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For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions" /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Relation" content="10.1136/bmj.q518" /> <meta name="DC.Description" content="Being questioned by patients and colleagues can feel invasive and isolating, but sensitive redirection and mutual education can diffuse this tension, hears Éabha Lynn Narut Pakunwanich, academic foundation doctor, interventional neuropsychiatry group, School of Clinical Medicine, University of Cambridge, says, “This seemingly innocent question is loaded with assumptions and implications, leaving doctors and medical students unsure of how to respond appropriately. It’s a question we minority ethnic healthcare professionals hear numerous times. “This question, and ones like it, are microaggressions—subtle but harmful remarks—that perpetuate stereotypes or biases. While much research has focused on ‘tolerance’1 improving in the UK, for many health professionals, acceptance is what is truly needed. “Microaggressions are highly context dependent and should be handled with care. Remember that the intent may not always be malicious. But, regardless, the underlying cultural insensitivity or ignorance must be tackled. In order to facilitate a truly accepting atmosphere, the approach must always be constructive to both sides. The tension can be relatively easily diffused in isolated cases without malintent. “By using the compliment sandwich technique, I use this as an opportunity to educate, not retaliate. …" /> <meta name="DC.Contributor" content="Éabha Lynn" /> <meta name="article:published_time" content="2024-02-27" /> <meta name="article:section" content="Careers" /> <meta name="citation_title" content="How to respond when asked where you’re ‘really from’" /> <meta name="citation_abstract" lang="en" scheme="teaser" content="<p>Being questioned by patients and colleagues can feel invasive and isolating, but sensitive redirection and mutual education can diffuse this tension, hears <b>Éabha Lynn</b></p>" /> <meta name="citation_journal_title" content="BMJ" /> <meta name="citation_publisher" content="British Medical Journal Publishing Group" /> <meta name="citation_publication_date" content="2024/02/27" /> <meta name="citation_mjid" content="bmj;384/feb27_2/q435" /> <meta name="citation_id" content="384/feb27_2/q435" /> <meta name="citation_public_url" content="https://www.bmj.com/content/384/bmj.q435" /> <meta name="citation_abstract_html_url" content="https://www.bmj.com/content/384/bmj.q435.abstract" /> <meta name="citation_full_html_url" content="https://www.bmj.com/content/384/bmj.q435.full" /> <meta name="citation_pdf_url" content="https://www.bmj.com/content/bmj/384/bmj.q435.full.pdf" /> <meta name="citation_issn" content="1756-1833" /> <meta name="citation_journal_abbrev" content="BMJ" /> <meta name="citation_doi" content="10.1136/bmj.q435" /> <meta name="citation_pmid" content="38413163" /> <meta name="citation_volume" content="384" /> <meta name="citation_article_type" content="Other" /> <meta name="citation_section" content="Careers" /> <meta name="citation_author" content="Éabha Lynn" /> <meta name="citation_author_institution" content="The BMJ" /> <meta name="citation_reference" content="citation_journal_title=Ethnicities;citation_author=JG. Janmaat;citation_author=A. Keating;citation_title=Are today’s youth more tolerant? Trends in tolerance among young people in Britain;citation_pages=44-65;citation_volume=19;citation_year=2019;citation_doi=10.1177/1468796817723682" /> <meta name="twitter:title" content="How to respond when asked where you’re ‘really from’" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:description" content="Being questioned by patients and colleagues can feel invasive and isolating, but sensitive redirection and mutual education can diffuse this tension, hears Éabha Lynn Narut Pakunwanich, academic foundation doctor, interventional neuropsychiatry group, School of Clinical Medicine, University of Cambridge, says, “This seemingly innocent question is loaded with assumptions and implications, leaving doctors and medical students unsure of how to respond appropriately. It’s a question we minority ethnic healthcare professionals hear numerous times. “This question, and ones like it, are microaggressions—subtle but harmful remarks—that perpetuate stereotypes or biases. While much research has focused on ‘tolerance’1 improving in the UK, for many health professionals, acceptance is what is truly needed. “Microaggressions are highly context dependent and should be handled with care. Remember that the intent may not always be malicious. But, regardless, the underlying cultural insensitivity or ignorance must be tackled. In order to facilitate a truly accepting atmosphere, the approach must always be constructive to both sides. The tension can be relatively easily diffused in isolated cases without malintent. “By using the compliment sandwich technique, I use this as an opportunity to educate, not retaliate. …" /> <meta name="og-title" property="og:title" content="How to respond when asked where you’re ‘really from’" /> <meta name="og-url" property="og:url" content="https://www.bmj.com/content/384/bmj.q435" /> <meta name="og-site-name" property="og:site_name" content="The BMJ" /> <meta name="og-description" property="og:description" content="Being questioned by patients and colleagues can feel invasive and isolating, but sensitive redirection and mutual education can diffuse this tension, hears Éabha Lynn Narut Pakunwanich, academic foundation doctor, interventional neuropsychiatry group, School of Clinical Medicine, University of Cambridge, says, “This seemingly innocent question is loaded with assumptions and implications, leaving