From surviving to thriving: Building personal resilience in the era of micro, macro, and “atomic” aggressions.

We often hear about the role of microaggressions, macroaggressions, and atomic aggressions during discussions about health equity. Often driven by unconscious bias, microaggressions are intrinsic to the processes of marginalization, racism and sexism that impact both patients and providers during the complex interactions that occur every day in the healthcare setting. How do we go about reducing and eliminating these types of harmful behaviors and transgressions? Can raising awareness at the grassroots level and then legal remedies at the policy level work in tandem to change behavior and provide protection?

In today’s roundtable discussion, our panel explores these questions from a variety of perspectives, touching on the importance of fostering an inclusive culture for diverse students heading towards healthcare professions, and how this will also benefit patients. Hosted by Dr. Michelle Leak, and featuring Sarah Wenger, DPT, Christina M. Jimenez, PhD, Frank McClellan, JD, and with a special guest appearance from Augustus A. White, III, MD, PhD, a pioneer in our understanding of implicit bias in healthcare.

Access the full recording of the workshop here: Play audio file

“Microaggressions are really like papercuts, a subtle word, action, or comment, that is often unintentional. If it is intentional, it moves up the intensity to a macro or even atomic level.” – Christina Jimenez.

“The healthcare system is designed to perpetuate health disparities and health inequities, that really is an atomic type of transgression.” – Michelle Leak

“I titled my book Healthcare & Human Dignity because the more I reflected on the stories that were told to me as a practicing lawyer, the more I realized they were recurring instances of people who had suffered serious emotional harm.” – Frank McClellan

“We recognize transgressions as a form of stress, and we know a lot about how stress affects us physiologically, psychologically, and socially, on all levels of our lives.” – Sarah Wenger

“Cultivating awareness amongst our organizational communities is work that is really meaningful. It is important to change minds and behaviors and create a greater sense of belonging, equity and inclusion.” – Christina Jimenez.

Episode Transcription

From surviving to thriving: Building personal resilience in the era of micro, macro, and “atomic” aggressions.

We often hear about the role of microaggressions, macroaggressions, and atomic aggressions during discussions about health equity. Often driven by unconscious bias, microaggressions are intrinsic to the processes of marginalization, racism and sexism that impact both patients and providers during the complex interactions that occur every day in the healthcare setting. How do we go about reducing and eliminating these types of harmful behaviors and transgressions? Can raising awareness at the grassroots level and then legal remedies at the policy level work in tandem to change behavior and provide protection? In today’s roundtable discussion, our panel explores these questions from a variety of perspectives, touching on the importance of fostering an inclusive culture for diverse students heading towards healthcare professions, and how this will also benefit patients. Hosted by Dr. Michelle Leak, and featuring Sarah Wenger, DPT, Christina M. Jimenez, PhD, Frank McClellan, JD, and with a special guest appearance from Augustus A. White, III, MD, PhD, a pioneer in our understanding of implicit bias in healthcare.

Dr. Leak:          So, welcome to our podcast this afternoon. We’re going to be sharing with you some of the highlights from our workshop at the Movement is Life 2021 Caucus entitled From Surviving to Thriving in the Face of Micro-Macro Anatomic Aggressions.

My name is Michelle Leak. I am a hospital administrator down in Jacksonville, Florida for Mayo Clinic, and a member of the Movement is Life executive committee, and I am pleased today to host this podcast on behalf of Movement is Life. We’re going to focus on a workshop that we did at our 2021 Caucus entitled Striving to Thriving, Especially, in the Era of Micro-Macro and Atomic Aggressions. And I have three of our presenters from our workshop joining us for this conversation this afternoon. And I would like to invite each of them to introduce themselves starting with Mr. Frank McClellan.

Frank:              My name is Frank McClellan and thank you, Michelle. Very happy to be here. I’m a professor of law emeritus at Temple University and a member of the executive and steering committee of Movement is Life.

Dr. Wenger:     Hi, I’m Sarah Wenger. I’m a professor at Drexel University of physical therapy, and I also provide pro bono PT services at FQHC in North Philadelphia.

Dr. Jimenez:    Hello, I’m Christina Jimenez. I’m a professor of Latin American History at the University of Colorado, Colorado Springs, and I’m also a regular presenter on equity, diversity, and inclusion issues. So, I’m really happy to be here. Thanks, Michelle.

