This blog post was written to accompany a Simulated PEM Adventure at Neptune 2025, the UK Paediatric Trauma Conference.
Let’s be honest: most of us have had moments at work where we’ve felt hurt by something someone has said or done. Healthcare can be high-pressure and emotionally demanding. But one thing that shouldn’t come with the job is feeling belittled, underestimated, or excluded, just because of who you are.
What are microaggressions?
Microaggressions are those everyday comments or actions, sometimes subtle, sometimes not, that send demeaning or dismissive messages to others. The term microaggression was coined in the 1970s by psychiatrist Chester Pierce. The concept was expanded by psychologist Derald Wing Sue as “brief and commonplace daily verbal, behavioral, or environmental indignities… toward people from marginalized groups.”
In healthcare, these may appear as offhand comments or assumptions tied to stereotypes that, although subtle, signal that someone doesn’t quite belong. They can be hard to spot if you’re not on the receiving end, but their impact is real and cumulative.
Microaggressions are often brushed off, and the person making the comment usually doesn’t mean harm. But they do harm, and the impact lingers.
Why this matters
We work in high-stakes environments, and we rely on each other to deliver fast, effective and safe care. Communication, trust and psychological safety are essential to performance and safety. Yet psychological safety is fragile. When someone repeatedly feels dismissed because of their gender, race, cultural background, sexual orientation, religion, or disability, it chips away at their engagement and willingness to speak up.
The British Medical Association (BMA) has reported that 91% of female doctors have experienced microaggressions at work. Nearly two-thirds of women felt they had been discouraged from choosing specific medical specialities because of their gender. 70% believed their clinical skills were questioned or underestimated because they were female.
These figures are not abstract; they correlate with burnout, disengagement, and hesitancy to speak up – critical weak links in patient safety.
Intersectionality: Layered Identities, Layered Bias
Overlapping identities of gender, race, religion and sexuality shape unique discrimination experiences. A woman from a minoritised racial group in medicine can be twice dismissed, first by gender, then by race, each interaction potentially amplifying multiple layers of bias.
NHS Workforce Race Equality Standard (WRES) data shows that ethnic minority staff report higher rates of harassment than white colleagues. Clinicians facing microaggressions, especially women and staff from minoritised groups, have significantly increased burnout and unsafe perceptions of their work culture.
The result is a domino effect: less confidence, increased isolation, and a higher risk of burnout.
Responding to Microaggressions: The LIFT Model
The LIFT framework, developed by Govindraj and team at the University of Boston, delivers a respectful, structured way to address microaggressions in real time
L – Lights On
Make the invisible visible. Many microaggressions fly under the radar, going unnoticed or unchallenged, because they’re subtle or brushed off as ‘just a joke’. Shining a light on it, by calling them out, helps shift awareness. This doesn’t need to be confrontational, but can simply invite reflection.
“Can we pause on that comment?”
I – Impact vs Intent
Recognise good intentions but focus on impact. People rarely intend harm, but their actions can still have a damaging impact. Framing the issue in terms of impact helps reduce defensiveness. A useful response might be:
“I know you probably didn’t mean it that way, but here’s how that came across…”
This keeps the focus on how the comment affected someone, rather than getting stuck on what was meant.
F – Full Stop
Disarm and redirect. Sometimes the behaviour needs to be stopped firmly and immediately. You can interrupt or change the tone and move the energy to reduce harm.
“Let’s stop there. That comment isn’t appropriate, and it doesn’t reflect the values of our team.”
By doing this, you signal that harmful language or assumptions won’t be tolerated.
T – Teach
Educate or learn. Sometimes this involves a gentle explanation; other times, it’s an opportunity for the team to learn.
“I’m wondering if you’ve thought about how that might land for someone in a different position?”
It doesn’t need to be a lecture; it’s about opening the door to better understanding.
It all comes back to psychological safety. Team members who feel respected and psychologically safe are more likely to contribute effectively and raise safety concerns.
These strategies won’t always be comfortable, but what matters is that we try. How we respond sets the tone for our teams. It tells people: You belong here. Your experiences matter. We’ve got your back.
The Cost of Silence and the Value of Speaking Up
Ignoring microaggressions has a ripple effect: it legitimises disrespect, erodes psychological safety, and ultimately jeopardises patient care. Inclusion and respect in healthcare workplaces are directly correlated with improved staff well-being and reduced errors.
This is where bystanders play a crucial role. Not just the person on the receiving end, but those around them can make a critical difference.
It’s easy to rationalise staying silent: “It’s not my place,” “It wasn’t that bad,” or “That’s just how they are.” But silence communicates complicity. When microaggressions are allowed to slide, it reinforces a culture where disrespect becomes normalised, and where only those directly affected are expected to bear the burden of change.
When a colleague calmly calls out a microaggression or offers quiet support afterwards, it sends a powerful message: We see you; you’re not alone; this isn’t okay. That validation can go a long way toward restoring a sense of belonging and psychological safety for the person impacted.
