The White Guys Vs. The Janitors: How Racial Microaggressions Lead To poor Care Outcomes

Modern-day discrimination still has elements of slavery, segregation, and inaccurate assumptions about people of color. Just last month, a Texas high school principal sent a letter to parents explaining her dismay about a recent racist act where students pretended to sell their Black classmates in a social media slave trade. Chris Johnson – a Black student targeted in the incident – told school board officials, “… it was not a game.”

His story is my story.

The final year of my physical therapy program greeted me with a similar racist experience when my professor segregated our class into two student groups for a competitive learning activity: “The White Guys” vs. “The Janitors.” The janitor group consisted only of students of color. I was in the janitor’s group, and I echo Chris Johnson: It did not feel like a game.

How did my discriminatory classroom incident impact the students? How did the dismantled civility impair information exchange and shared decision-making for students in the classroom? How did this encounter affect academic outcomes? The incident led to poorer grades for the students of color due to stress and isolation from being pushed to the margins of the academic environment.

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I hope this outcome is not the case for Chris Johnson and his classmates in Texas.

My experience and Chris Johnson’s experience were incidents of racial microaggressions.

Microaggressions are conscious or unconscious discriminatory acts directed toward people based on gender, sexual orientation, religious affiliation, disability, race, and any other marginalized status. Chester Pierce coined the term in the 1970s, and its occurrence has been found in everyday social interactions. While some people can survive microaggressions without lasting impact, these acts are a known contributor to negative outcomes, including negative health outcomes.

Racial microaggressions cause increases in blood pressure; difficulty managing self-care and diabetes, also known as diabetes distress; and more frequent heart attacks and hospitalizations. We know this to be the case in other health care fields, but there is little evidence within the field of physical therapy.

What we know thus far within physical therapy is:

• People of color have raced-based outcome disparities, such as longer lengths of stay in rehabilitation facilities following a stroke
• People of color have a lower improvement in their ability to walk and care for themselves after having a stroke
• People of color have higher rates of residual disability following inpatient rehabilitation for spinal cord injuries.

The mechanisms that give rise to these poor outcomes are understudied.

A few weeks ago, a white physical therapy colleague of mine unconsciously committed a racial microaggression. She was interviewing her patient, a middle-aged Black male, about his living environment. She asked him if his daughter was at home with him all day or if she went to work.

He asked her why she would even assume that his daughter did not work. The patient was so upset that a third party intervened to help the therapist finish the assessment. How did this incident impact his care? How did their dismantled communication impair information exchange and shared decision-making? How might this encounter affect his physical therapy outcomes?

My colleague and I discussed the incident, and she realized that her manner of questioning resurfaced deeply rooted unconscious and inaccurate assumptions about people of color, particularly the Black community. Her intention was to gain an understanding of his home environment; the impact was a painful reminder of poor, systemic assumptions.

My current research is centered around these experiences of racial microaggressions for people of color during their physical therapy encounters. I am conducting one-on-one interviews with people who have had these experiences to understand how these events have impacted their outcomes and lives. The goal is to offer recommendations and train health professionals to critically consider their own conscious and unconscious assumptions and foster matured sensitivity to their patients’ perspectives.

It is our duty to foster true liberty for all and not just for some. Let us harmonize around dialogue and behaviors that honor us equally. In the words of Chris Johnson, “… the only apology I’m accepting is changed behavior. When will you make the changes needed to ensure all of us feel treated fairly.”

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