My Running List of Micro-Affirmations

By Dr. Elizabeth Rubin, M.D.

Micro-affirmations are the antidote to microaggressions. Microaggressions, the little insidious comments or acts of barely perceptible injustice and bias that bite and nip and slowly erode our confidence in our belonging, worth, and power. As I continued the journey of medical training, I continually searched for the antidote. Mere protection against the daily barbs and arrows was not enough. I needed more than protection- I needed an offensive strategy as well. For me, searching for micro-affirmations is the answer. My pursuit of the positive, instead of always battling against the negative. I learned to seek out the small comments, actions, or conscious moments that boost my  self-worth, reinforce belonging, and make the skip in my step a little lighter. 

When I started residency, my fellow women residents and attendings bonded together with stories of the frequent microaggressions that made us fight harder to be included in the conversation and heralded with the same respect as our male colleagues. Since then, I started listing for myself the interactions that made me feel the opposite. Made me feel included, welcomed, even honored, in the world of medicine within the House of God. 

Below is a very incomplete list of the microaffirmations that I hope will bolster, propel, sustain, and nourish the soul of those women who valiantly dare to thrive in this field. 

1. “When I saw you were a woman doctor, I just breathed the biggest sigh of relief.” Representation matters. In all fields. For those suffering from trauma, or living a life with specific cultural boundaries, or simply walking into a medical encounter accompanied by important life stories, sometimes the fact a fellow woman as the ideal caregiver and physician can change the trajectory of her care.
2. “I hope to go to medical school too! It’s cool to see you could do it.” I am generally a more private person not hoping to be held up to some standard of ideal or lofty goal. In these cases, however, I am always grateful to be a source of inspiration, motivation and affirmation. 
3. “It’s the ladies running the show tonight.” There are no better night shifts than when I work with my all female crew. The level of comfort, ease, and kinship makes for fun nights, great patient care, and good vibes.
4. “Wow. Strong work.” A simple compliment- from EMS, nurses, colleagues, or consultants is essential for someone like me whose love language is words of affirmation. 
5. “You are clearly a momma.” I’ve heard this in multiple contexts and am proud in each. I did choose to, and was blessed to be able to, have children and that is such an essential part of my life.  Some adult patients act like children, and need to be guided (sometimes sternly) towards better decision making. Some patients are actually children, and that familiarity with the latest Disney Jr. show helps foster a connection. I always felt like being a mom made me a better doctor. 
6. “Are you the nurse or the doctor?” This comment used to rub me as a microaggression, but I have reclaimed it. Women can succeed in both roles! Men can succeed in both roles! I proudly reiterate that I am in fact, the Doctor, and will try to re-introduce the nurse as well to establish the care team.  I also make it a point to remind them of my physician role throughout the encounter. I worked hard for this role- it feels good to reinforce it. 
7. “You have kids? I don’t know how you do it.” In the beginning, this type of comment would make me bristle. With time, I realized I am a wonderfully efficient, trying-my-best, powerful, strong, successful doctor and mother. I do it with love, and effort, and coffee. I do it with my partner. I do it with my family. I do it the way that works for me, and my family. I do it in a way that is constantly changing as the demands of work and family ebb and flow. So that comment makes me smile. You don’t know how I do it? Well, watch and see. I’m still learning how I do it too. 
8. “I’m really glad I came in tonight.” Even when all I provide is reassurance, knowing that I made a connection with a patient that left them happy with their medical care is affirming. 

I’ll continue to look out for the micro-affirmations to make each shift brighter. Hopefully we can change the narrative.