doctors and medical students unsure of how to respond appropriately. It’s a question we minority ethnic healthcare professionals hear numerous times. “This question, and ones like it, are microaggressions—subtle but harmful remarks—that perpetuate stereotypes or biases. While much research has focused on ‘tolerance’1 improving in the UK, for many health professionals, acceptance is what is truly needed. “Microaggressions are highly context dependent and should be handled with care. Remember that the intent may not always be malicious. But, regardless, the underlying cultural insensitivity or ignorance must be tackled. In order to facilitate a truly accepting atmosphere, the approach must always be constructive to both sides. The tension can be relatively easily diffused in isolated cases without malintent. “By using the compliment sandwich technique, I use this as an opportunity to educate, not retaliate. …" /> <meta name="og-type" property="og:type" content="article" /> <meta name="og:image" property="og:image" content="https://www.bmj.com/sites/default/files/highwire/bmj/388/8457.cover-source.jpg"/> <meta name="twitter:card" content="summary_large_image"><meta name="twitter:image" property="twitter:image" content="https://www.bmj.com/sites/default/files/sites/defautl/files/attachments/bmj-article/2024/02/cc_where_u_really_from.jpg"><meta name="twitter:title" content="How to respond when asked where you’re ‘really from’" /><link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/384/bmj.q435.full.txt" /> <script>window.dataLayer = window.dataLayer || [];window.dataLayer.push({"page":{"hwTitle":"How to respond when asked where you\u2019re \u2018really 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class="panel-display" > <div class="hero"> <div class="hero-wrapper"> <div class="hero-content" style="position: relative; left: 0px; top: 35.5px;"> </div>  </div>  </div>  <div class="row"> <div class="left-content col-xs-12 col-sm-8 col-md-8 col-lg-8"> <article> <div class="panel-pane pane-highwire-article-citation" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node1093975" data-node-nid="1093975" id="node-1093975--2545280819" data-pisa="bmj;384/feb27_2/q435" data-pisa-master="bmj;bmj.q435" data-apath="/bmj/384/bmj.q435.atom"><cite class='highwire-cite highwire-citation-bmj-article-top'> <span class='highwire-cite-article-type'>Careers</span> <h1 class="highwire-cite-title" id="page-title">How to respond when asked where you’re ‘really from’</h1> <span class='highwire-cite-journal'>BMJ</span> <span class='highwire-cite-published-year'>2024</span>; <span class='highwire-cite-volume-issue'>384</span> <span class='highwire-cite-doi'> doi: <a href="https://doi.org/10.1136/bmj.q435">https://doi.org/10.1136/bmj.q435</a></span> <span class='highwire-cite-date'>(Published 27 February 2024)</span> <span class='highwire-cite-article-as'> Cite this as: <span class="italic">BMJ</span> 2024;384:q435 </span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs" > <div class="pane-content"> <ul class="tabs inline panels-ajax-tab"><li class="first"><a title="Article Tab - Article" href="/content/384/bmj.q435" class="panels-ajax-tab-tab" data-panel-name="jnl_bmj_tab_art" data-target-id="highwire_article_tabs" data-entity-context="node:1093975" data-trigger="" data-url-enabled="1"><span>Article</span></a><a title="Article Tab - Article" href="/panels_ajax_tab/jnl_bmj_tab_art/node:1093975/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li><a title="Article Tab - Related Articles" 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class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><div class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="last" id="contrib-1"><span class="name">Éabha Lynn</span></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address>The BMJ</address></li></ol></div><div class="teaser"><p id="p-1">Being questioned by patients and colleagues can feel invasive and isolating, but sensitive redirection and mutual education can diffuse this tension, hears <strong>Éabha Lynn</strong></p></div><div class="section other1" id="sec-1"><h2 class="">Fight for acceptance, not tolerance</h2><p id="p-2">Narut Pakunwanich, academic foundation doctor, interventional neuropsychiatry group, School of Clinical Medicine, University of Cambridge, says, “This seemingly innocent question is loaded with assumptions and implications, leaving doctors and medical students unsure of how to respond appropriately. It’s a question we minority ethnic healthcare professionals hear numerous times.</p><p id="p-3">“This question, and ones like it, are microaggressions—subtle but harmful remarks—that perpetuate stereotypes or biases. While much research has focused on ‘tolerance’<a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a> improving in the UK, for many health professionals, acceptance is what is truly needed.</p><p id="p-4">“Microaggressions are highly context dependent and should be handled with care. Remember that the intent may not always be malicious. But, regardless, the underlying cultural insensitivity or ignorance must be tackled. In order to facilitate a truly accepting atmosphere, the approach must always be constructive to both sides. The tension can be relatively easily diffused in isolated cases without malintent.</p><p id="p-5">“By using the compliment sandwich technique, I use this as an opportunity to educate, not retaliate. I always start by thanking them for their curiosity to learn more about others, but then inform them that some of the phrasing, such as ‘really from,’ might make people feel excluded. If these microaggressions are from a position of ignorance, then it would be useful to discuss the differences between ethnicity, nationality, and personal identity. As a person of Chinese descent, Thai birth, and British nationality, it can certainly be difficult for me to navigate this both when asked in the UK and in Thailand. Finish by thanking them for taking time to learn more about you and your background.