Dr. Leak:          Thank you. And so, I thank each one of you for coming together this afternoon to hold this conversation. You know, this has been an unprecedented year for all of us and unprecedented in terms of certainly COVID but the very bright, bright light that it has shown on healthcare inequities and health disparities. So that’s our space, right? So, we’ve been dealing with this since 2012 for Movement is Life. And now, thankfully we have a lot of other voices that feel as passionate about this as we do, but we wanted to step back a little bit in this workshop and think about, you know being on the front end of healthcare disparities as a patient. That’s certainly distressing and stressful. Certainly, when you add on top of that a pandemic and all of the other social issues that we’ve had, social justice issues that we’ve had over the past year. So, it really, really calls us to think through what can we do as individuals and collectively to create resilience in ourselves and in our communities. So, how do we combat some of these transgressions, some of these stressors, whether they’re micro-macro or atomic aggressions, it’s all a matter of scale and impact, right? And how severe the hurt is when you look at that spectrum of transgressions. So, our workshop just tried to elaborate a little bit and illuminate and highlight some of those issues from a legal perspective and legal remedies to transgressions, to what are the things that we can each do as individuals in taking care of ourselves when we are the recipient on the end of those types of transgressions. So that takes us to my first question. What are some of the reasons why this subject is so important to you personally, and from your perspective in the work that you do as an attorney, as a healthcare provider, and as an educator. So, how does this resonate with you? Why is it so important to have this conversation and to elevate the conversation? Maybe, Frank, we could start with you?

Frank:              One matter that became really clear as a result of the pandemic was that we were experiencing the pandemic, Covid differently, depending upon our socioeconomic status, where we lived the racial status, et cetera. We started introducing new terms into the vocabulary, like essential workers, which meant that they were the people who had to go out and confront the virus in order to do their job and really to live because they weren’t being paid unless they appeared and performed and other people who were not touched at all except what they considered a positive way. And many of us, for example, in academia were able to continue doing our jobs, but we didn’t have to leave our homes. We could do it remotely and there’s all the spectrum in between. So, given the fact that we’re experiencing it differently and it was exposed, I think about in many ways, like Hurricane Katrina, where all of a sudden you had to look at what people were doing and how they were living because I kept asking myself, why did they just leave? And they didn’t have cars. So, the same thing with respect to Katrina. So, I’ve always been interested in using my professional skill, whether or not it was in training, whether or not it was as a lawyer or as an educator to try and see if I could make life better for people in the community that I have an opportunity to make things better. So, that’s why it’s important to me.

Dr. Leak:          Thank you.

Dr. Wenger:     This is Sarah. I think my perspective really comes from a patient care perspective where I treat a primarily underserved population of people. And I am constantly seeing my patients come in sort of not well cared for. They haven’t been heard. Their needs have not been met by the healthcare system. Sometimes that has to do with access, but even when they have access that they’re going in and I’m listening to the advice that they’re receiving, I’m listening to what they tell me and the advice they receive, and it doesn’t fit. You know, they’re not getting what would be considered the standard of care. They’re not getting the time and attention and education that they need to be able to take care of themselves. And that’s, I would say atomic aggression and I feel like giving patients tools to deal with those transgressions of the medical system is important. And then also being able to, I mean, in my role as a professor, being able to better equip the healthcare force to address patients who are underserved and patients who show up with a lot of complexity and show up who are under a lot of stressors to be able to approach those patients more skillfully and to provide higher quality care. And I have to say, I really appreciated being on this panel with Frank because one of the ways in which I feel disempowered is sort of changing the system and the laws and the context with which all of this is happening. So, it’s been great Frank to have your input on that higher level.

Dr. Jimenez:    I think how I am drawn personally to this work is probably just through my role as a faculty member and a professor as well. I really want to make the University a place that students, all students feel like they belong and long. And, you know, we can’t do that if there are students that are experiencing, which still happens, macro-micro and atomic aggressions every day on our campus, whether it’s in the classroom or in the dorm or in the cafeteria you know, these subtle insulting and discriminating little actions, words, statements that I call microaggressions that we call microaggressions really do have an impact on students’ everyday experience. And I know here at Movement, is Life, we’re really focused on the patient experience, the provider experience, and the healthcare setting generally. And I’m really taking my experience as an educator from that setting and then kind of connecting it to a patient perspective.

So, I think cultivating awareness both on the behalf of people who are experiencing this and then kind of knowing what’s happening to them is very powerful and important, but also just cultivating awareness amongst, you know, our campus community, our organizational communities. I feel like it’s work that’s really meaningful and I’ll echo Sarah that while I kind of get frustrated at times about not being able to do more on the kind of big scale of systemic racism, like Frank, thank you, but changing laws, right, that’s really important, but it’s equally important, I think, to change minds, and attitudes, and behaviors and therefore hopefully again, create more sense of belonging, more equity, and inclusion.

Dr. Leak:          Thank you.

Dr. Wenger:     And can I add to that actually?

Dr. Leak:          Sure.

