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LGBTQ microaggressions:
The Champion Bystander

First off let's have a definition:

Microaggression: "indirect, subtle, or unintentional discrimination against members of a marginalized group."

Ex: An attending asking a (in this case gay) male resident with a wedding ring what his wife does.

The resident now is put in the awkward position of coming out and telling his attending about his husband, offering vague answers "they're a doctor too", or embracing the attending's assumptions.

The attending most likely did not intend to put the resident in this difficult spot, but the hurt still remains.

This is the destructive nature of microaggressions: well meaning people who hurt others without even knowing it.

In some ways overt hostility, homophobia, and transphobia are easier to deal with because the lines are less blurry.

Less hemming and hawing about homophobic slurs spoken, than the slights of microaggressions.

Microaggressions need to be called out.

But.

Not by the party being harmed.

If the resident calls out the attending, it makes the attending feel uncomfortable and often I've seen people act defensively to this and direct their irritation at being corrected at the party correcting them.

This is why bystanders are so important.

If a bystander corrects the attending then the ire is directed towards them, and not the resident.

Having a bystander correct in the moment often makes it more palatable as well (frustratingly at times, though I love my champion bystanders).

The best handling I've seen of microaggressions, which can be as simple as misgendering a resident, have involved a confident, knowledgeable, and invested bystander.

I have been subjected to numerous and countless microaggressions and have had bystanders who were confident, who were knowledgeable, and who were invested, but unless the bystander was all three, no actions were ever taken.

Knowledgable: can't correct something unless you know it's wrong

Invested: won't correct unless there is some connection to the person or community involved

Confident: won't correct due to fear of social stigma, awkwardness, or repercussions

From what I've seen, most people have the knowledge and many are invested, but the confidence is not there.

The fear of repercussions is real, and in medical education evaluations could be affected.

I can't create this confidence in others. I can't make bystanders stand up for me, stand up for others, for LGBTQ folk, for Black folk, other POC, those with disabilities, different religions, or different life experiences.

But I can tell my story.

Fall 2019.

On rounds with a fellow, an intern, a more senior resident, and two interviewing 4th year med students.

Dealt with a micro (bordering on macro) aggression by the fellow.

NO ONE SAID ANYTHING.

I can and will stand up for myself, but at that moment I was so stunned and hurt that I found myself completely speechless.

I felt so completely alone.

The two interviewing 4th med students weren't invested.

My co-residents had the knowledge. They were invested. But, that day, neither of them had the confidence to correct the fellow during that moment.

The hurt has eased over the past year, but I will always remember that moment. The memory still fresh with the vivid details of the hallway, how everyone was positioned, the fellow's face, and the suffocating quiet.

Fast forward to last month.

I was presenting on night rounds in the NICU. The charge nurse (who didn't know my pronouns) misgendered me.

The fellow (different from the last one) quickly and instantly corrected the charge nurse.

The nurse acknowledged and we all moved on.

That fellow had that final piece. The confidence.

I was struck by this and the usual discomfort I feel when I get misgendered about whether to correct or not, was instantly relieved.

I felt seen. I felt safe. I felt immense gratitude.

I can't make people stand up for others.

But.

Maybe, I helped convince a few tonight.

Thank you for 5,000 followers. I will do my best to continue to teach, to promote, and help where I can.

Your queer med friend,
Dr. L