Abstract

In lieu of an abstract, here is a brief excerpt of the content:Microaggressions among Healthcare Providers Facilitate Microaggressions toward PatientsH. Rhodes Hambrick (bio) and Sonya Tang Girdwood (bio)In the conclusion of Freeman and Stewart's (2024) book, Microaggressions in Medicine, the authors specifically recognize the existence of microaggressions among healthcare professionals but have chosen not to focus on these microaggressions in the book. However, it is imperative to acknowledge that microaggressions committed among healthcare professionals can perpetuate microaggressions toward patients by creating a permissive culture wherein microaggressions are committed and accepted as the norm.Microaggressions among healthcare professionals, especially when there are hierarchal differences, often masquerade as concerns regarding "professionalism" (Miller et al. 2023). While we recognize that establishing standards of professional behavior (e.g., thorough and timely communication with patients and healthcare staff, commitment to providing safe and effective care) is crucial to the ethical practice of medicine, the precise definition of professionalism in medicine is nebulous. Therefore, individuals in power within medicine can overlay their personal opinions about what constitutes "professional" behavior. This subjectivity and the lack of a consensus definition can lead to the policing of trainees both within the walls of the hospital and within their personal lives.Given that microaggressions are often centered on aspects of a person's behavior, dress, or personality that may pertain to a particular identity, these are also coined by Freeman and Stewart as self-identity microaggressions (chapter 6) and are distressingly common in medicine. Enforcing dress codes is an example of policing trainees under the guise of professionalism that may simultaneously constitute microaggressions toward people of certain demographics, specifically those who are nonwhite and nonmale. For example, women are often given advice to wear dark-colored, conservative suits for interviews and instructed that dresses and skirts must be long in clinical settings to avoid distracting men. Black trainees may be told that their natural hairstyles are [End Page 157] "unprofessional" and are given advice on how to appear more "presentable" in interviews and on rotations. To cite a recent example of a self-identity microaggression, it made news when a Latina student had points deducted during her practical exam with a standardized patient for wearing large hoop earrings, a type of jewelry she has worn her whole life and represents her cultural heritage (Hatzipanagos 2021).Disappointingly, this policing even extends beyond clinical and "professional" settings. One surgical residency searched the social media profiles of their residents to investigate how many "unprofessional" photos trainees posted, and the results were published in a journal prior to retraction of the publication (Hardouin et al. 2020). Among the list of "unprofessional photos" were those of residents in "inappropriate attire," which included bikinis and swimsuits being worn in non-clinical settings. Fortunately, when the findings were published, the journal received severe backlash on social media. Physicians, both men and women, posted pictures of themselves in swimsuits on social media under the hashtag "#medbikini," arguing that what we wear, especially in our private lives, does not affect our abilities as physicians. While the article was retracted, it was made clear that trainees are judged by their appearance by their superiors and that microaggressions can even be published in reputable journals. Conducting and publishing research like this constitute a type of self-identity microaggression, in which trainees are made to feel that part of their identity outside of work, such as their choice of swimwear, which, in the case of a bikini, may be tied to their gender identity, is fundamentally "unprofessional," even when it has no bearing on their ability to function as doctors.Microaggressions can also be committed when trainees are policed on their behaviors, speech patterns, or mannerisms. They may be reprimanded for using certain vocabulary or speaking with subculture-specific idioms because they will be seen as "unprofessional," when in reality, these forms of speech may simply reflect a cultural or personality difference. Superiors may express their preferences or dislike of certain behaviors by using the threat of labeling them "unprofessional." For example, using bright colors or personal touches on presentations might be given as feedback of "looking unprofessional." Expressing preferences and labeling them as opinions are encouraged, but tagging on the term unprofessional carries a weight that removes any choice from...