Dr. Wenger:     Because also for our students, I mean, I could say all the same things that you have just said about the educational environment. And if we look at creating a more diverse workforce, which we know is associated with better patient outcomes, you know, we need a welcoming environment in our educational settings and we need to make sure that our diverse students are excelling and having a positive experience and having the support that they need to get through and go out there and do wonderful things in the world instead of experiencing microaggressions and things that, you know, instill doubt or are in the way of their progress.

Dr. Leak:          I so much love the analogy that you shared with us during the workshop about these sorts of like microaggressions that are, you know, subtle many times, but I think you use the terminology, paper cuts, and the accumulated effect, Christina. Yes, Christina.

Dr. Jimenez:    That’s an analogy we use a lot.

Dr. Leak:          And I like that. And I think our listeners would… that would really resonate with them in terms of the spectrum of the type of transgressions that we’re talking about. So, there are those micro, macro and then the atomic ones. And if you could comment just a little bit on those paper cuts, right? And then, I think we could move into some of those more macro and atomic aggressions, which Frank does such a wonderful job of elevating in his book, and I would love for him to talk about his book and give us one or two examples there in the legal remedies that might be available to us. So, Christina, please.

Dr. Jimenez:    Sure. So, you know, these micro-level transgressions that we kind of label microaggressions really are very similar to paper cuts because it’s quite maybe subtle action, word, comment, often unintentional. It could be intentional. I think that’s where the intensity really moves it from a microaggression to a macro or atomic aggression. But a microaggression, like a paper cut, sometimes you barely notice that it happened, but throughout the day, even moments after it continues to bother you. And all of a sudden, you know, you remember it because you’re picking up something and, ooh, it really hurts your finger, or, you know, you’re washing something, and soap gets in there. So, its impact is, you know, longer than just this little, teeny cut that you might think, oh, well, you just kind of get over that. When you experience a microaggression as, you know, a person of a marginalized group.

So, this is here, we’re talking about it could be based on your race or ethnic identity, it could be based on your sexuality. It could be based on your gender, religion, age, or ability. So, these paper cuts, let’s imagine that you were getting a paper cut, like every hour on different fingers, like that would really start to become something that bothered you all the time, regardless of what you’re doing. And I think microaggressions operate the same way. We know a lot through the research of, for example, of, you know, stereotype, threat, and implicit bias, that there are all sorts of ways in which these types of transgressions just occupy and take up some of our mental and emotional energy all the time. And that impacts, not only our performance and our job in life. It impacts our relationships, it impacts our wellbeing, especially if you’re experiencing microaggressions regularly; and let alone macroaggressions, which would be again a much more, maybe overt, intense, and intentional insult in some way.

Dr. Leak:          And I think Sarah when you talked about the issues with the healthcare system and the way the healthcare system is designed that perpetuates health disparities and health inequities, right? That’s an atomic aberration, right? A really, atomic type of transgression. And Frank, if you could comment a little bit from your perspective in your book, especially because I think there are some wonderful case studies in your book that are terrific examples of micro, macro and atomic aggressions.

Frank:              So, I titled the book, “Healthcare and Human Dignity” because the more I reflected on the kinds of problems and stories that were told both in case books, as well as my experience as a practicing lawyer, the more I realized that there were recurring incidences of people who had suffered serious emotional harm. And it may not have been severe enough for that harm to have caused physical consequences, but it was serious enough to cause that kind of cut that Christina talked about, or even though it was an emotional cut, and it presented a real challenge to the law. So, I started out the book by talking about the experience of the Olympic gymnasts who were going through physical examinations with a physician who was physically assaulting them, and they were trying to get help. And what I recognized is the commonality of their situation with many people who suffer these kinds of indignities is, it was a power differential, a power disparity in terms of the interaction that, one, allowed the perpetrator to act in a certain way and made it difficult for the victim to respond.

So, many of these girls were, their parents were there in the room when they were being examined and they were looking around for help, but the power dynamic and the status of the physician who was such that nobody really believed that this could really have been happening. And so, I started trying to empathize and saying, you know, what could the law do? So, with the Olympic gymnasts, the law has the ability to respond because of the physical harm and the egregiousness of the conduct. And so, the question was, how do you invoke it and make it more accessible? Just like we talk about accessibility to healthcare. So, that’s one kind of problem to work on in terms of the structure. And then, I follow that up with a comparison of a real case, in which two individuals who were same-sex couples were not allowed to see each other in the hospital because the hospital administrators said, we have a policy that only when someone’s this sick, only persons who are blood relatives or married are allowed to come in and see them.

