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Teaching and Learning Moments

A Case of the Microaggression Mondays

Sims, Alexandra M. MD, MPH

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doi: 10.1097/ACM.0000000000003705
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I did not want to write about this. I wanted to continue with my day, get my groceries, and settle in before the thunderstorms started. But racism and all of its tentacles managed to enter my day.

I was scheduled for a minor dental procedure. My own childhood dentist was kind and was the first health professional who made me feel cared for. I try to make him proud with diligence about regular cleanings, but I needed a minor procedure, and Monday morning felt like a good time.

As I reclined in the examination chair, the dental hygienist entered. We first made polite conversation about the procedure. The hygienist provided reassurance that this was routine and that I should expect a speedy recovery. “You have several things going for you,” he said. He rattled off several protective factors: I am a nonsmoker, I am young, and my imaging that morning looked favorable. Check, check, check. “And,” he added, “You’re African American.”

“And by that you mean …?”

“Well, you guys have great bone density. I mean, there are things that don’t work in your favor, like sickle cell and diabetes. But you guys have really strong bones, so that is at least one thing going for you, genetically.”

He winked at me. My stomach turned. “I mean, I’ve seen it,” he reinforced, as he made a drilling motion with both hands. “You guys have strong bones.” That is at least 3 “you guys,” I thought, and started keeping a mental ticker.

“Does that have something to do with Vitamin D?” I asked. I hoped he did not mean what I thought.

He shrugged. “Oh, I don’t know about that. I’m just saying I’ve seen it here with you guys.” 4. Again, the drilling motion with his invisible jackhammer.

Almost as quickly as we entered this rabbit hole, he shifted the conversation. “Well you know, you see it in sports. You guys run faster, jump higher, and outperform every other race at every sport.” 5.

“That is not genetic though,” I said plainly. Calmly. Don’t seem angry.

“Well, you know, I don’t know if you call it conditioning or genetics, but you guys run faster, jump higher. I’ve seen it myself. I play sports.” 6.

My brain kicked into overdrive, and I briefly entered my very own episode of “This Is Your Life: The Micro/Macroaggression Edition.” I grew up in the suburbs of Richmond, Virginia—the capital of the former Confederate states. There are parts of my hometown that I love: People say good morning to passersby, things slow down on Sundays, and traffic is still bearable. However, our country’s ugly, unresolved legacy of racism is present enough to remind you that some do not think you belong. My high school classmates flew confederate flags from their trucks in the student parking lot. I started 11th grade the same year that LeBron James entered the NBA. A fellow student spoke with conviction about how Black people had an extra ligament in their feet, which made them jump higher, hence Mr. James’ success. The same classmate insisted the following year that my 100% college acceptance rate was solely due to affirmative action.

The memories flooded me. Walking down Newbury Street in Boston, I got called the n-word for the first time. In medical school, a classmate asked if I was in the decelerated program (I was not). On my obstetrics rotation, the resident showed me the Sims Retractor, and said “Hey, maybe you’re meant to be an OBGYN.” I went home and learned that Dr. J. Marion Sims became the “father of gynecology” by perfecting his techniques on enslaved Black women—without anesthesia or informed consent. I prayed there was no relation. The innumerable times I have been mistaken for an ancillary staff member instead of the doctor flashed to mind. The list goes on and on.

The hygienist was still conflating science with his myopic personal experience when I came back to myself. “So, yeah, I play a lot of basketball and I see it. You guys outrun everyone.” 7. “You even have quicker recovery times, it’s just amazing. And hey, I’m Middle Eastern.” (As if that made a difference.)

Deep breath.

“What you are saying is racist. That’s a racist trope from slavery that Black people are a separate species, that we are stronger and feel less pain. The logic that you’re using was used to justify slavery. That is not science.”

I then outed myself as a physician, and one who, among other things, studies and teaches implicit bias. I explained that he was making dangerous jumps and generalizations. I was met with weak personal anecdotes cloaked as fact. My refrain remained the same. “What you are saying is rooted in racism.” He eventually relented and said, “Thank you for telling me that.”

Being the patient is not easy. In the moment, I worried about seeming like the “angry Black woman.” We all know it just takes one unexpected event to throw off a clinic schedule, and I worried about that, too. But then my worry shifted. Now I was nervous about the routine procedure. Would the hygienist be less careful because of my “genetically strong bones”? Even with insider knowledge, I was starting to panic.

Speaking up was inconvenient. And sometimes, in moments like this, I am paralyzed by anger. But somehow, I found my voice. I spoke with the leadership onsite who were supportive, and I was reassigned hygienists at their insistence. I learned that their staff receives regular implicit bias training. As someone who has led these workshops, I felt disheartened. The dentist refuted the hygienist’s eugenics-based narrative as nonscience, and there is good data to support this.

The procedure went fine, and I was able to work the next day. But what if it was not me this happened to? What if someone without a medical background was falsely reassured based on “genetics”? Would they have picked up their antibiotics and completed the course? Would they have felt empowered to call if things went awry?

And perhaps it is the part of me that loves numbers, but I keep trying to quantify what happened that morning. If we were to gather together my emotional expenditure, extra time spent explaining, and my worry and guilt, along with the disrupted clinic flow and my lack of productivity for the day, what would it all equal?

My experience is a small window into the danger of race-based medicine. Beliefs that we are chemically different from one another can fuel bigotry. Despite what we know, we still use race as a static, unidirectional proxy for health and disease. Even for risk factors that might have an associative relationship, it can be dangerous to jump to causation, or to apply that relationship to individual patients without thought, care, or critique. This cavalier approach harms patients and falls short of the professionalism that health care calls for. If public health crises rooted in inequity have taught us anything, we should flip that vector and use race and ethnicity as lenses to understand patients’ experiences and to explore how racism, whether in the form of housing segregation, the wealth gap, police violence, or microaggressions at the dentist, contributes to health disparities.

An Academic Medicine Podcast episode featuring this article is available wherever you get your podcasts.

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