Sexual Harassment in Healthcare
It is tempting to think sexual harassment is a problem that happens to other people in other places. Sadly, that is not the case. According to Medscape’s 2018 survey of 6,200 physicians, 7 percent of physicians have experienced some form of sexual harassment in the last three years.
by Autumn Dawn Galbreath, MD, MBA
Raise your hand if you have ever had to sit in front of a computer at your workplace and watch a 20- to 30-minute video on sexual harassment. Raise your hand if you have ever thought the video was ridiculous and the examples it gave were so obvious that they were silly. Sexual harassment training can sometimes seem like harassment in and of itself, and it’s easy to feel like it is a waste of time.
It is tempting to think sexual harassment is a problem that happens to other people in other places. Sadly, that is not the case. According to Medscape’s 2018 survey of 6,200 physicians, 7 percent of physicians have experienced some form of sexual harassment in the last three years.1 The number is even higher (11 percent) among nurses, nurse practitioners and physician assistants. If 7 percent sounds like a small minority of physicians, consider that this statistic means approximately 70,000 U.S. physicians have been harassed in their workplaces in the last three years alone. That is 4.75 times the population of the small town I live in—and that number does not include the 14 percent (or approximately 140,000) of physicians who witnessed an act of sexual harassment. Sexual harassment is happening in healthcare, despite the annual training videos, the news reports about sexual harassment in other industries and the generally increased national awareness of sexual harassment as a problem.
As I talked with women in healthcare about this topic, I found that most have stories about being sexually harassed, with residency being a particularly vulnerable time. From “So, how’s your sex life?” from an attending across the operating table to “Are you pregnant? It looks like the booby fairy came!” from a male nurse on the ward, inappropriate comments are the most common type of sexual harassment experience these women report. But some women’s experiences extend to unwanted back rubs, requests for sex in call rooms, men publically viewing pornography in shared co-ed call rooms and even rape on hospital grounds. While some stories are years old, there are plenty of recent and current examples to support the data in Medscape’s study.
And women are not the only victims of sexual harassment in healthcare. Recently, I came upon a conversation in which a group of women was looking at pictures of the male physicians and rating them on their looks. One doctor is often called “Dr. McDreamy,” both behind his back and to his face. And there is a quite a bit of discussion about staff members who have married male doctors, from “How did she manage to snag him?” to comments about wanting to “take lessons on marrying a doctor” from her. In addition, Medscape’s large survey shows that some male doctors are sexually harassed by other male doctors or staff, with 23 percent of the male physicians who reported harassment reporting that the harasser was also male. Furthermore, in addition to the complex dynamics between colleagues, physicians can also be sexually harassed by patients. From lewd comments during a genital exam to being fondled by a patient while holding pressure on a bleeding femoral vessel, many physicians describe uncomfortable situations with patients.
"During team sign out in the evening, the male chief resident told me, ‘I brought a family pack of condoms and some movies. Let’s see what the night brings.’” —Female surgical resident.
Before we proceed with the specifics of the problem in healthcare, let’s agree on the basics. What is sexual harassment? The Equal Employment Opportunity Commission (EEOC) defines it as “unwelcome sexual advances, requests for sexual favors and other verbal or physical harassment of a sexual nature” and then specifies that, although “the law doesn’t prohibit simple teasing, offhand comments, or isolated incidents that are not very serious, harassment is illegal when it is so frequent or severe that it creates a hostile or offensive work environment or when it results in an adverse employment decision (such as the victim being fired or demoted).”2
Furthermore, according to Psychology Today, “sexual harassment can and does run the gamut from demeaning comments to requests for sexual favors to unwanted sexual advances. In addition, it doesn’t always but certainly can include sexual assault, which is any non-consensual or coerced sexual act, including sexual touching.”3 The stereotype of sexual harassment is a woman employee being harassed by a male superior, but both men and women can be perpetrators of sexual harassment, while the perpetrator does not have to be in a superior position to the victim. In fact, in Medscape’s recent survey, only 37 percent of victims of sexual harassment reported that their harasser was in a superior position to theirs. The remaining victims were harassed by a colleague in an inferior or equal position.
Healthcare’s challenges in this area are not unique. Sexual harassment has become almost commonplace in the media over the last year. According to one website’s count, “219 celebrities, politicians, CEOs and others…have been accused of sexual misconduct since April 2017.”4 The #Me-Too movement generated millions of social media posts in more than 85 countries, and TIME Magazine named “The Silence Breakers” (the voices of the #MeToo movement) their 2017 Person of the Year. As healthcare professionals and as Christians, we are marinating in a culture in which sexual harassment remains a backdrop to finding and keeping a good job and to climbing the ladder of success in one’s profession. One recent poll shows that 81 percent of women and 43 percent of men have experienced some form of sexual harassment in their lifetimes,5 while other polls show a figure closer to 20 percent.6 While this is a wide range, even 20 percent is an unacceptably high number of Americans having been harassed in their workplaces while simply trying to do their jobs.