This person then began to obviously experience real emotional distress and tried to find out because his partner was dying. And so, the administrator blatantly said to him, this is Florida, and this is an anti-gay state, and by the time you get a lawyer, this will all be over anyhow. So do whatever you have to do. And this person then began to scramble to try to find a lawyer. And by the time he did, their partner had died. So, even though I introduced these legal, I mean, these factual situations that are really disturbing, I wanted to point out during our session, how hard it is for the law to really be an effective tool. And therefore, even though we needed to look carefully at reshaping the law in a way to make it more effective, it was critical for people to understand that other means were essential. And that’s why I think sharing the podium and really following the discussion of what are experts on, how do you respond? How you make judgments about the difference between what you’re going to respond to and what you’re going to ignore was the critical aspect of these human relationships and not simply trying to rely on the law.

Dr. Leak:          Absolutely. And that I think brings us to the physical and mental impact of transgressions, right? Be they micro, macro or atomic. So, Sarah, maybe you could help our audience understand a little bit about that mental, and physical aspect of it and how it shows up.

Dr. Wenger:     So, we recognize transgress as a form of stress and we know a lot about how stress affects us physiologically, psychologically, and socially, sort of in all levels of our lives. So, it physiologically, it affects all of our different body systems. It affects how our brains, the connectivity of our brains, it affects hormone regulation. It affects our immune system, our GI system, our GU systems, all of our different body systems, and our musculoskeletal systems, you might feel muscle tension. So, it has these widespread physiological effects, and it also is going to have psychological effects. And part of that has to do with what’s going on in your brain and what’s going on with your hormones and all of that is going to affect how you feel and how you think. So, it can affect the clarity of your thinking, and your ability to problem-solve. So, if you are in a very emergent situation, so if you’re under high levels of, stress, so think combat or being in a physically violent situation or a very dangerous situation, you know, you don’t have time for problem-solving in those situations. So, if you are regularly exposed to high, dangerous situations, your brain is going to invest a lot of time and energy in its ability, in your body’s ability to respond quickly to an emergency situation, and it’s going to invest less energy and connectivity into your ability to sit there and, you know, problem solve and think things through because that’s not something you have time to do in an emergency situation. So, if you have somebody with a history of stress, and again, transgressions are an example of stress, but there are numerous examples of stress throughout our lives and all of those social determinants of health that we talk so much about at Movement is Life are all examples of stressors, right?

So, if somebody has experienced a lot of stress and they have this improved ability to deal with things in an emergency situation, but maybe have spent less energy cultivating that problem-solving piece, because they just have not gotten to a point where they have the space to do that, and you give that person a transgression versus somebody who has less experience maybe with these emergency situations, but a lot of time to sit there and has developed their skill sets in problem-solving. So, someone who’s been under less duress in life, those two people are going to respond to the same stimulus in very different ways, right? So, I think what we need to understand is just fellow humans, but certainly, as healthcare providers is the way that a person is presented to us and a way that a person responds to interaction with us. I mean, it can be a transgression, or it can just be something we said that is seemingly unrelated, but as a trigger for that person for some reason that we just can’t imagine, right? If we understand this, this physiology, if we understand what stress does to our bodies and how it changes our bodies and how it shifts our skill sets and the way that we sort of interact with the world and with our environment, it gives us a platform for understanding how somebody might react one way and somebody else might react another way. And I think that can largely replace basically us taking that personally. Why did this person snap at me? Or why is this person so unengaged in what I’m saying? Or why is this person not executing this awesome advice that I gave them as their healthcare provider?

So, instead of either us taking it personally like this person’s being a jerk, or this person is non-compliant, one of many pet peeves of mine, you know, instead of labeling a patient a particular way or labeling an interaction and taking it personally, it gives us a platform for really understanding, hey, I don’t know what this person’s life trajectory is. I don’t know why they’re responding this way and what has contributed to their, you know, what kind of physiology they’re coming into my office with. But I at least can entertain the notion that for whatever reasons, the way that a person is responding has something to do with their story, with their context, with their resources, with their relative level of safety in life, and instead of me taking it personally, or me labeling a patient as, you know, non-compliant or unmotivated, or like, I can’t help them if they don’t help themselves. Instead of digging into those kinds of narratives, it gives us a platform for really understanding that maybe this is somebody where we need to build some resilience. And it may be somebody who is under a lot of stress or has a history of being under a lot of stress and they need some additional support and some additional resources.

Dr. Leak:          Absolutely. And you know, it really struck home to me when you explained that to us in the workshop, just the impact if you are in that sort of vicious cycle with the social determinants of health, the political determinants of health, and how that impacts your degree or sense of safety, and that sense of safety is how you perceive whether the transgression is a threat or not and what end of the spectrum that threat is. And that is also going to inform your response. So, I think your framework was just perfect and Christina, if we could go straight away to you, the other thing I loved in the workshop was how you engaged the audience and set them up to really reflect upon a time when they had experienced a transgression, be it micro, macro, or atomic, and how it made them feel. Could you talk a little bit about why you selected that to sort of begin the engagement with the audience? Why did you select that way to begin to engage them?

