Veiled Harm: Impacts of Microaggressions on Psychological Safety and Physician Burnout

Abstract

Microaggression is widespread in the health care industry and occurs in every health care delivery setting. It comes in many forms, from subtle to obvious, unconscious to conscious, and verbal to behavioral. Women and minority groups (eg, race/ethnicity, age, gender, sexual orientation) are often marginalized during medical training and subsequent clinical practice. These contribute to the development of psychologically unsafe working environments and widespread physician burnout. Physicians experiencing burnout who work in unsafe psychological environments impact the safety and quality of patient care. In turn, these conditions impose high costs on the health care system and organizations. Microaggressions and psychological unsafe work environments are intricately related and mutually enhanced. Therefore, addressing both simultaneously is a good business practice and a responsibility for any health care organization. Additionally, addressing them can reduce physician burnout, decrease physician turnover, and improve the quality of patient care. To counter microaggression and psychological unsafe, it takes conviction, initiative, and sustainable efforts from individuals, bystanders, organizations, and government agencies.

Gendered racial microaggressions and stress in PAs who are Black women

“…This is a burdensome coping mechanism 12,24,25. Perhaps the reason why these microaggressions present as less stressful is because Black women PAs are using coping mechanisms, such as shifting identity, which place unnecessary burdens on PAs and subtract from the mental energy that could be used for collaborating with the healthcare team and providing patient care 12,26…”

“…Mental resources are drained when a PA must shift through the ambiguity of microaggressions. Their focus is no longer on optimal patient care 26…”

“…This study has important implications for clinical practice. Gendered racial microaggressions harm mental health, reduce job satisfaction, and can affect patient safety 26,27. The experience of being devalued decreases the ability to perform complex cognitive tasks.…”

“…Microaggressions undermine credibility and can lead to lower self-esteem, depression, anxiety, and trauma responses 13,28. Several studies have shown that when microaggressions start to affect job satisfaction, clinicians are at higher risk for burnout 26-29. This effect on mental health and job satisfaction can lead to patient harm.…”

Fostering Psychological Safety and Supporting Mental Health Among Cardiovascular Health Care Workers: A Science Advisory From the American Heart Association

“…39 c. Microaffirmations such as small acts of kindness and goodwill toward team members help foster team unity and boost psychological safety in the workplace. 40,41…”