Ruth C. Carlos
2019–2020 ARRS President
Here’s a word that you still won’t find in Stedman’s: microaggression. A short, often casual exchange that, regardless of intent, can send a disparaging message to a certain individual because of group membership, there’s nothing particularly new about it. Lest you think this word was forged in a social media storm, in fact, it was a tenured professor of education and psychiatry at Harvard Medical School who first used it. Coined in 1970 by Chester M. Pierce, the first African-American full professor at Massachusetts General Hospital, to combine the subtle dismissals and outright injustice non-black Americans inflict upon African Americans, today’s wider term applies to any routine marginalization based on race, gender, sexuality, age, ability, or socioeconomic status. As Meridith J. Englander and Susan K. O’Horo observed in last October’s AJR Journal Club, microaggression has “entered our everyday vernacular”.
Need the word in a sentence, with some real-life examples? When an attending physician tells an international student that he or she is doing exceptionally well on rounds, “especially considering their background.” The subordinate or colleague who keeps hearing that they’re “just too pretty” or “far too handsome” to be stuck in a dark reading room.
“Think of microaggressions like mosquito bites,” wrote Carolynn M. DeBenedectis, lead author of “Microaggression in Radiology,” the September commentary published in the Journal of the American College of Radiology. “A single or occasional mosquito bite is annoying for a second but can be ignored, but when the mosquito bites are unrelenting and in large numbers, they can be damaging.” Left untreated, these bites of bias— again, unconscious or not—can lead to diminished self-confidence, poorer self-image, as well as serious mental health conditions like anxiety and depression.
Responding to the August commentary in JAMA Pediatrics, the New York Times’ headline wondered, “Is it possible to train doctors without hurting anyone’s feelings?”. Of course, as JAMA’s own title duly noted, “Avoiding the eggshells is not the answer”. We practice medicine, and sooner rather than later, all practicing diagnostic radiologists will have to render a difficult face-in-PACS decision and engage in a potentially problematic discussion face-to-face. For academic and mentor radiologists alike, it’s our duty to point out the mistakes of others—shedding light on each artifact and every pitfall.
Acknowledging that a person’s gender, ethnicity, or circumstances are real-world facts, how should we respond as the “other?” Moreover, what does a true ally do in these most fraught moments? To start, always consider the source, where context remains key. Being too brusque helps neither party, especially if the microaggressor is closely connected to the microaggrieved. “Keep the initial conversation short, and schedule a time to talk about it later to give the other person time to think things over,” suggests NiCole T. Buchanan, an associate professor of psychology who leads workshops on microaggressions at Michigan State University.
At the same time, passive-aggressiveness can hurt everyone, beyond the microaggressor and the microaggrieved even. As leadership consultant Mario Rodriguez noted during this year’s Association of Medical Imaging Management annual meeting, following a simple, three-step process often helps to diffuse conflicts in a pointedly, albeit respectful manner. According to Rodriguez, “you should describe the problem simply, explain clearly how it makes you feel, and, then, outline the changes you’d like to see”.
As Judy Melinek wrote, “social justice is good medicine”. Together, we can be both radiologist and advocate.
The opinions expressed in InPractice magazine are those of the author(s); they do not necessarily reflect the viewpoint or position of the editors, reviewers, or publisher.