Prescribing kindness in modern medicine
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 做厙輦⑹ alumna (MPhil'17) argues, those who vow to first do no harm are, in fact, causing harm regularly via microaggressions.
In the recently published , 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.
In a newly published book, CU Boulder alumna and bioethicist Heather Stewart (MPhil'17) argues that the effects of microaggressions in medicine may compound over time.
Microaggressions are particularly pernicious forms of bias or discrimination precisely because theyre frequent and subtle, and so theyre 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 maam, Miss or Mrs.
When done unintentionally, the person committing the microaggression often doesnt realize why its harmful, but its 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 masters in philosophy from CU Boulder in 2017, adds that being misgendered, especially routinely, can be incredibly harmful to trans and non-binary peoples 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 arent 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 theyre 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.
The goal is to better understand the nature of this distrust so that we can work to form better relations between these communities and the important institutions which govern our lives, says Heather Stewart.
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 doesnt share details of her personal healthcare experiences in the book, Stewart does say shes had first-hand experience in not being taken seriously by a healthcare provider and that shes faced harmful consequences such as misdiagnoses and delayed diagnoses.
Ive 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 havent 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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