I was coaching a physician on communication, and at one point our conversation took an interesting turn.
We had been talking about interprofessional communication, when the physician told me she was worried about offending people unintentionally. At first, I thought she was talking about her colleagues. But she also gave some examples of interactions with patients.
I have been thinking about this part of our conversation for several months. This physician, like many I have met, is committed to equity and to reducing health disparities. I have observed that these values are an important part of her identity and her professional practice.
It seemed to me she was realizing that sometimes, her words did not meet her own standards.
That is, sometimes she suspected she was not catching the negative or discriminatory impact of her own words.
And she knew the impact of words could be harmful. As a minority physician, she has spent her career as the subject of overt and subtle discrimination from many sources.
You already know about implicit bias
Recent research on implicit or unconscious bias has shown how public health, medical care, and human service providers can unintentionally contribute to racial and ethnic health disparities. There are documented links between health care professionals’ unconscious bias, and disparities in receipt of health care, and in multiple clinical outcomes.
You also know everyone has unconscious biases, and that these emerge through words and actions.
And you want to do something about it.
Yet addressing unconscious bias can be distressing and uncomfortable for providers, who are already under immense demands and pressures to be—as more than one health care professional has told me– almost superhuman. And who do genuinely seek to give good care to all patients and clients. And who often espouse values of equity and justice, as the above physician does.
I’m not giving you another impossible standard to live up to.
I’m taking a tack that won’t surprise you if you’ve read in this site or heard my podcast series. I’m going to talk about language.
This is about helping your words flow from your values.
Our language reflects our values…sometimes
We are socialized into ways of seeing and being in the world, partly through language.
I’ve written before about how linguists demonstrate that our words reflect what we think is normal. Our language reveals our perspective on what Gee calls “being ‘normal,’ ‘acceptable,’ ‘right,’ ‘real,’ ‘the way things are,’ ‘the ways things ought to be,’ or ‘what people like us do’.” (p.2) This includes ways of talking about other people.
And we get these ideas and terms over time by the many communities we’re part of. These are reinforced through media we consume, for example, or casual talk at dinner, or sharing stories in online groups.
But sometimes this escapes our notice. We are often unaware of the sophisticated workings of language in our everyday lives as they are habitual–or unconscious.
How can we begin to address unconscious biases in our words?
I’ve written before about what law scholar Charles R. Lawrence III calls “a slip of the mind” when,
“While one says what one intends, one fails to grasp the racist implications of one’s benignly motivated words or behavior.”
We don’t want our words working against us.
One way to catch ourselves in the act of implying negative messages we do not intend is by paying attention to phrases or statements–small pieces of language.
One such example of language that has been studied and shown to contribute to discrimination unintentionally are known as microaggressions.
Microaggressions, as I pointed out in an earlier essay, are “brief and commonplace daily verbal, behavioral, and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults” (Sue et al, 2007) to members of marginalized groups. They are communicated through words and actions (here I focus on words).
Microaggression research is often around issues of race, ethnicity, and gender. Yet microaggressions also include biased or discriminatory statements based on:
- sexual orientation
- age (any age, not only elderly)
It is important to note here that in making such a list, I am not equating racism with other –isms. Though all of these forms of prejudice and bias are real, they are not the same.
Microaggressions can be instances of explicit bias – that is, when people are aware of what they are saying and they intend the biased or stereotypical meaning. However, some microagression research focuses on the unintentional and unconscious manifestations of these brief, ordinary, negative remarks.
Where are you really from? (You are a perpetual alien because of appearances)
There is only one race, the human race (Denying the person as a racial/cultural being)
Those people…. (‘Outing’ the other as remote or removed)
We see the world from our own frame of reference, but this also means we can have blind spots when it comes to others’ frames of reference. Echoing Lawrence’s “slip of the mind,” authors of the research review of Microaggressions Toward Lesbian, Gay, Bisexual, Transgender, Queer, and Genderqueer People find “The person who uses such language may be aware of her or his language choice but not the impact those words have on the LGBTQ people who hear them.”
Research has also explored instances of microaggressions in health care environments. This 2016 study looked at the microaggressions physicians can suffer:
“Examples of such microaggressions might include questioning where the practitioners received their degree, what country they were born in, or whether they are being supervised. Presumably there are innumerable permutations of microaggressions in health care delivery, experienced within all health care professions”
This 2017 study looked at microaggressions toward LGBTQ families. A common ‘hidden message’ was that LGBTQ families were “not a real family.”
Authors of the study Unconscious biases: racial microaggressions in American Indian health care point out “Microaggressions are possible in any intercultural exchange and are liable to be enacted by all of us, including the most caring, sensitive providers.”
Yet they argue “there is great impetus for critical self-reflection and broadened understanding of microaggressions” because
“The potential impact of microaggressions in clinical encounters is notable given the provider-patient relationship and inherent power differential wherein authority and prestige favors the clinician. When a healthcare provider commits a microaggression, the exchange may undermine attempted provision of care, trust may be broken, and the visit becomes a source of patient stress.”
What to do?
Microaggressions work because of their ‘hidden messages.’ So I am inviting you to bring these hidden messages up to light.
We have reflexivity as a tool to examine our own language and values. You get to decide whether or not you want to hold on to those messages beneath your language, once you know what they are.
Tune your own ears
Where do you hear microaggressions? The point is not to catch others, but start to catch yourself.
Involve other people
Start with a friend or colleague who will call you out. (And check out some of the research I’ve linked here.)
What do you think you think about this group of people? How does that measure up to what you just said? (adapted from Cochran-Smith, 2000)
Stirring up the sediment
This is about being willing to stir up or unsettle those sedimented ways of talking that we all carry with us.
This study points out that “The recognition of bias cannot be taught in a single session.” The process of addressing bias may be more as this study indicates, a matter of developing a new “habit, developed through a continuous process of practice, feedback and reflection.”
Our everyday words and actions (and silences and inactions) can and do, sometimes unwittingly, contribute to discrimination. Even structures and systems, policies and laws, are written and interpreted and reinterpreted and enacted by humans. I’m not suggesting a level playing field, or that bias and discrimination will somehow fall away if we all just buckle down.
Yet I do wish to support the efforts of providers who, like the physician mentioned at the start, are committed to reducing health disparities. I agree with those who recognize that examining our own language is a process, and this is one possible starting point.
If you are interested in taking your language use seriously, why not start with your metaphors? This workshop shows you how to break down the metaphors you use, understand their cognitive and affective aspects, and evaluate them in use. On demand, right on this site.