Dr. Jimenez:    Sure. Well, I mean, as kind of an educator, I really believe in the power of not only you know, a variety of kind of pedagogical approaches, teaching approaches to a subject, which is really kind of what we’re doing in these workshops, right? We’re sharing information, we’re teaching people who are here to really learn and reflect. So, I am a visual learner and an experiential learner. So, for me having an exercise just personally, where I can put into action, what I’m asked, being asked to learn about is very helpful. I also think that part of the work that we’re doing here is working on ourselves. Right? So, we have to always start here. How am I situated in this problem, whether I’m trying to be part of the solution or realize that I’m actually part of the problem, right, which I think is a harsh realization for some people and asking participants to just reflect on their personal experience with the transgression, I think is really powerful because we can all kind of stay in our heads about theorizing it, intellectualizing it, but then when you actually have to go back to, wow, when did I experience this? And how did that feel? It takes us to a different place.

Dr. Leak:          Absolutely. So, I would invite our listeners to sort of think that through as well. So, what was your experience? How did it make you feel? Think about that and we are going to segue into some of the things that we can each do as individuals to help us manage those feelings. I would like to just share before we move to that. I thought that this whole workshop, bringing it to a Caucus, a conference like this, I don’t know, outside of my workplace, when we’ve done all kinds of equity, inclusion, and diversity work, and you’ve had those types of sessions, I don’t know, in a large national/international conference where you actually talk about microaggressions and macroaggressions at the time, and everybody has experienced them, everybody has; whether you are a white female operating in a healthcare environment and patients and colleagues refer to you as Michelle. Whereas there’s a white male physician, and he’s always referred to as Dr. McClellan, right, or Dr. Winger or Dr. Jimenez. So, those things happen, they are real, and they have an impact, but we don’t get to talk about them in settings like this and break them down and debrief them and share strategies for addressing them. So maybe if we could invite our colleagues here at the table to share some of those things that you can do in the moment or later.

Dr. Jimenez:    I’ll start off really with, you know, one or two. I mean, I think it’s in the moment, I think it’s really, important to just take a deep breath and to not feel like you have to respond at that moment. Maybe it’s a minute later that you respond, maybe it’s a day or a week later that you respond. I do encourage people to respond to microaggressions in some way even if it’s not directly… Okay, start over.

Dr. Leak:          Combative or confronting.

Dr. Jimenez:    Confronting. Even if it’s not directly confronting the person who’s perpetrated the microaggression, you know, maybe letting their supervisor know, or at least talking with friends and colleagues about what’s happened so you can process it and you’re not experiencing it alone. So, those are all things that we in our workshop talked about as building resilience. You know, having a strong network of relationships, having a good sense of you know, balance in your life, whether that’s through physical activity, exercise, a lot of people get back to nature and really feel a sense of grounding doing that. Something that I really appreciated working with Sarah is that I came to understand how many of these practices, those are just a few, and you all can talk about others in a minute, but so many of those practices that build resilience, aren’t just ways that we cope with and respond to these stressful situations. They’re actually building us up. It’s like a muscle that we’re strengthening, and they create a kind of protective barrier for us when we encounter not just transgressions, but all sorts of stress in our life. So, Sarah actually taught me that, and maybe you want to, you can talk more about protective and factors because I think that, and how that’s really important in these stressful situations.

Dr. Wenger:     Sure. Thanks. So yeah, if we think about stressors sort of being one side of the seesaw and kind of weighing us down and making us vulnerable to health issues, psychological and social, you know, there’s a weight on us that crosses all those areas and stress can break us down across those areas. There are also protective factors that protect us, build us up, and help us cope and help us get through stressful situations sort of unharmed, or at least without any kind of serious deleterious effects. I shouldn’t say unharmed entirely, but those protective factors like Christina were talking about are social connection is huge, right? Having enough resources, having a sense of safety. And there is so much that goes into all of these things, feeling like you are supported wherever you are. So, you know, at work at home within your community, whatever. We are in many spaces.

I think what’s important is sort of this idea of the seesaw. So, you have these things that make you vulnerable and put you at risk, and then you have things that build you up and make you robust, these protective factors. And if you accumulate, you know, if the balance between those things’ tips, you can be at this place where you start to see some of these physiological changes that can be harmful and can lead to health problems. You can see some of these physiological and social effects that can also lead to health problems and quality of life, you know, can diminish your quality of life. And so, as we’re looking at tipping that seesaw, you know, it’d be great if we could just get rid of all the stress. And we have some, we are empowered to some extent to manage stressors and diminish stressors, but we are often not empowered to get rid of the stress, to the extent that we need to.

