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Hey #medtwitter #DEItwitter. I have been frequently asked for ways to handle #microaggressions from patients. This week’s thread will cover some strategies we can use. Let’s go!
You experience a #microaggression. What do you do?
There are 2 strategies I use: a non-scripted method or a scripted method.
The non-scripted method is simply a go-to phrase that allows the aggressor to backtrack and/or re-direct the conversation. It requires little thought and can be done automatically
The non-scripted method is simply a go-to phrase that allows the aggressor to backtrack and/or re-direct the conversation. It requires little thought and can be done automatically
Example Phrases:
“What do you mean?” (My go-to)
“Let’s be professional”
“We do not tolerate that kind of behavior here”
Check out Dr. Amy Cowan's article for more insight into how she employs a non-scripted method https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2701633
“What do you mean?” (My go-to)
“Let’s be professional”
“We do not tolerate that kind of behavior here”
Check out Dr. Amy Cowan's article for more insight into how she employs a non-scripted method https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2701633
The scripted method more thought-out but can be effective at addressing the microaggression head-on & gives us time to reset.
This six-step approach is based off of the work of Dr Maryann Overland @UWMedicine
It so happens GAINES is a good acronym to help remember the steps
This six-step approach is based off of the work of Dr Maryann Overland @UWMedicine
It so happens GAINES is a good acronym to help remember the steps
G= Good Vitals? 
Ensure the patient is stable
A= Address comment & name the behavior as inappropriate
“We do not tolerate those kinds of comments here ”
I= ‘I’ Statement
“I am here to focus on your (insert reason here)”
Ensure the patient is stable A= Address comment & name the behavior as inappropriate
“We do not tolerate those kinds of comments here ”I= ‘I’ Statement
“I am here to focus on your (insert reason here)”
N= Negative Feeling
Share your perspective on how the comment made you feel. "When you called me ___ it made me feel ___”
E= Expectations
Remind patient of the roles of the team members.
"I am your doctor and I am here to focus on your health”
Share your perspective on how the comment made you feel. "When you called me ___ it made me feel ___”
E= Expectations
Remind patient of the roles of the team members.
"I am your doctor and I am here to focus on your health”
S= Step Out
Temporarily remove yourself and other learners from the situation. This gives you time to reset and follow up later in the day
Temporarily remove yourself and other learners from the situation. This gives you time to reset and follow up later in the day
I strongly recommend checking out the work by Dr Overland and others on microaggressions. This article is an excellent source of information https://onlinelibrary.wiley.com/doi/10.1002/pmrj.12229
These methods can be adjusted as you see fit! 
Be aware of your emotional state at the time of the microaggression. It’s okay to feel too drained to address them everytime. The key is to have a method handy when you are ready to take them head-on!
Be aware of your emotional state at the time of the microaggression. It’s okay to feel too drained to address them everytime. The key is to have a method handy when you are ready to take them head-on!
Thanks for checking out this thread! Stay-tuned for more #DEItweetorials next week