Bystander intervention also interrupts the pattern. When microaggressions are addressed, even briefly and respectfully, they’re less likely to recur, and those watching learn that there’s accountability within the team.8 Saying something, even small, can reduce future harm.
Importantly, speaking up doesn’t always have to mean confrontation. Bystander action can be subtle and situation-specific:
Re-directing the conversation: “Let’s stick to names in the handover, please.”
Checking in afterwards with the person affected: “I noticed what happened. Are you okay?”
Highlighting impact, not intent: “I’m sure you meant well, but this is how that might have landed.”
Naming the behaviour without labelling the person: “That comment could be taken the wrong way.”
Incorporating these moments into team culture helps everyone, not just those directly impacted. It sets a standard that respect and dignity are integral to clinical professionalism.
Crucially, we must move away from the idea that only overtly discriminatory remarks warrant a response. Microaggressions are so dangerous because they are small, frequent, and often ambiguous. That’s exactly why they require shared responsibility. Even one voice saying, “I noticed that, and it didn’t sit right,” can be enough to change a moment.
What to do if you get called out
Being called out for a microaggression can be a confronting experience. You might feel defensive, embarrassed, or misunderstood. However, it’s also a pivotal moment for reflection and growth, setting the tone for a safer working environment.
In their article for the Harvard Business Review, Knight recommends this approach:
Pause and breathe. Take a moment before you react. This helps prevent defensiveness.
Listen. Really listen to what the person is telling you about the impact of your words or actions. Focus on understanding the other person’s perspective.
Acknowledge and reflect. Acknowledge the impact.
“Thank you for pointing that out, It’s hard to hear and I appreciate you trust me enough to share this feedback.”
Apologise, briefly and sincerely. There’s no need for dramatic remorse. A simple, direct apology is often enough.
“I’m sorry. I hadn’t realised it came across that way and I can see how that could have been hurtful.”
Follow up and learn. Take the time to understand why it was harmful and how you can do better next time.
The key is this: being called out doesn’t mean you’re a bad person, it means you’ve been given a chance to show humility and grow. That’s what good leadership looks like.
Your Call To Action
None of us is perfect, but we can get better at noticing, speaking up, and supporting one another. By incorporating LIFT strategies, responding constructively when called out, and fostering inclusive norms, we can reshape workplace culture and, ultimately, patient care. So here’s our Call To Action for you:
Spot microaggressions – subtle words or actions that reinforce stereotypes or signal that someone doesn’t quite belong
Use LIFT – when you see or hear a microaggression, address it
Normalise reflection – admit mistakes, share learning and invite feedback.
Every respectful interaction builds psychological safety. Every apology builds trust. Every call-out handled well builds culture. And every microaggression addressed is a small step toward a safer, more inclusive environment.
References
Sue DW, Capodilupo CM, Torino GC, Bucceri JM, Holder AM, Nadal KL, Esquilin M. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007 May-Jun;62(4):271-86. doi: 10.1037/0003-066X.62.4.271. PMID: 17516773.
Edmondson, A. (1999). Psychological Safety and Learning Behavior in Work Teams. Administrative Science Quarterly, 44(2), 350-383. https://doi.org/10.2307/2666999
British Medical Association. Sexism in Medicine. 2021. Available from: https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/gender-equality-in-medicine/sexism-in-medicine-report
NHS England. Workforce Race Equality Standard: 2020 Data Analysis Report for NHS Trusts and Clinical Commissioning Groups. February 2021. Available from: https://www.england.nhs.uk/wp-content/uploads/2021/02/Workforce-Race-Equality-Standard-2020-report.pdf
Desai V, Hernandez Conte A, Nguyen VT et al. Veiled harm: Impacts of Microaggressions on Psychological Safety and Physician Burnout. Perm J. 2023;27:2 https://doi.org/10.7812/TPP/23.017
Estacio EV, Saidy-Khan S. Experiences of Racial Microaggression Among Migrant Nurses in the United Kingdom. Glob Qual Nurs Res. 2014 Jun 3;1:2333393614532618. doi: 10.1177/2333393614532618. PMID: 28462288; PMCID: PMC5342848.
Govindraj R, Binda DD, Harris AC et al. Responding to Interprofessional Microaggressions: Bystander Training-A Virtual Simulation Curriculum for Internal Medicine Residents. MedEdPORTAL. 2024 Sep 17;20:11435. doi: 10.15766/mep_2374-8265.11435.
Byrd CM. Microaggressions Self-Defense: A Role-Playing Workshop for Responding to Microaggressions. Social Sciences. 2018; 7(6):96. https://doi.org/10.3390/socsci7060096
Knight R. You’ve been called out for a microaggression. What do you do? Harv Bus Rev. 2020 Jul 27. Available from: https://hbr.org/2020/07/youve-been-called-out-for-a-microaggression-what-do-you-do