And so, our other tool, and I think this is a tool that’s just so underutilized, certainly in healthcare, but I would venture across industries is this opportunity to really build up our protective factors. So, if there’s a certain amount of stress that is not going anywhere, how are we going to improve our coping skills, improve our resilience? And there are an equal number of ways of doing that. So, you know, you can look at all these stressors and think, oof, God, you know, that’s problematic, you know, we’re never going to get out of that. But there’s an equal number of ways to build yourself up. And so, I think there are a lot of opportunities that we can take as fellow humans in whatever role, but certainly within our role as healthcare providers to help create safety for people. I mean, so this gets into the theme of this year’s conference, which is a community, right? So, we can be a support to somebody else. We can be a safe space for somebody else.

Dr. Leak:          An ally for somebody else?

Dr. Wenger:     Yes, exactly, an ally, we can create positive medical experiences instead of harmful medical experiences that all builds resilience. We can help people learn what they need to learn, to have the tools they need. We can help them because we all know there’s a giant gap between knowing something and executing something. So, we can teach people things, but then we can also mentor and guide and support as that new knowledge transitions into new decisions and new behaviors. And I think that we have this huge potential to be somebody else’s resilience and to be somebody else’s positive factor. And that’s within all, you know, within our roles as family members, as friends, as community members, as coworkers, and as healthcare providers.

Dr. Leak:          Absolutely. And I would just add to that. I know Christina when we first started this conversation about tools and how do you respond, she said, just take a breath, just step back, and just pause for a few. And I know we talked about exercise, but movement and breathing, so important to managing the distress because I think these types of transgressions are distress. We all have some level of stress in our lives, but there’s good stress and then there’s bad stress and these types of transgressions is bad stress and it’s distressful. But I do think the power of movement is certainly at the top of the list in terms of remedies.

Dr. Wenger:     Well, as a physical therapist, I, of course, have to comment on that. I mean, what I teach my students is exercise, and being fit like improved fitness makes all your body systems work better. It makes all of them, neurology, your neurological system, your immune system, your digestive system, and all your body systems work better, not just musculoskeletal. So, we know that when you exercise, you get stronger and you get better cardiovascular fitness, but it makes all your body systems work better and it better prepares you to meet whatever the demands of your life are.

Dr. Jimenez:    You know what I also learned, this is Christina, is that doing the walk, the exercise getting out in nature. I mean, I learned from this workshop, working with you all, collaborating is that it’s also building that resilience muscle and it’s helping well, me, personally, but I think a lot of people, even though we’re going out there to do it for maybe some physical activity, it’s actually creating you know, mental and emotional strengthening, that’s actually protecting us and de-stressing us, but preparing us for more stressors the next day. This is what makes me think about that, the PT or physician getting out the, you know, prescription pad and writing out like having a conversation with your best friend, like twice a week. You know, take the time to do that or go out and walk your dog. You know, even if it’s around the block once a day because we need that to build our health.

Dr. Leak:          Absolutely.

Dr. Wenger:     And I want to link that back to what you were saying about paper cuts, right? So, if stressors are taking these paper cuts, we can have whatever the positive version of a paper cut would be like, we can do these small little things. They don’t have to be huge. We can have this little resilience and coping skills and resilience-building things that we just do in little, small doses all day long. And they also accumulate and make an impressive impact.

Dr. Leak:          Yes. In addition, I was thinking back to another of our Movement is Life colleagues, an esteemed executive committee member, Dr. Augustas White joined us for the workshop, but was not able to be here in person for the podcast. We did a recording of his comments and presentation and shared it at the workshop. And he had some really, sage advice for us in terms of how to respond to a transgression. And one of the things that he said was to, you know, remain professional, poised, and decide whether or not it’s the rock to die on. And I think that’s so important because there is that power differential, especially in the educational environment and especially in medical schools. So, there are so many outcomes that are not so good that could happen. So, you really do have to pick your moment and do it in the appropriate way. And I would just like to mention as well, Dr. White’s latest book entitled, “Overcoming: Lessons in Triumphing over Adversity and the Power of our Common Humanity,” getting back to Frank and his publication in terms of human dignity.

Dr. Jimenez:    Yeah. I remember Dr. White also mentioned operating within your sphere of influence and it really does kind of get back to what Frank was saying as well because we might have a lot of thoughts and energy about the way that we want to change the system, but it’s really, hard as one person to change the system. So, if we operate within our sphere of influence, then maybe we’re not changing the system, but we’re making these, you know, impacts in our community in these positive ways that perhaps they’ll accumulate and over time, change a broader system.