"During my surgery rotation the attending I was assigned addressed me as ‘the little girl’ for the entire eight weeks. We were required to give a presentation to the entire department and the attending introduced me to give my talk as ‘the little girl.’” —Female medical student.
Most Americans would agree that individuals should be able to perform their job duties without fear of harassment. Yet some individuals harass. Why? It is possible they are simply tone deaf to the impact of their words and actions, particularly if they came of age in a time when disparaging remarks toward others were more common. But it’s also possible certain psychological characteristics set them apart from the rest of the population. Dr. Ellen Hendrik-son hypothesizes that harassers are narcissistic, manipulative, Machiavellian individuals who morally disengage from their actions in order to justify themselves and dehumanize their victims.3 Since a wide range of behaviors constitute sexual harassment, there is likely a wide variety of reasons why perpetrators harass, ranging from problematic lack of awareness to malignant destructiveness. The difficult thing about harassment is that the definition hinges on the effect of the behavior, not the intent of the behavior. So teasingly disparaging a colleague can have the same result as intentional insults if the impact on the victim is equivalent.
Dr. Gregory Hood posits that issues “of sexual harassment are simultaneously extremely complex and yet profoundly straightforward. What may seem like flirting to one person may constitute sexual harassment to another.”7 Clearly, defining and recognizing sexual harassment is not an exact science. This is a complex interaction between multiple people from different backgrounds with different perspectives, and arguably there are times when the perpetrator of the harassment does not expect the words or actions to have a negative impact. In fact, in Medscape’s confidential, anonymous survey, very few doctors who were accused of sexual harassment agreed their behavior had crossed that line.
But if the victim and the perpetrator do not agree that the behavior in question was harassment, how is this adjudicated? There are two critical factors in this equation: (1) the victim is believed and supported, and (2) the accused perpetrator receives due process. Unfortunately, healthcare does not have a shining legacy in either regard. Many victims’ stories end with no action being taken after they report their harasser. In fact, according to Medscape’s survey, less than one-quarter of events that were reported were officially investigated. The rationale for not launching an investigation ranges from minimizing the event to being concerned about the impact on the perpetrator’s career, but the end result is the same: the event is not investigated and everyone loses. On the other hand, even when incidents are officially investigated, the outcome is not always good. According to Medscape’s survey, the perpetrator’s behavior can be trivialized (27 percent), the perpetrator can retaliate against the victim who reported the incident (16 percent), the organization’s management can retaliate against the victim (15 percent) or the organization can take no action (37 percent).1
Whether the incident is not investigated or the investigation does not result in appropriate action, the victim is left feeling violated and deprived of the opportunity to officially tell their story. The perpetrator is left with an unresolved accusation. If they are guilty of inappropriate behavior, they are not held accountable and may continue to offend, possibly in more serious ways. On the other hand, if they are not guilty of inappropriate behavior, the accusation hangs ominously in the air and the accused has no opportunity to defend himself. The institution is left with an unresolved issue between two of its personnel, which can cause a rancorous relationship and an undercurrent of concern or mistrust, as well as a breakdown of collegiality in other relationships. And, if the accused is guilty, the institution is left with a perpetrator whose behavior is unchanged and others in the institution will likely be affected.
Presumably out of fear of these possible outcomes, many victims of sexual harassment do not even report the behavior to the institution in the first place. In fact, 60 percent of Medscape’s respondents stated they did not report their harasser at all. Power dynamics in the workplace appear to play a role in the decision to report, as medical residents were more likely (78 percent) than working physicians (55 percent) to keep silent and not confront or report the perpetrator. These silent victims often continue to work in what has become a very stressful work environment, with 36 percent stating the incident was “very upsetting” and 18 percent reporting the incident “interfered significantly” with their ability to do their job. More than 10 percent of victims reported actually quitting their jobs due to the harassment, and about one-third reported various coping mechanisms ranging from isolating themselves to food, sleep or alcohol/drug/tobacco use.1
In his blog post “Culture Quake,” pastor and author James Emery White wrote, “They wrestle with guilt. They wonder if they somehow asked for it. Could they have deflected it? Were they making a big deal out of nothing? And that brings about the darkest kind of shame there is. It’s the shame you feel for what was done to you. When you’re the victim, yet you feel the shame of how you were victimized. Instead of seeing the shame belonging to the perpetrators, you take it on as the victim.”8
Sexual harassment is not dead in healthcare. In fact, we have a long way to go. And sexual harassment is particularly reproachful among a group of highly educated and gifted individuals who are held to a higher standard. Since the time of Hippocrates in the fourth century B.C., our profession has espoused a commitment to serving others with honor and compassion. Most of us recited the Hippocratic Oath when we graduated from medical school, stating: “Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free.” Given our undertaking to care for others as physicians, and given our promises to “help the sick” and “abstain from all wrong-doing and harm,” we are duty-bound to join the fight against sexual harassment in our own profession. As Dr. Hood wrote, “In the healthcare professions, we’re committed to being of service to others, to maintain a higher standard, and, above all else, to do no harm. There may be no greater abrogation of our responsibilities than to commit an infraction of a personal, sexual nature upon another person. Equally bad would be to witness another person engaging in such activity without taking appropriate action in response.”7
Furthermore, as Christian healthcare professionals, we are doubly committed to a higher standard. Sadly, the church has been in the news recently as much as any secular institution with regard to sexual wrongdoing. With two prominent evangelical pastors accused of sexually harassing multiple women and a huge cover-up of sexual misdeeds having been exposed in the Catholic church, American Christianity seems to have ceded the moral high ground in this area. And yet, we cannot deny that we are called to sexual purity as individual Christ-followers.
