In her new book, Microaggressions in Medicine, CU Boulder alum and bioethicist Heather Stewart writes that some healthcare professionals are causing emotional and psychological harm

Contrary to what is sworn in the Hippocratic Oath, a new book co-written by University of Colorado Boulder alumna Heather Stewart (MPhil'17) argues, those who vow to first do no harm are, in fact, causing harm regularly via microaggressions.

In the recently published Microaggressions in Medicine, Stewart defines microaggressions as “comments, actions, bodily gestures or even features of physical spaces” that subtly communicate bias or hostility toward those in marginalized groups.

“Microaggressions are particularly pernicious forms of bias or discrimination precisely because they’re frequent and subtle, and so they’re often disregarded as insignificant,” says Stewart, now an assistant professor of philosophy at Oklahoma State University. “From the perspective of those on the receiving end of microaggressions, however, they can be incredibly harmful, especially as their effects compound over time.”

A common example of microaggression, Stewart says, is misgendering a person who is trans or non-binary, referring to a person who is transmasculine with feminine identifiers such as “ma’am,” “Miss” or “Mrs.”

“When done unintentionally, the person committing the microaggression often doesn’t realize why it’s harmful, but it’s also likely that they assume their mistake is a one-off occurrence, and they fail to consider that trans and non-binary people may face misgendering regularly,” Stewart explains.

Stewart, who earned her master’s in philosophy from CU Boulder in 2017, adds that being misgendered, especially routinely, can be “incredibly harmful” to trans and non-binary people’s senses of who they are and how they want to be perceived and treated in the world. “From that perspective, microaggressions and their consequences really aren’t micro at all, but touch on core aspects of identity, belongingness and self-respect.”

Feeling unseen

In the book, Stewart and her co-writer, Lauren Freeman, describe several short- and long-term consequences of microaggressions. After a microaggression, they note, the person on the receiving end might feel confused, shocked, disrespected or unwelcomed.

“They might feel as if they’re not being seen, heard, recognized or respected,” Stewart says. “Over time, as microaggressions add up and wear on a person, they can cause real harm to one emotionally, psychologically and more. They can cause one to doubt themselves and question how others see them.

“In medical contexts, the stakes can be incredibly high. Frequent microaggressions can cause marginalized patients to lose trust in their healthcare providers, which makes them less likely to communicate openly, and can even lead them to delay or avoid seeking medical care. This obviously has serious consequences for the health and wellbeing of marginalized people and communities.”

While she doesn’t share details of her personal healthcare experiences in the book, Stewart does say she’s had “first-hand experience” in not being taken seriously by a healthcare provider and that she’s faced “harmful consequences” such as misdiagnoses and delayed diagnoses.

“I’ve certainly been on the receiving end of microaggressions, including being doubted and dismissed when making claims of pain,” she says. “A long-term consequence of these experiences has been that my trust in healthcare has been shaken. It takes a lot for me to allow myself to be fully open and vulnerable in healthcare settings.”

But her own experiences aside, Stewart says she sees the book as a way to “amplify the voices” of others and their experiences navigating healthcare, and to think about how healthcare can and must do better by them.

A key in solving the problem, Stewart says, is to improve “structural and background conditions.”

“For example, when healthcare professionals are under intense time pressures and constraints, it can be harder to be fully thoughtful, deliberative and empathetic with patients,” she says. “And when healthcare workers haven’t been given adequate education and training about diverse identities and experiences, they might not realize how their words or actions can be harmful. This points to the need for more robust and inclusive training throughout medical education as well as continuing education.”

In a similar vein, Stewart also is studying marginalized groups’ distrust in institutions, specifically distrust that LGBTQ+ communities often have in healthcare institutions.

“The goal is to better understand the nature of this distrust,” Stewart says, “so that we can work to form better relations between these communities and the important institutions which govern our lives.”

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