Many of these changes need to happen on an institutional level, but that doesn’t mean you can’t make a difference if you happen to witness these microaggressions.

If you see someone engaging in these types of behaviors — whether you’re a patient or a doctor — all it takes is for one person to stand up and say something. And if you’re not comfortable enough to say something in the moment, report it to someone higher up who can take the appropriate action.

Everyone has a right to equitable healthcare, no matter their gender, age, race, ethnicity, or identity. But the healthcare world is one of the most notorious settings for microaggressions, and these harmful behaviors often lead to worse healthcare outcomes for people in marginalized communities.

If we’re going to address microaggressions in healthcare, we need to start at the source — training and education for current and future healthcare professionals. Ultimately, it’s medical students, aspiring doctors, and other professionals who can make the biggest change in this space by taking that first step.