</p><p id="p-6">“The difficulty often lies not in misinformed icebreakers from patients, but from persistent microaggression from other staff members. In these contexts, it is important to express how uncomfortable it makes you, your co-workers, or patients feel. If, after several reminders, the microaggressions are sustained, seeking more specific advice from your colleagues, supervisors or your trusts’ equality, diversity, and inclusion team might be warranted.”</p></div><div class="section other2" id="sec-2"><h2 class="">Seek to understand the intention</h2><p id="p-7">Vijaya Nath, director, Contemplative Spaces, “In my youth, this question often prompted a series of questions in my head. I would politely offer a brief response by way of answer but the encounter would often leave me feeling dissatisfied. In my thirties, with more experience, this question became part of my story and something I chose to turn into an act of curiosity and relationship building.</p><p id="p-8">“Firstly, I seek to understand the intention behind the question; are you interested in where I was born? Or, where my ancestors were born? Where was I educated? Are you interested in how I speak or in my accent? I find, in most of my encounters, that seeking to understand the motivation behind the question can produce a mutually educational interaction. I accept that this is my personal view and choice.</p><p id="p-9">“Considering our roles as healthcare professionals, whether clinical or non-clinical, I have another view about how asking this question may look, sound, and feel to a patient, user, or relative. Those accessing our services may be in pain, stressed, or anxious, so a question which may query ‘belonging’ is not empathic or caring. To those providing care, I am advocating that we put ourselves in the patient or users’ place and ask questions which demonstrate a genuine interest in how we can help them, and what we can do for them.</p><p id="p-10">“If a patient, service user, or relative asks, ‘Where are you really from?’ my instinct is to respond with matched curiosity and to see if that invites a human-to-human interaction that could leave you pleasantly surprised.”</p></div><div class="section other3" id="sec-3"><h2 class="">Educate without confrontation</h2><p id="p-11">Kevin Wu, medical student, Duke University, North Carolina, says, “When confronted with this question in a clinical setting, I try to focus on professionalism and education. My response hinges on maintaining composure while gently redirecting the conversation.</p><p id="p-12">“Start by considering the intent behind the question. Instead of assuming malice, I seek clarification, allowing the person to explain their curiosity. This approach sets the stage for a constructive conversation, where I can educate without confrontation. I express an understanding of their curiosity while enlightening them about the potential impact of such questions, emphasising how they can be perceived as microaggressive and make people feel singled out.</p><p id="p-13">“My response may differ depending on who is asking the question. When faced with the question from patients, it’s important to educate them about the impact of questions related to ethnicity or nationality. Help them understand that such inquiries can inadvertently make individuals feel singled out. While doing so, maintain a reassuring and empathetic tone, fostering a sense of shared understanding.</p><p id="p-14">“If it comes from a colleague, I may tackle the matter privately. Here, I communicate my concerns, provide education on the impact of such questions, and politely request a more professional tone in our future interactions. To steer the interaction back to a professional context, I would redirect the conversation. For instance, I might say, ‘I appreciate your interest. Let’s discuss our current patient’s case or the task at hand.’ This helps create a boundary around personal inquiries while reinforcing the importance of focusing on our shared responsibilities in the workplace.</p><p id="p-15">“Ultimately, the goal is assertively to respond to microaggressions while contributing to a workplace culture that values diversity and promotes respectful communication. If the behaviour persists and becomes part of a broader pattern of discrimination, I am prepared to report it to the appropriate channels in the workplace to ensure a conducive and inclusive environment for all.”</p></div><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-384.feb27_2.q435.1" data-doi="10.1177/1468796817723682"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Janmaat</span> <span class="cit-name-given-names">JG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Keating</span> <span class="cit-name-given-names">A</span></span></li></ol><cite>. <span class="cit-article-title">Are today’s youth more tolerant? Trends in tolerance among young people in Britain</span>. <abbr class="cit-jnl-abbrev">Ethnicities</abbr><span class="cit-pub-date">2019</span>;<span class="cit-vol">19</span>:<span class="cit-fpage">44</span>-<span class="cit-lpage">65</span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1177/1468796817723682</span></cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DEthnicities%26rft.volume%253D19%26rft.spage%253D44%26rft_id%253Dinfo%253Adoi%252F10.1177%252F1468796817723682%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1177/1468796817723682&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi 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