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CHICAGO -- What barriers are there to reporting sexual harassment in medicine? What can bystanders do when they witness inappropriate behavior among healthcare providers? What are the consequences, real and perceived, to filing complaints?
Experts in law, psychiatry, and academia discussed these and other questions during a panel focused on the #MeToo movement at the American Medical Association (AMA) House of Delegates meeting here.
Henry Lin, MD, a pediatric gastroenterologist and the associate medical director of the Office of Safety and Medical Operations at the Children's Hospital of Philadelphia, offered this scenario: A female surgery fellow completes a challenging maneuver in the operating room. A male attending observes the maneuver, slaps the fellow on the rear-end, and says "Atta girl."
This is sexual harassment, the panelists agreed.
The audience -- well over 100 participants -- agreed, but by a show of hands voted that the attending should not lose his job assuming this was an "isolated incident." Instead, they voted that the male attending should receive counseling, and attend a program about sexual harassment.
David Gabor, JD, a partner with the Wagner Law Group in the Boston area, also recommended speaking with other people who work with the male attending to see that the behavior has stopped, and confirmation by the target of the harassment that no retaliation occurred.
"In that situation, at the very least, it should be a last-chance warning [to the male attending physician]," he said. "Meaning 'You mess up one more time, you're out.'"
Status Matters
But what if the physician in the scenario is the chief of surgery, asked AMA delegate Krishna Sawhney, MD, a general and vascular surgeon at the Henry Ford Health System in Detroit.
"We are very good at handling our junior staff, but when it comes to our seniors, we are total failures," he said.
Panelists referenced remarks made by Australian surgeon who suggested junior women physicians should give in to requests for sexual favors rather than report complaints that could threaten their careers.
"The worst thing you could possibly do is to complain to the supervising body because then ... you can be sure that you will never be appointed to a major public hospital," McMullin said in
McMullin claimed that her statement was meant ironically. Panelists did not support her proposed strategy, even ironically, but did not disagree that sexual harassment reporting can potentially hurt a career.
Problems Persist
A 1995 cross-sectional survey of women at U.S. academic medical facilities found 52% of women physicians said they had been sexually harassed versus 5% of surveyed men, said panelist Reshma Jagsi, MD, a radiation oncologist and director of the Center for Bioethics and Social Sciences at the University of Michigan in Ann Arbor.
Jagsi used the same questions from the 1995 survey for her own , asking respondents if they had received "unwanted sexual comments" or advances from superiors or colleagues. She reported that, nearly 20 years later, 30% of women physicians still answered "yes" versus 4% of men.
In the study, among the women reporting harassment in the study, 59% perceived "a negative effect on confidence in themselves as professionals" and 47% said their experiences "negatively affected their career advancement."
Jagsi recounted her , and stressed the importance of having "allies." She said that when a senior physician made several suggestive comments, and tried to walk with her to her hotel, she literally latched onto a female colleague, who read the situation and understood it.
Fortunately, Jagsi said she was not harmed by the incident, but she did give up a "valuable scholarship experience," because of it. Click here for an earlier 鶹ý interview with Jagsi.
Jagsi said she has received countless emails from female physicians about harassment. She said she urged them to go public with their experiences, but they declined, expressing concerns about retaliation or marginalization.
Make It an Issue
The panelists stressed that institutions need to be more proactive in dealing with sexual harassment.
Jagsi said researching sexual harassment needs to be a priority -- finding out where it's occurring and how often, and then sharing that information. "That's a way of making it clear to the entire community that this behavior will not be accepted," she said.
She also encourages anonymous reporting systems and, in a follow-up email to 鶹ý, underscored the importance of "clear, well-disseminated, and well-enforced policies" around reporting and sanctions.
Gabor recommended live trainings to teach about sexual harassment, rather than "canned" online programs. The latter encourage people to multi-task, disregard the material, and lack opportunities for discussion, he said.
Tiffani Bell, MD, a child psychiatry fellow at Wake Forest University in Winston-Salem, North Carolina, spoke of the importance of having mentors to guide junior physicians through challenging situations.
"There is a realistic risk that quite possibly [reporting] could have lasting effects, and that's when ... it really matters that you have mentors and connections elsewhere, because potentially you could transition into another program," Bell told 鶹ý.
Even if the targets of sexual harassment choose not to report incidents, Bell encouraged them to seek professional help. Exposure to harassment can lead to symptoms such as post-traumatic stress disorder, weight loss or gain, and anxiety or depression, and its important to have them evaluated, she noted.
All of the panelists noted the role of engaged bystanders, who can distract the harasser, removing the target of the harassment, or report the incident, Jagsi said.
Nancy Church, MD, an obstetrician-gynecologist in Oak Lawn, Illinois and a representative for the American Medical Women's Association, told 鶹ý that she uses humor to defuse tense situations.
She described a female colleague who wouldn't respond when a male surgeon repeatedly called her "honey. Finally, he said 'You, come here'... She was the only woman in the room, and she said 'Oh, I didn't realize you were talking to me.'"
"A sense of humor makes a big difference. It's then no longer confrontational, but it is without [men] realizing it," said Church, who was not on the panel.
Asked whether reporting an incident could hurt a female physician's career chances, Church said, "You have to figure out what is worth it to fight... and what will hurt you if you fight it. If it will hurt you ... you do what you can to work around it. I work around it by coming to these workshops and speaking up; training my junior residents in how to handle things."
鶹ý asked Jagsi in a follow-up email if she was hopeful about ending sexual harassment in medicine.
"I think there is reason -- especially now that the #MeToo movement has opened up a national conversation about these issues -- to be hopeful that we can indeed achieve the cultural transformation we need," she said.
The "hierarchical nature" of medicine does make the problem more challenging, but "we -- men and women alike, whether senior leaders in the field or just starting as trainees -- must ourselves commit to be allies to whom targets of inappropriate behavior can turn, and who will speak up when we see something is wrong," she stated.