Dr. Leak:          Absolutely. I would ask if there are any concluding comments that anyone would like to share. I hope that our audience and our listeners have gotten a sense of what our workshop was all about, what were some of the high points of it and what we were trying to convey in terms of these types of transgressions and how to address them from a legal perspective, as well as what we can each do personally and collectively to protect ourselves and to help each other. But any additional comments would be most welcome.

Frank:              So, I would just like to emphasize the challenge that Dr. White made to us of trying to seek joy, that we don’t want to just survive these situations, but we want to survive them in a way that allows us to experience joy. And I think it’s important to keep in mind that these microaggressions, particularly occur sometimes in situations where you’re going to have them reoccur because it’s a relationship or employment status or something like that. And other times, they are simply chance encounters. I think that pausing and breathing is helpful for survival in all those situations, but in situations where it’s an ongoing structural thing, you have to think about how I use resources to change the structure because otherwise, I’m going to continue to be a victim. And I think that’s a part of seeking joy, is to say I’ve done something to help myself.

Dr. Leak:          An advocate for yourself.

Dr. Wenger:     That was beautifully said. And I’ll add to that also helping others seek joy. So, that idea that you can be the source of resilience, you can be the source of de-stressing, you can be a source of support for other people. And that also feels good for you, too. So, I think there’s healing for yourself in supporting others.

Dr. Jimenez:    Yeah. Well, I’ll end with the final thought that we had on the workshop which was just about start where you are. So, wherever it is that you feel like you need to kind of work on in terms of building your own resilience so that you can start to not just survive but thrive and seek joy. You know, don’t be hard on yourself about it. Just take those small steps and you’ll see progress.

Dr. Leak:          A wonderful way to end our time together. And I just want to thank you again on behalf of Movement is Life.

Dr. Jimenez:    Thank you.

Dr. Wenger:     Thank you.

Frank:              Thank you.

Dr. Leak:          I’d also like to add for our listeners, that I have referenced Dr. White’s recording that we shared in our workshop. We are going to end our podcast this afternoon and close it out with Dr. White’s recording that we mentioned earlier.

Dr. White’s recording: “Dr. Chester Pierce is the person who coined the phrase microaggression*. And I would just like to honor him and share with you also the fact that he was a mentor and a dear friend during his time here at Harvard. Microaggression. Microaggression is a statement, action, or incident regarded as an instance of indirect, subtle, or unintentional discrimination against members of a marginalized group, such as a racial or ethnic minority, large scale, or overt aggression toward those of another race, culture agenda, ethnic minority or marginalized group all come under this particular, classification. Here’s an example also of a macroaggression, which is a bit more direct not at all subtle, and sort of in your face, if you will. And a colored sign saying this is for colored only. And racial microaggression is a color sign saying Jim Crow, racism, segregation, and that is really a macroaggression.

An atomic aggression takes it to another level. I just want to share an example of an atomic aggression. This is a quote from an individual who was, as it will explain working on rounds at Harvard Medical School, one of the Harvard hospitals. I was on service last night. It was busy with several admissions. A patient really wanted a cup of coffee, and I asked the attendant to make it if she/he forgot. So, I went back and made the coffee myself and brought it to the patient. The patient said, “You know, you should be grateful I didn’t call you a nigger, like my sister, would’ve done.” Now, obviously, this particular doctor was an African American female which resulted in this particular unfortunate atomic aggression is what I’d like to call it.

So, here’s another example. This is an incident reported by a student and another atomic aggression. And basically, I will just paraphrase it. A woman who was referred to in a sexual context about her sexual presence and a joke was made and it made the woman on the service who was rotating on the service very self-conscious to hear these sexual innuendos jokingly commented on about the patient. And he even said, “He wanted to take one nurse into the back room and slap her around, some.” Totally an atomic type microaggression, if you will. So, there’s also an opportunity in this dynamic, which is important to have some humanitarian pushback for social justice. And just a reminder, this is reminiscent of Michelle Obama doing the campaign for the presidency of her husband, Barack Obama, where she recognized and pointed out that as things got more negative and more hostile and more down and evil and mean, she would campaign and conduct herself to get even more humanitarian in her activities and so forth, and this would be her pushback for social injustice would be social justice.

And here are some things. Diane Goodman is a woman who’s written a wonderful book with many examples of how to engage in pushback with various types of stereotype activity. And she says, gives information, share your own experience and your own differences that you were involved with, and the alternative perspectives that can be offered other than those that are in nature, which could be considered macroaggressions? And one of the things to do is to promote empathy and say, oh my goodness I wonder how you would feel if someone said something like that about you or some of your loved ones, or your friend, or your partner, or your child. We don’t want to make those kinds of comments about our patients. They relate to our patients, because this is a microaggression, undesirable in any interaction, but certainly when you have the role of a caregiver. So, it’s good to express your feelings and say, you know, I noticed the comment you made to that patient, and I’d like to show you and tell you why it was offensive to me. It made me uncomfortable. You can go on and say to your colleague, and you can say that it’s something that is offensive to me. And it makes me feel out of place and unwanted and unrespected and therefore not good as we’ve tried to work together here in this hospital setting. One can go even further. Diane Goodman suggests here and even go so far to say, you know, here’s the way it made me feel. And it made me feel very insecure as though I was being pushed to feel bad about myself and I don’t feel bad about myself, nor do I feel bad about this particular patient that you are demeaning.

