#MeToo in medicine

Kirsten Patrick is Deputy Editor at CMAJ

 

This post really needs no introduction. First came #WomenBoycottTwitter when Twitter straightjacketed Rose McGowan and women reacted angrily to what they felt was unfair ‘victim silencing’. But many pointed out the irony and probable ineffectiveness of self-imposed silence to protest enforced silence. Then yesterday my social media feeds were full of the hashtag #MeToo along with story after story after story from women friends, of sexual harassment, abuse and unwanted physical attention. Women I look up to; tough women…the sort about whom you might think, “It would never happen to them.” Lawyers, a chemistry professor, a neuroscientist, respected colleagues in medical research.

Last week, writer Anne Donahue tweeted, “When did you meet YOUR Harvey Weinstein? I’ll go first…,” which has tens of thousands of replies and ‘quote’ retweets and prompted Trevor Noah to tweet "The number of replies to this tweet is insane. As men we have to do better to stop this."

One reply came through my Twitter feed,

Regularly in the Operating Room when surgeons would approach from behind while I was 'scrubbing' at the sink, hence unable to move.

Boom. Yes. Instantly, I was reminded of the myriad opportunities within the medical work environment for those who would ‘take’ inappropriate physical contact from those who are quite unable to do anything to avoid it.

Among the #MeToo posts I read yesterday was one owning to

'just' harassment, not assault, which makes me lucky... which makes me furious that only being harassed counts as 'lucky'!

That reflected my own feelings rather well. For me it was...

Only the male friend of my parents who liked to poke or tickle girls and women between the ribs - in my case until I peed myself, which made me embarrassed and ashamed.

Only the swim coach who liked to give us back massages and suggested that swimsuit straps got in the way.

Only the man who exposed himself to me when I was walking my dog.

Only the gastroenterology consultant on the unit in the hospital where I interned who boldly suggested we have sex, and seemed to believe that it was clear that I was leading him on because sometimes I wore skirts that showed off my ‘nice legs’ and I’d once bought him a chocolate bar to thank him for seeing a patient of mine really quickly – of course that meant I was asking to be propositioned, right?

Only the orthopaedic resident who, when I was the anaesthetic junior covering the ortho emergency list one night, naturally assumed that when I offered to help him ‘close’ a long leg incision so that we could both get finished a little quicker, what I was actually hoping for was that the two of us could hook up afterwards.

That last one may need some explanation. It had been a crazy night with too many broken patients and not even a bathroom break. I was exhausted. The ortho resident was inexperienced and slow; his colleague had left him to close on his own. My anaesthetic assistant was experienced and more than able to monitor this stable patient for 20 minutes. I had done a basic surgery course prior to working in a rural hospital and had substantial recent surgical experience. I knew I could close that incision in a fifth of the time that it would take the ortho resident to do it and that if I helped we might all get a break. He said okay so I scrubbed and we set to work. I started with the inmost ‘layer’ and he followed behind with the next. We worked right next to each other. Whereas before he had barely acknowledged my existence, now suddenly he was overfamiliar, pressing his body up against mine; he stared at my face in a way that made me feel uncomfortable, especially given the close proximity in which we were working; he made comments about my appearance while doing so. I began to feel nauseous and to sweat. When we were done suturing the tissue layers I left him to close skin with clips while I got on with finishing the anaesthetic. I took the patient to recovery. He followed me there. Surgeons never came to recovery. The recovery nurse gave me a look. I gave her a look back. Perhaps the surgeon had a reputation. I don’t know. But she invented a story. A call from my senior who’d asked me to help him in the intensive care unit. I took my ‘break’ in the women’s changeroom rather than the doctors’ tea room. Later the operating department nurses told me that the orthopaedic resident had been looking for me.

These are just a few of my mild ‘me-too’ stories. Others have had it much much worse. I watched the career of a friend in my graduating class who wanted to be a plastic surgeon. It was the late '90s. To say Surgery in our academic hospital was male-dominated would be to euphemize. What she had to suck up every day for years to achieve her dream was sickening. The only female general surgeon in the large academic hospital where I completed my internship was overtly harassed, bullied and belittled to burnout by her male colleagues – and their diagnosis? “She just couldn’t cut it.” There are blurred lines between endemic misogyny and sexual harassment in medicine. Nurses and medical students, in my experience, bear the worst of it; medical students seem to feel the need to suck it up most quietly to avoid jeopardizing their future careers.

I want to emphasise that the vast majority of my experiences with both male and female colleagues in my medical career have been respectful, positive and free from any inappropriateness. But sexual harassment and assault are still too common.

