Sculpting a Civil Work Environment: Managing Microaggressions

12 Jan 2020

By Jaime D. Lewis

Many of us can come up with a list of ways that we and our colleagues have been reminded that we do not fit the expectations of a surgeon. For women in medicine these incidents often center on similar themes: sexism, sexually inappropriate discussions, pregnancy and child care concerns, limitations placed on perceived ability, relegation to tasks unlikely to advance their career, and exclusion and marginalization. Those who are underrepresented minorities (URM)  in medicine often face additional scrutiny based on their race or ethnicity.

Not only do these events, or microaggressions, interrupt our daily lives, they also impact the advancement of women and URM in medicine and other fields. In 2019, more women than men entered medical school for the first time in the US. However, gender representation in many fields of medicine and the proportions of individuals of increasing ranks in academics do not reflect this shift. Similarly, improvement of URM is occurring at a nearly glacial pace. Not only can they impact our career trajectories, microaggressions can also exact a high toll on physical and mental health leading to decreases in self-esteem and increases in blood pressure, anxiety, alcohol use, and even suicidal ideation.

At the 2019 annual Association of Women Surgeons meeting, many of us participated in a session on managing microaggressions which opened the channels for further discussion on the topic. Having terminology to describe the offenses and a cadre of responses and retorts will help us to pave the way forward.

Macroaggressions: systemic, overt discrimination towards a group based on race, gender, etc. 

Microaggressions: term coined initially in 1970 to describe racial insults, but now expanded to include “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative…slights and insults” directed at a personal level towards individuals of a particular group. Microaggressions include:

  • Microassaults: “old-fashioned”, blatant acts of discrimination
  • Microinsults: more subtle actions or statements that are insensitive and/or demeaning towards the recipient’s gender, race, heritage, or identity
  • Microinvalidations: negate or dismiss an individual’s thoughts and experiences
  • Environmental microaggressions: culture and climate reflect the microassaults, microinsults, and microinvalidations experiences by the individuals who share the workplace

Sometimes it’s tough to know if an offence has even occurred. In addition, the offence may be obvious to a spectator or witness but unrealized by the offender. A number of methods for clarifying and responding have been proposed, including:

Open The Front Door
               Observe: describe what you saw
               Think: explain what you are trying to accomplish
               Feel: clarify your/their emotions
               Desire: specify how you hope to proceed

              Ask: clarify with questions
              Come: approach the situation with curiosity
              Tell: describe what you saw as concerning
              Impact: explore what the event meant to others
              Own: understand how the event affected you
              Next: encourage action

               Gather: pause and collect thoughts
               Restate: ask speaker to or personally restate the comment of concern
               Inquire: seek clarification
               Talk it out: discuss impact, intended or unintended

To discuss further, join @womensurgeons along with our moderators Dr. Jaime D. Lewis (@jaimedlewismd), Dr. Elizabeth Acquista (@AcquistaE), and Dr. Elizabeth Shaughnessy (@DrBethS1) for a tweetchat on Monday January 20th at 8pm Eastern Time. The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtag #AWSchat. If you haven’t participated in a tweetchat with us before, check out this tutorial written by Dr. Heather Yeo (@heatheryeomd) to know more.

We will be discussing the following topics during our tweetchat:

1.     Are you aware when microaggressions occur?
2.     How have microaggressions impacted your career and/or your health?
3.     What evidence have you seen of environmental microaggressions in the workplace? Have you noticed any efforts to address?
4.     Do you have a systematic way of addressing microaggressions such as Open The Front Door, ACTION, or GRIT? How has this worked for you? Have you had any challenges?
5.     Do you have allies who will help you to address microaggressions when they occur? Who are these allies and how do they help?

Jaime D. Lewis, MD, FACS, practices breast surgery at the University of Cincinnati College of Medicine in Cincinnati, Ohio, where she also completed her general surgery residency. After residency, she spent a year in Tampa, Florida training in breast surgical oncology at the Moffitt Cancer Center. Dr. Lewis is committed to improving wellness and professional development opportunities of the medical students and residents with whom she is privileged to work. Outside of the hospital, she enjoys running and spending time with her family. You can find her on twitter at @JaimeDLewisMD.


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

Leave a Reply

Your email address will not be published. Required fields are marked *