"One attending nicknamed female students with fruit names based on their breast size.” —Female medical student.
More than 2,000 years ago, the apostle Paul cautioned that we “flee the evil desires of youth, and pursue righteousness, faith, love and peace, along with those who call on the Lord out of a pure heart” (2 Timothy 2:22). He also cautioned us to treat “...older women as mothers, and younger women as sisters, with absolute purity” (1 Timothy 5:2). Sexual misconduct is a long-standing problem for humanity. And yet, sexism and its expression have no place among God’s people. As Pastor White writes, “When God created mankind, He made us male and female. Men and women. And the Bible says that both were made, equally, in the image of God. There’s not more of the image of God in one than the other. And we have been given a mutual charge to steward the world. Together. There is not an ounce of sex-ism in what God created, how God created, or the intent of God’s creation of us as men and women.” 9 a discernment to know right from wrong, as well as a renewed commitment to follow a path of righteousness.
Sexual harassment and misconduct is a difficult area to navigate. It is integrally interwoven with the history of healthcare, with our collegial relationships, with the politics of the organizations where we work and even with the reputation of the Christian church in the world today. And yet navigate it we must. We must hold ourselves apart from the behaviors that harass both men and women. We must confront those who engage in such behaviors in our workplaces. And we must “stand with the oppressed and assaulted and harassed and demeaned and disrespected no matter who the perpetrator may be.”9 Because we are healthcare professionals who have committed to caring for the well-being of others, and because we are Christians who are called to protect and defend the vulnerable.
As caretakers, protectors and defenders, how should we respond to this difficult issue? If you have been guilty of sexual harassment, then I pray you will have the conviction and courage to seek forgiveness from God and those you have offended. If you have been guilty of turning a blind eye to sexual harassment, then I pray God will give you eyes to see and the courage to respond. If you have ever been a victim of sexual harassment, I pray for healing, as well as for justice and protection in your workplace. And for all of us, may we have a discernment to know right from wrong, as well as a renewed commitment to follow a path of righteousness.
"I have been grabbed repeatedly by a male nurse, even once my rear was forcibly grabbed and groped while treating a patient under anesthesia. When I made a complaint, nothing happened to him. They forced us to keep working together. It has been a demoralizing experience.” —Male attending.
1 Leslie, K., MA. (2018, June 13). Sexual Harassment of Physicians: Report 2018. Retrieved September 01, 2018, from https://www.med- scape.com/slideshow/sexual-harassment-of-physicians-6010304.
2 Sexual Harassment. (n.d.). Retrieved from https://www.eeoc.gov/ laws/types/sexual_harassment.cfm.
3 Hendrikson, E., PhD. (2017, November 9). Four Psychological Traits of Sexual Harassers. Retrieved September 01, 2018, from https://www.psychologytoday.com/us/blog/how-be-yourself/201711/four-psychological-traits-sexual-harassers.
4 North, A. (2017, December 22). More than 200 powerful people have been accused of sexual misconduct in the past year. Here’s a running list. Retrieved September 01, 2018, from https://www.vox. com/a/sexual-harassment-assault-allegations-list.
5 Kearl, H. (2018, February). 2018 Study on Sexual Harassment and Assault. Retrieved September 01, 2018, from http://www.stopstreetharassment.org/ resources/2018-national-sexual-abuse-report/.
6 Lee, H. (2017, December 19). One-fifth of American adults have experienced sexual harassment at work, CNBC survey says. Retrieved Septem-ber 01, 2018, from https://www.cnbc.com/2017/12/19/one-fifth-of-american-adults-have-been-sexually-harassed-at-work.html.
7 Hood, G. A., MD. (2018, June 13). What We Can Do Together to Fight Sexual Harassment. Retrieved September 01, 2018, from https://www.medscape. com/viewarticle/897875?src=WNL_bom_180702_MSCPEDIT&uac=121128 EX&impID=1674167&faf=1.
8 White, J. E. (2018, February 8). Sexism. Retrieved September 01, 2018, from https://www.churchandculture.org/blog/2018/2/8/sexism.
9 White, J. E. (2018, February 5). Culture Quake. Retrieved September 01, 2018, from https://www.churchandculture.org/blog/2018/2/5/culture-quake.