So, you can use humor, you can exaggerate the comment, use some ridiculous exaggeration or even some gentle sarcasm and a good point, though, you can introduce all of these rebuttal type remarks with a sentence that says, allow me to respectfully share an opinion with you. We are all professionals here trying to do a good job. And please let me make this particular comment about what just happened. And we need to behave as professional individuals. Another response is she says, oh my goodness, just blurted out that really hurt me. I don’t know how it made the patient feel, that nurse feel, but it really, it really hurt me. And I wonder if the hospital administration would condone this kind of behavior. I doubt it. In fact, I’m sure, they will not. And we should be careful that we do not risk making our patients be harmed or feel bad when our goal is to make them feel good. How much pushback? This requires a lot of good judgment and goodwill and experience and good luck really. Do you start a fight? I don’t mean even a fist fight. And certainly, not a fist fight, but do you start a verbal battle? Do you risk your job by doing that? Might you risk your job by doing that? Might you lower your grade if you are a student on rounds and the professor observes you doing it to someone else or to him or her? No, you don’t want to do any of those things in that circumstance. You want to exercise equanimity. And let me recommend an article, which is not in our handout, but an article, which says, it’s called “Aequanimitas”. The article is written by Sir William Osler, a distinguished professor at Johns Hopkins many years back. Aequanimitas is the name and the translation in Latin is equanimity. And it means to be cool, be consistent, and be relaxed.

So please, here’s the advice that we encourage you to do. Develop your resilience. You can improve your resilience, and there are many things in the literature and many of the references we’ve offered. Look at them, those that you resonate with, read them, think about them, and please take it on good faith, you can significantly enhance your resilience. And at the same time, then we can advance both strategies. You can have a pushback strategy and you can have a resilient strategy, and this is a good, healthy way to go forward. And this is what we encourage you to do. So, to repeat, again, yes, pushback. Pushback strategically. Don’t get in big fight if you can avoid that, with respect, introduce your comments with respect. And here’s a book, one of the books here, this book summarizes the evaluation of Vietnam refugees, and the so-called famous Hanoi Hilton, years ago. And they had posttraumatic stress syndrome and Dr. Softwick and Charney studied a number of these individuals and came out with about 10 characteristics that constituted those who had resilience, and those who survived better. And that included such things as exercise, if you will, during these difficult times. So, please review this book and others that are suggested for resilience enhancement.

So, let’s do both, let’s push back against these microaggressions, macroaggressions, and even atomic of aggressions, and let’s also work to enhance our resilience and you have plenty of references to do that. So, as you do these things, you will be acting within your sphere of influence and you have a strong impact, and you make a strong contribution through your sphere of influence. So, as you study microaggressions and how to address them, think also about your sphere of influence, because you are not going to change racism or change the realities of healthcare disparities by winning arguments or debates, or conflict and competition with your wit, with people involved in microaggressions and macroaggressions. But you can change it and you can make a difference as you improve your spheres of influence, your resilience and your spheres of influence will help you to adjust and improve that situation significantly.

Please see that Robert F. Kennedy greatly supported working in one sphere of influence which is the influence we can have around ourselves, impacting others will combine and will greatly have the strength, combining small ripples will be like a positive tsunami of strength in favor of progress in humanitarianism. So, please consider that characteristic if you would. And another way of thinking about this is that the pushback is sort of in the spirit of Malcolm X and humanitarianism, and then Michelle Obama going to a higher level will give us a sense of what we can do by following Dr. King. And Dr. King, who says he wouldn’t want us all in medicine and think we should, and can, and should be humanitarian role models. And he recognized that the arc of the universe moves and dances slowly. The arc of the universe dances slowly but it bends in the direction of righteousness. The arc of the universe is long, but it bends toward justice. You have to write that down. So, thank you. Thank you so very much for your attention respectfully submitted, Gus White.”


* Chester Pierce (1974), a prominent African American Harvard-trained psychiatrist, was the first to describe these covert acts as microaggressions in the 1960s. He defined microaggressions as “black-white racial interactions [that] are characterized by white put-downs, done in an automatic, preconscious, or unconscious fashion.”


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Produced by Rolf Taylor for Movement is Life


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