About Project Respect

What is Respect?

Respect is a relation between a subject and an object in which the subject feels a sentiment and or demonstrates a behavior towards the object that recognizes its dignity and worth.

What is the goal of Project Respect?

Dr. VJ Periyakoil (Twitter: @palliator) founded Project Respect a few years ago to study healthcare communication and foster mutually respectful interactions between health professionals and their patients. Respect is demonstrated through verbal and nonverbal microbehaviors.

Why did we choose to study the concept of ‘respect’? What is the basis underlying the notion of respectful interactions? 

The Universal Declaration of Human Rights recognizes inherent human dignity. It describes the equal and unalienable rights of all members of the human family to be universally protected irrespective of race, color, gender, language, religion, political or other opinion, national or social origin, property, birth or other status. However, people are often disrespectful in their daily microbehaviors.

What are microbehaviors?

Microbehaviors are small and fleeting verbal and nonverbal ways we act or respond when we interact with others. Microbehaviors can be oriented positively (microvalidation, microsupport) or negatively (microaggressions). For example, smiling or saying hello is a positive microbehavior. Speaking over someone or interrupting them is a negative microbehavior. See more below.

Why should we care about microbehaviors? They seem really small and inconsequential?

Microbehaviors are indeed small and fleeting. However, they have macroconsequences over time. For example, if a doctor demonstrates respect to a patient through microbehaviors, the patient is more likely to listen carefully to the doctor’s assessment and adhere to the doctor’s instructions. Similarly, in a professional environment, respectful microbehaviors enhance collegiality and foster teamwork and collaboration.

What is microcommunication?

In any encounter, small packets of information are exchanged continuously like a tennis volley. There a minute-by-minute variation of the information communicated, the underlying affect and how it impacts the effectiveness of the communication. As we communicate, we transmit information admixed with microaggressions and microvalidations. The quality of communication is eroded with every microaggression and augmented by each microvalidation.

What is non-verbal communication?

Communication comprises of both verbal and nonverbal information. Over 90% of communication is nonverbal. Nonverbal communication is heavily contextual and is influenced by the culture of the communicator. Nonverbal behaviors include eye movements, body posture and movement, tone and cadence of voice, use of touch, use of silence, use of space, and use of artifacts. The skillful use of nonverbal communication can foster effective intercultural interactions. Effective communication involves awareness and modulation of our microcommunication pattern on an ongoing basis.

What is a microaggression?

It is a negative micro-behavior

• Brief and commonplace verbal, behavioral, or environmental indignities
• Often unintentional and unconscious
• Often voiced by well-intentioned individuals who may be unaware of the negative connotations and the potentially harmful impact
• Communicates hostile, derogatory, or negative slights and insults.
• Stressful, demeaning, isolating

Microaggressions are often a behavioral manifestation of the unconscious biases and prejudices that leak out through microcommunication.

What is the impact of microaggressions during patient care encounters?

The US population is becoming more diverse. The odds of intercultural doctor-patient interactions are increasing rapidly. If you look at direct healthcare workers, ethnic minorities form the majority of the workforce. In any clinical encounter, both the clinician and the patient have to adhere to principles of civility and respectful interactions.

Data show that when patients experience microaggressions during clinical interactions, they experience anxiety and depression. Their mistrust increases and their adherence to the treatments recommended decreases.

When clinicians encounter racist or otherwise biased patients, they may choose to protect themselves by unconsciously distancing themselves from the patient. This can result in poor quality care.

In keeping with the increasing diversity in the population, patients and clinicians should adhere to a code of conduct that included mutual respect and tolerance for each other

What is the impact of microaggressions and disrespect on women and minorities?

Persistent gender stereotypes and other forms of unconscious bias hold back the careers of women. Though women made up nearly half of medical school assistant deans at fully accredited medical schools in 2013–2014, there is little sign of their advancing to the highest levels of leadership. Elevating women to leadership roles will increase the diversity of thought and perspective. A recent article in the Harvard Business Review pointed out that while training programs and reporting systems won’t end sexual harassment, promoting more women will. The AAMC has acknowledged that women bring a different voice and a different perspective that can help solve many of the problems facing academic medicine today.