It’s not a big deal

Written by Nikita Arora (c2018)

“Women should be shy.”

“This stethoscope will be great for picking up chicks.”

It’s not that I hadn’t heard this before. I grew up wading in filthy pools of these comments and I still hear them everywhere. It’s a classic example of a microaggression. “Microaggressions are the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, that communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership.” To me, microaggressions are little things that may happen to you on an everyday basis that both feed into and come out of a greater value system that holds a certain population in lower regard compared to another. Sexist microaggressions are a specific example of this phenomenon related to the treatment of women.

Recently, I have realized that I have experienced many, many microaggressions in the few months I have been in medical school. As physicians, as much as we portray ourselves as professional and able to self-regulate, the events that play out in real life are messy, unregulated and, sometimes, unprofessional and oppressive. For some reason, before entering medical school, I thought that the medical profession was  “above this” because of its rigorous selection process. Yet, these past few months have proven otherwise. For example, one physician recently told me: “it is good that you are shy, women should be shy” in passing during a patient encounter. I talked to some close friends about this, and was mostly advised not to speak with the physician in question about it because of “what might happen” or “who the physician might know.” Other things I was told was “this will happen all the time and you will have to learn how to work with those people.” I would argue that these complicit responses which followed are what prompted me to write this piece, as opposed to the initial incident.

“It’s not a big deal”

Microaggressions are painful, for me, because of several reasons. They are painful because they imply on a deeper level that my existence is lower than someone else’s. However, because they are “small everyday happenings”, they are considered too little to take real action against. My reactions and feelings towards them are invalidated because I am told that they are not a big deal, they happen all the time, they will continue happening, and realistically, even if I report them, no one will do anything about it, and my favourite:  that I am being too sensitive and shouldn’t be so quick to become offended. This part of the microaggression makes it even more painful because it makes the incident so much harder to act against. People do not react the same way to microaggressions as they do to outwardly sexist comments, like “women are lesser than men.” Yet, blatant sexist comments and microaggressions stem from the same value, a value that draws an uneven line between men and women. A culture that dismisses microaggressions as insignificant allows people to change their language to include small pieces of sexism instead of big pieces, while never having to change their fundamentally discriminatory values.

This begs the question: In the end, if people don’t express their prejudiced values in blatant ways, do they matter?

The patient

In health system dialogues, it seems that no issue is big enough to matter if it doesn’t negatively affect the patient. And indeed, deep-seated sexist values manifest as many adverse outcomes for females in the healthcare system. For example, studies show that women’s pain is taken less seriously in clinics, and they consequently experience longer wait times, as well as delayed treatment. Another common example is the characterization of the clinical presentation of a heart attack  based on male heart attack symptoms. Ultimately, this leads to physicians misdiagnosing women having heart attacks and not being able to initiate treatment in time. I have heard many physicians say that “women are more likely to present atypically in heart attack situations”, which begs the question as to why the “typical”, the “default” population is men, and why the symptoms of women, who make up half of the population, are not included in what is considered typical presentation. Moreover, there are larger health repercussions of propagation of sexist values by a physician, who is a member of society whose voice is powerful and can often shape public opinion. Perhaps this will translate to women earning less because they are not allowed to be aggressive in their workplaces and are confined to “shy” personalities. And we have all looked at the robust relationship between health and socioeconomic status.

The medical student/resident/fellow/co-worker

In other ways, sexist remarks to learners and colleagues in healthcare settings can translate to adverse health outcomes for female health care personnel. What is the mental health effect of your mentor or co-worker telling you day in and day out that you are lesser? I can’t count the number of times I have gone home after being exposed to a sexist microaggression, fighting against it, knowing it is unreasonable and sexist, but also on some level, believing lesser of myself because I have heard the statement so many times before. Research demonstrates that sexist remarks contribute to lower self-esteem and psychological distress for victims of discrimination, as well as for female bystanders. In many cases, this adversely affects the ability of females to learn and work in healthcare settings.

Sometimes, it can be difficult to see the connections between all of the aforementioned gender disparities in society. However, if one examines these inequalities, it is apparent that they are often not because of gross, intentional actions (although sometimes they are). I am sure most physicians do not actively think, “I will see Adam now and let Sheela wait in the waiting room for ten more minutes because women exaggerate their pain and are hysterical.” But I have realized that the judgement call is often more subconscious, originating from a deep-seated value. The same deep-seated value that may have caused the physician to microaggress against a medical student many months ago.

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