A survey of interns and residents enrolled in one California internal medicine program, published in the NEJM in 1993, found that 73% of women and 22% of men reported that they had been sexually harassed at least once during their training and that this had created a hostile environment that interfered with their work performance. Almost nobody reported it. It was a small survey but pretty groundbreaking at the time.

In 2016, research published in JAMA aimed to quantify the extent of perceived gender bias, gender advancement and sexual harassment among recipients of NIH medical research grant between 2006 and 2009. Questions about these things were embedded in a longer questionnaire about career issues in general. 30% of women surveyed reported experiencing sexual harassment compared with 4% of men; of those women 40% reported a severe form of harassment and a large majority said that it had impacted their professional confidence or negatively affected their career advancement.

In those surveys most of the respondents were white, but let's not forget that women of colour are frequently even more vulnerable to assault and to being silenced than white women.

Things may be changing as medicine feminizes. Yet we still have a long way to go. I've shared my experiences with other women and heard their stories. We all agree that our 'today' selves would have handled the situations differently. I believe that we can use our hindsight to help the women that are starting out in this career, to help them to tackle head on what we felt we needed to sweep under the carpet. As we women climb the ladder in medicine we need to clean it. We should point out the dirt, loudly and deliberately, and look backwards to check on the fate of those climbing after us.

3 thoughts on “#MeToo in medicine

  1. Christine OConnor

    “Things may be changing as medicine feminizes. Yet we still have a long way to go. I’ve shared my experiences with other women and heard their stories. We all agree that our ‘today’ selves would have handled the situations differently. I believe that we can use our hindsight to help the women that are starting out in this career, to help them to tackle head on what we felt we needed to sweep under the carpet. As we women climb the ladder in medicine we need to clean it. We should point out the dirt, loudly and deliberately, and look backwards to check on the fate of those climbing after us.”

    Did anyone else feel at the end of the article an emphasis on what women “should” be doing to prevent sexual harassment, and miss the presence of any sort of strong suggestion that men also play a role in this work? Is anyone else frustrated by this?

    Reply
  2. Kirsten Patrick

    Good point, Christine. Men really do have a role to play. Later in my career I was amazed and pleased to see a male work colleague tell another male colleague that his comments about a female colleague’s appearance were not okay. I felt good that this happened and I thought it was brave because the colleague giving the schooling was younger than the one being inappropriate. More men need to do this. But things won’t change if we wait for them to do it. If we are silent – as I have been in many situations…not wanting to be seen as oversensitive or making excuses for it – we are giving the message that it’s acceptable to us. I believe it has to be us. Men can join in or not – and many have, and will – but we have to do it for ourselves.
    Kirsten

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  3. Louise B Andrew MD JD FIFEM

    This certainly struck a cord. On impulse I had googled “metoo medicine” to see if anyone has yet attempted to collate stories of women in THIS hierarchy who have been sexually harassed or assaulted. I think many in the public would find it hard to believe that women physicians too are often victims of such sexualized bullying, and perhaps it would make them realize that they are not “weak” for not having been able to fend it off successfully.
    Having trained at two of the top US institutions in medicine I can certainly confirm that such behavior was rampant during my era, although I would like to think it is better now. Although I pursued a second career in law specifically to help physicians handle the stress of litigation, still, under the strong women faculty I enjoyed in law school (having had practically none in medical school or residency) I developed a keen interest in gender discrimination and harassment in medical training, and in fact did my JD thesis on that topic. Naturally, quite a few of the illustrative anecdotes were my own.
    What most galls me about this problem in medicine is that we can be bullied in far more ways than can the ordinary citizen, even or perhaps especially when we are brave enough to pursue a whistleblower role.

    I was once asked to be an expert witness for a Canadian Muslim woman physician who was sham peer reviewed and then fired from her position because she had the audacity to stand up to a harassing department chair who was regularly intimidating and assaulting the nurses. This seasoned emergency physician, herself a former nurse, was suddenly found to be lacking in clinical acumen, as alleged by a newly minted orthopedist at the behest of the departmental chair. (while 30 physician colleagues and all of the departmental nurses wrote letters in support of her clinical excellence). The expert witness for the (US) emergency physician group said she was exaggerating her inability to get a new job (which in my mind was no doubt due to blackballing—quite common in EM) and at any rate, “she could always return to nursing”…

    The large group practice made this abusive department director “Chairman of the Year” and transferred him to a new hospital, where the nurses called the nurses at the prior hospital to see if he had always behaved in such a reprehensible manner as with them. The doctor won her case, but I sincerely doubt she has ever worked in EM again. I hope she got a huge settlement, and I hope she might now be empowered to speak up about this some 15 years hence. But probably not, guessing from the usual US legal system’s confidentiality gags.

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