Micro-Affirmations have Macro-Implications

by Steven Reames, ACMS Director

Most of us have heard about microaggressions in the workplace, a term for brief and commonplace daily, verbal, behavioral, or environmental indignities. They communicate hostile, derogatory, or negative prejudicial slights and insults toward any group. The "micro" refers not to the insignificance of these exchanges, but rather to their being so commonplace that they hardly draw any attention. Even though a comment may not be intended to offend or cause harm, it does not change its effect on the receiving party.[i]

In addition to specific groups of people, I would add that over the past couple of years, healthcare workers have also experienced microaggressions from patients, their families, and even being out in public. I have heard of several health professionals who have taken off their hospital ID badge before going to the supermarket or even "smudged" their name on Facebook so that patients cannot find them there.  In some ways, it reminds me of the opening scene of “The Incredibles,” where the superheroes being “interviewed” think of their job as their identity. But “malpractice” circumstances force them underground and they are no longer seen as an asset to the community but as a liability.

Recently, our Physician Vitality Program volunteer mental director Abhilash Desai pointed to an article suggesting those in healthcare might start adopting the practice of “micro-affirmations.”[ii] Now, for many people, especially those whose “love language“[iii] is affirmation, this comes very naturally. It almost flows out of their mouths when they are around:

• “Oh, I love your blouse. That looks so cute on you.”
• “You handled that difficult situation perfectly. Strong work!”
• “The way you treat your patients with such respect is really inspiring.”

But for others, a micro-affirmation might feel more like a foreign language to speak. Perhaps we don't feel confident about saying niceties to people because we were told it makes you look like a suck-up. Or, maybe we simply have more of a critical mindset because of our training towards constant performance improvement. We fail to see the good because we are so dang good at identifying flaws.

If this is you, it could be all the more reason to make some intentional effort at affirming others on a small scale. If you are perceived to think that nothing ever meets your standards enough to say anything nice, it is likely that you suck any joy out of a room every time you walk into it. A small gesture, word, or kindness from you, even just an acknowledgment that somebody exists rather than serving invisibly, could be quite powerful.

I was second from the front at a stoplight where a man sat holding his sign: “VIETNAM VETERAN. Old, broke, and ugly. Anything helps.” I am certain we have all had these moments where we may waffle between empathy, guilt, self-justification, and feigned ignorance. “Now anything isn't really going to help him,” I tell myself silently. “I cannot change the PTSD he probably emerged from a war with. Even if I could solely support him, it likely would not change the reasons he is broke. I certainly cannot change the fact that he is old.”

But ugly? No, that is either a clever ploy for more handouts but much more likely a value judgment against himself, a persona, an identity he has taken on after many indignities. This is something he probably believes about himself because of internal or external voices. And I can do something about that.

Just before the light turns green, I make eye contact with him and wave. He acknowledges me back. I slowly roll forward opening the window, immediately thinking he might be disappointed I am not handing him money. Instead, I say, “You’re not ugly man. You’re beautiful!” He smiles, I accelerate away, and I may not encounter him again. It was a micro-affirmation of his worth as a human being, not because he cleaned himself up, found work, or landed a permanent home. But simply because he lives and breathes just like me.

Just imagine if you initiated a revolution of loving and kind comments at your practice! It would certainly require greater observation, intentionality, and even some courage on your part. As much as we need to work to eliminate micro-aggressions, the introduction of micro-affirmations could be a potent inoculation.

Consider the number of people in your workplace right now: physicians, PAs, NPs, nurses, technicians, MAs, custodians, cafeteria workers, groundskeepers. Patients! If any of them were to hold up a sign that described how they really felt about themselves, what might it say?

• “Single mom, three kids, working just as hard for my patients as the doctors, and can barely make my bills. Does anybody even see my effort?
• “Overweight. Haven’t taken care of my health. I deserve this amputation.”
• “Fraud. If anybody knew how much of a screw-up, I was, I would lose my license.”

Whatever it might say, the power of your micro-affirmation authentically offered could be a tremendous antidote to debilitating self-talk. Just imagine if you initiated a revolution of loving and kind comments at your practice! It would certainly require greater observation, intentionality, and even some courage on your part. As much as we need to work to eliminate micro-aggressions, the introduction of micro-affirmations could be a potent inoculation.

Pro-Tip: My wife is a natural at this and she recently told me how the favorite part of her job is her quarterly check-ins with her reportees. It gives her an opportunity to look them in the eye (and via Zoom oftentimes, in the camera) and declare to them how she sees their behaviors aligning with the company’s values. For example, “Last month, when you covered your co-worker’s unexpected absence, you showed her compassion by encouraging her to take time with her family.  Your support in this situation demonstrates to me how important it is to you to put people first.” Doing this authentically gives your employees and colleagues an emotional boost and reinforces your aspirational workplace culture.

Last month I heard Dr. Elizabeth Hughes, a Seattle dermatologist, tell the story of a patient sent to her after what started as a small wound turned into a medical conundrum and loads of specialty care. The patient was getting all the treatment she needed but with no change in her condition. She arrived at Dr. Hughes’ office depressed and declared that she did not expect she would receive much help since she’d already been run through a gauntlet of medical care already.

As she heard the patient, some "righteous indignation" rose up in Dr. Hughes and she stated bluntly, "Well that is a pile of bullshit and you need to stop believing that. You are going to get better.” Within just a few days, the patient's condition turned around completely and, in less time than she had already been being treated, she was completely well.[iv]*

The power of our words is incredible and can lead to health or unhealth, depending on how we use them. I dare you to experiment with micro-affirmations for a week. Whether it is once a day or you manage to get in a few, train your brain to look for ways to build people up in small ways. Even the tiniest of kind words or gestures could unleash a viral movement of positivity in your practice. It is the kind of workplace you would do better in yourself, and it certainly would be better for everyone around you. And frankly, I believe it is the kind of person you know deep in your heart that you want to become.

Let me know how it goes.