Gender harassment, where members of one gender are targets of unwanted verbal or nonverbal behaviors, is highly prevalent in the field of medicine. The gender ratio in the workplace, especially in leadership positions and certain specialties is still male-dominated. 12 This uneven representation may lead to persistence of inappropriate gender based expectations and gender power disparities. 12 This process of gender socialization in which males are rewarded for assertive behavior and females are encouraged to avoid confrontation, may lead to continued harassment by male perpetrators against women along with the hesitation of victims to report and wrongdoings. 12 In the higher education and academic environment, sexual harassment is often seen as permissive due to “whistleblowers” being retaliated against and lack of sanctions against perpetrators. 3 The normalization of sexual harassment and gender bias in these environments leads to individuals lacking faith that their accusations would be taken seriously. The cost to recruit and hire a new physician employee has been estimated to be between $400,000 to $1,200,000 per physician, which may actually motivate organizations to protect its employees against allegations of misconduct. 12 Individuals in roles with lesser power including medical students, residents, and early career physicians may not feel comfortable challenging any misconduct and other sexual harassment. 12 An interesting finding from much of this research is that patients are often the most common perpetrator in instances of sexual harassment in the medical field. A 2018 Medscape study demonstrated that 27% of physicians were sexually harassed by patients while only 7% were harassed by other clinicians, medical personnel, or administrators at their workplace. 13 Dermatology had the highest rate of sexual harassment by a patient (46%), with a separate study reporting that 84% of female dermatologists had experienced some form of sexual harassment from patients. 13 Specific patient-perpetrated behaviors included comments on appearance, questions about marital status, jokes or stories of a sexual nature, and being asked out on a date. 13 Certain factors of medical practice such as 1:1 contact behind closed doors, a perceived power differential between provider and patient, and the concept that medicine is a service industry with providers trained to put patient’s needs first all may attribute to the risk of sexual harassment by patients. 13 Although not as common, sexual harassment certainly occurs against men, especially in the field of medicine. Studies reporting incidence of harassment against males in healthcare demonstrate high variability, possibly inferring that this may be under-reported in many situations. 14 One study interviewing male physicians (residents and attendings) revealed that men appear to experience and interpret sexual harassment differently than women. Men appeared to experience less of an emotional response to harassment but did have a high level of concern of how sexual harassment could affect their professional identity. 14
Instructions: Review the case below and consider the questions that follow. Case Study 1 Dr. C, a PGY-1 resident in emergency medicine, overhears one of her attending physicians making a derogatory comment regarding women physicians while on shift in the emergency department. Dr. C is unsure if this comment is actually a form of sexual harassment because he did not physically touch or harass a specific individual. 1. This behavior would best be described as? A. Gender harassment. B. Sexual coercion. C. Normal emergency department behavior. 2. Consider if this happened in your practice. How could you best respond to this behavior?
Among women in academic faculty positions, 30% were reported to have personally experienced sexual harassment as opposed to men (4%). 7 Among women reporting harassment, 40% reported more severe forms with 59% reporting a perceived negative effect on confidence in themselves as professionals and 47% reporting that these experiences negatively affected their career advancement. 7 Recognizing the prevalence of these behaviors is important to help show that these are not rare occurrences and should not be stigmatized as such. Harassment also commonly occurs among physician residency training programs, where 10.3% of all residents from surgical specialties reported sexual harassment. 8 The most frequent source of sexual harassment of women in this study was patients or patient’s families (31.2%) followed by attending surgeons (30.9%), other residents (15.4%), and nurses or other staff (11.7%). 7 Although causation is not certain, this study did reveal an association between burnout and suicidal thoughts with mistreatment. 8 It is also important to mention the prevalence of sexual harassment among nurses. Since their profession calls for nurses to be physically and emotionally close to patients and families, they are afflicted with the highest rate of harassment within the profession. 9 One systematic review reported the prevalence of sexual harassment against nurses to range from 10% to 87.30%, with different types of harassment including verbal, non-verbal, physical and psychological. 10 The most common perpetrators in this review were from patients (46.59%) followed by physicians (41.12%), patient’s family (27.74%), and other nurses (20%). 9 Study examples such as these demonstrate that sexual harassment and mistreatment in medicine, especially of women, is a frequent occurrence and legitimate concern. Why does sexual harassment occur in an esteemed field such as medicine?
The NASEM report identified four characteristics which creates higher levels of risk for sexual harassment to occur: 3 1. Male-dominated environment, with men in positions of power and authority 2. Organizational tolerance for sexually harassing behavior (failing to take complaints seriously, failing to sanction perpetrators, or failing to protect complainants from retaliation) 3. Hierarchical and dependent relationships between faculty and their trainees 4. Isolating environments in which faculty and trainees spend considerable time. Researchers suggest that in the fields of surgery and emergency medicine, the higher rates of sexual harassment may be attributed to these fields valuing a hierarchical and authoritative workplace with a majority of male leaders. 3 Medical residencies often portray expectations of abusive and rigorous training conditions, and residents may just accept sexual harassment as part of this process, leading to “tolerable sexual harassment”. 3 Students, interns and residents will often spend a considerable amount of time together in intense training conditions such as 24 hour on call shifts where they may be sharing “call rooms” or other similar sleeping areas. This combined with the already present mentoring hierarchy of the attending physician-to-resident-to-intern-to- student relationship creates a breeding ground for opportunities of sexual harassment. Perceptions of what is and what is not sexual harassment surely vary between students, residents, and attending physicians, and the power structure that exists within medicine and enables sexual harassment to occur also likely prevents open dialogue due to fear of retaliation. 10 Newer fields such as hospitalist medicine also demonstrate high levels of sexual harassment and gender discrimination which likely contributes to the high burnout rate and inequities in pay, leadership, and academic opportunities. 11
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