Some men reported a concern that, because of their gender, they would be held responsible for the inappropriate encounter and may not be believed if the encounter was reported by the woman involved as well. 14 When witnessing male colleagues making inappropriate comments, none of the interview responders reported speaking up or attempting to stop the behavior, but were more likely to respond when a female trainee (student or resident) was being harassed. 14 This interview study revealed that more work needs to be completed to help males deal and respond to sexual harassment, either when experienced by themselves or witnessed as bystanders. 14 Effects of Sexual Harassment Sexual harassment awareness initiatives like the #MeToo movement have helped to demonstrate the profound consequences of sexual harassment on the mental and physical health of those affected. Research has demonstrated that women’s experiences with sexual harassment are associated with reductions in their professional, psychological, and physical health. 3 The relationships between sexual harassment and these outcomes also remain significant when controlling for other factors such as the experiences of other stressors, other features of the job, personality, and other demographic factors. 3 The more often women experience sexual harassment the more likely they are to leave a job which ultimately leads to a loss of talent and overall negative consequences. 3 In regards to professional outcomes, sexual harassment has been linked to the following: 3 • Decrease in job satisfaction • Work withdrawal (targets disengaging from work but not actually leaving their job) • Job withdrawal (targets intentions to leave their job through turnover or retirement) • Reduced productivity and performance (not just targets but also team or workgroup productivity) • Reduced commitment of individuals to their organization • Stress • Loss of employment Among women in science, engineering, and medicine in higher education, responses to sexual harassment predominantly include stepping down from leadership opportunities to avoid the perpetrator, leaving their institution, or leaving their field altogether. 3 Sexual harassment may affect women seeking career and academic advancement as well. Women seeking advance opportunities, especially in academic medicine, may have increased opportunity for exposure to sexual harassment. 15 These are often male dominated professions where advancement opportunities depend on a hierarchical power structure. Sexual harassment from a supervisor or colleague can include “quid pro quo” harassment, making women seeking advancement more vulnerable to these unwelcome advances.
Experiencing sexual harassment likely affects mental health and overall well-being as well. The more often women experience sexual harassment, the more they report symptoms of depression, stress and anxiety, and impaired psychological well- being. 3 Other psychological outcomes include: 3 • Negative mood • Fear
The common characteristics of organizations with a permissive climate towards sexual harassment include: 3 • Perceived risk to victims reporting harassment • Lack of sanctions against offenders • The perception that one’s complaints will not be taken seriously Having a positive organizational climate can lead to decreased sexual harassment rates, reduced retaliation against those who confront and report harassment, and results in better psychological health and workplace experiences. 3 Any changes must begin with leadership, who must maintain a respectful, diverse, and inclusive workplace in which any types of harassment are not acceptable. Having a system in place in which employees, including leadership, are held accountable for their actions and behavior is necessary. More importantly is that those who engage in harassment are held responsible in a meaningful and appropriate manner. Formal reports against misconduct and harassment are important, but often miss many cases of unreported harassment. These mechanisms should be supplemented with proactive efforts to fix the organizational climate that is tolerating and facilitating sexual harassment. 3 According to the NASEM report, the following approaches should be undertaken for an organization to reduce and/or eliminate sexual harassment: 3 • Create a diverse, inclusive, and respectful environment • Diffuse the power structure and reduce isolation • Develop supportive structures and systems for those who experience sexual harassment • Improve transparency and accountability • Ensure there is diverse, effective and accountable leadership that is unambiguous about its commitment to reducing and eliminating harassment • Develop and use sexual harassment training Organizational leadership should work to develop formal policies against sexual harassment. Recommendations for anti-harassment polices and procedures include: 18 • Maintaining a comprehensive anti-harassment policy (which prohibits harassment based in any characteristic) • Ensuring that said policy is communicated to employers regularly and in a variety of forms and methods • Offering a range of reporting methods for formal reports of harassment • Taking steps to ensure that retaliation against reporting does not occur • Ensure that when harassment occurs, discipline is prompt and proportional to the behavior that occurred, while maintaining confidentiality for all parties involved
• Disordered eating • Lower self-esteem • Increased alcohol and illicit drug use • Anger • Lower satisfaction with life in general
The negative and sometimes debilitating psychological effects certainly have the potential to affect professional and personal lives as well. One could ascertain that these effects could contribute to lack of interest and passion at work, work withdrawal (disengaging from your employment), and ultimately loss of employment which could further stress mental health and well-being. Although not as well studied, sexual harassment may also contribute to an individual’s physical health as well. Women who experience psychological distress may report stress-related physical complaints such as headaches, exhaustion, sleep problems, gastric problems, respiratory complaints, musculoskeletal pain, weight loss/gain. 3 One study by JAMA evaluated women ages 40-60 years who were previously free of cardiovascular disease and concluded a prior history of sexual harassment was related to greater odds of hypertension along with clinically relevant depressive symptoms, anxiety, and poor sleep. 16 A major recent topic among physicians and in health care has been burnout. Burnout is a constellation of symptoms caused by a deterioration of one’s values, dignity, spirit and will, with the three main symptoms including exhaustion, depersonalization, and lack of efficacy. 17 Burnout is important because of direct link to negative consequences such as lower patient satisfaction and care quality, higher medical error rates and malpractice risk, higher physician turnover, drug and alcohol abuse and addiction, and finally physician suicide. 17 A 2018 poll reported out of 15,000 physicians, more than 42% reported burnout. 12 A poll study of female physicians from Louisiana demonstrated a strong correlation between gender harassment and physician burnout. 12 Strategies to Prevent Sexual Harassment Understanding the prevalence and consequences of sexual harassment in medicine is important, but learning to mitigate and prevent further sexual harassment is the only way to help eliminate this serious problem. Although sexual harassment is often an individual behavior, organizational climate and workplace environment likely has the greatest impact in enabling sexual harassment and continuing to allow it to occur. Organizational climate is defined as the shared perceptions within an organization of the policies, procedures, and practices in place. 3
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