Sexual harassment is not a new phenomenon in the workplace, and medicine is no exception. Unfortunately, like many women in the medical field, my career has been littered with harassment from the beginning.
Midway through my first year of medical school, I was attending a lecture about the pituitary axis. The professor projected a slide depicting two young women at an antiwar rally during the Bush era. The women were clad in bras and panties that read, "axis of evil," which somehow made it relevant to the pituitary axis. To make matters worse, the professor said, "I'll let everyone appreciate that axis for a minute," pausing before he advanced to the next slide.
I was absolutely floored. I sent my concerns to the school's administration. Keep in mind, this lecture was recorded -- there was no question about what had happened. The result of my complaint? The unfortunate norm, a fake apology during which the professor stated he was sorry that he "offended someone," failing to recognize that his actions were the incorrect part of this equation, not my reaction to them. Outside of his "apology," there were no actual repercussions.
As I progressed into my second and third year, I saw similar patterns of behavior. There was a staff physician who was known for showing female students favor, often commenting on their appearance. His behavior made many female students uncomfortable, but none of us reported him. During my time, this physician advanced his position in the school multiple times despite his inappropriate behavior.
Fast forward a few years, and I'd matched into my preferred specialty -- emergency medicine. I was blowing off steam at a house party with a number of residents, with a few attending physicians also in the mix. I had walked into the mudroom to put a can in the recycling bin, when I heard the door shut behind me unexpectedly. I spun around to see that a male attending had followed me into the small room and closed the door, isolating me from the rest of the party.
As he leered at me, I tried to avert danger by saying, "We should really get back to the party before people notice we're missing." Unfortunately, my polite suggestion fell on deaf ears as he lurched forward, trying to kiss me. I managed to sidestep his advance and rushed through the door, back to the group. I quickly found one of my trusted resident friends, explained what happened, and asked them to make sure I wasn't left alone with that attending again.
I wish I could say I reported this event to leadership and that my experience resulted in real change, but sadly, this is not the case. Like so many others, I did not file a complaint.
A Tragically Common Occurrence
My experience is not unique. The rates of sexual harassment are much higher in medicine than in other occupations or sciences. In 2018, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a detailed report entitled . This damning report found almost 50% of female medical trainees surveyed reported sexual harassment during their training. This is consistent with a 2000 Annals of Internal Medicine almost 50% of academic female physicians reporting sexual harassment.
Why is this behavior so pervasive? Much of it has to do with the structure of the medical education system. Firstly, men dominate leadership roles. A report by the American Medical Association women comprise a mere 3% of healthcare CMOs, 6% of department chairs, and 9% of division chiefs. Without women in leadership, these bad behaviors are less likely to be addressed, and are more likely to be minimized.
Secondly, the high-stakes nature of medical training compounds the issue. Harassers are likely preceptors or other attendings involved in grading students. Trainees may feel pressure to react positively to advances for fear of professional repercussions if they refuse or report the behavior. In the , only 21% of students who experienced harassment reported the behavior to faculty. Given the amount of time and money that trainees put into their careers, they often avoid actions that could jeopardize their current and future success.
Lastly, and most meaningful to me, a pervasive fear of ostracization from one's peers may present a barrier to reporting problematic behavior. In my situation, I feared I would be perceived as creating problems for a universally-liked faculty member. In the eyes of some, I would be the one on trial. Had I flirted with him? Had I given him some indication I was interested in a sexual liaison? Had I been drinking alcohol at the party that clouded my memory? Anyone who has completed residency knows the training is grueling enough without being the center of rumors and animosity from peers.
Stifling the Plague of Sexual Harassment in Medicine
What can we do to be better? To begin with, the set of behaviors and culture that define sexual harassment should be clearly laid out by medical education institutions, hospitals, and other health establishments. Additionally, they must regularly reiterate -- verbally and on paper -- that these behaviors will not be tolerated. Written, well-known policies for reporting sexual harassment would then follow. These policies need clear channels for reporting that also create and ensure a safe space for victims. Promoting women into leadership positions would also go a long way to combat outdated and harmful attitudes and actions.
Lastly, be an advocate yourself and encourage others to do so as well. Keep your eyes open for any untoward behavior, and if you see any, say something. If a trainee reports sexual harassment to you, believe them, and help them navigate the reporting process. We can be better.
is an emergency medicine doctor and the Facility Medical Director for the Emergency Department at Albany General Hospital in Albany, Oregon.