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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Most doctors work in close quarters with patients as well as with colleagues, supervisors, and support staff. And medicine is not a profession isolated from the problem in society with sexual abuse, harassment, or misconduct.
Medscape surveyed more than 3000 male and female physicians about whether they had seen or experienced sexual harassment by patients or coworkers during the prior 4 years, both at or away from the office. Who were the most frequent offenders, and what did they do? How did doctors respond to the misbehavior? How did the harassment affect their job performance and personal lives?
In addition, we asked physicians whether they had been accused of sexual harassment and if so, how valid the accusations were.
(Note: Some totals in this presentation do not equal 100% because of rounding. Also, some comparisons are made with Medscape's 2018 report, which asked about incidents during the prior 3 years vs 4 years in this report.)
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
"Certainly there have been efforts on the part of medical institutions to make explicit the expectations for civil conduct," says Reshma Jagsi, MD, DPhil, who was director of the University of Michigan Center for Bioethics and Social Sciences in Medicine before leaving recently to chair the Department of Radiation Oncology at Emory School of Medicine.
"Still, while I would hope things have gotten better, I think these behaviors are continuing to occur at a shockingly high rate," Jagsi continues.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
This chart shows responses from those physicians who personally experienced harassment from patients. With several of these bad behaviors, male physicians more frequently said they had been victimized than their female counterparts did. Female doctors were likelier to say that they had not encountered any harassing acts from a patient in recent years.
"Over the past few years, there has been a lot of publicity about male patient harassment of physicians and fear of being reported," says Kali Cyrus, MD, MPH, a psychiatrist with Johns Hopkins Medicine. She previously was on a team at the Yale School of Medicine that educates medical students on how to respond to mistreatment.
As for why female patients were more often behind making comments about anatomy or body parts, "maybe women assume men will be okay with this," Cyrus says. "I think there are a lot of stereotypes around sexual aggressivity and how we might expect that from men, in their openness to both receiving and giving it."
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
By far, the most common actions taken by a doctor to deal with a patient's harassment were telling that patient to stop or taking steps to never be alone with them. More punitive responses, including internal or external complaints, were pursued far less often.
"There's a lot of resistance to dismissing a patient" from a medical practice that has an ethical obligation to provide treatment, notes Theresa Rohr-Kirchgraber, MD, FACP, FAMWA, an internist and president of the American Medical Women's Association. "You may have to give them 30 days to find a new physician, or maybe they'll just be assigned to another physician in that practice. A lot of physicians just stop saying anything."
She recalls trying to get a patient dismissed after getting a verbal threat to "hit you on the head with a brick." Her administration would not dismiss the patient but did reassign them to another site.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Doctors who experienced harassment by a patient told Medscape that the more common impacts were typically internalized — for example, how well they concentrated, listened, or conversed, and whether they thought about resigning. Physicians much less often said that the harassment more directly affected their performance through missed work or appointments, treatment mistakes, and the like.
"In medical training, we are taught to act like superheroes, to believe that we are invincible and can focus exclusively on our patients," Jagsi notes. "We try to go above and beyond in terms of minimizing the impact any of our experiences have on the delivery of care. We are reluctant to admit, perhaps, when experiences do affect our professional abilities."
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Nearly two thirds of physicians said that the effects of a patient's bad behavior did not follow them home. Among those who said that harassment did influence their personal lives, self-isolation was their most frequent response. Doctors less often admitted to self-destructive behaviors like overusing food, alcohol, tobacco, or drugs.
"Doctors tend not to seek a lot of mental health treatment, for various reasons," Cyrus says. But "the more severe the harassment, the more it's going to seep into your personal life."
Some physicians who believe a patient's harassing behavior is not affecting their personal lives may not fully realize they are talking with their families less or drinking more, she believes.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Three in four doctors said they had not experienced harassment by a coworker — as a witness, the victim, or the accused — during the past 4 years. If they had, they were twice as likely to be a witness than the victim.
During her family medicine residency in Indianapolis, Carolina Vogel, DO, says she has noticed that "a lot of the time, people don't realize what they experienced was harassment or are afraid to categorize it as harassment. Sometimes, even the term 'harassment' has become a bit of a taboo."
Rohr-Kirchgraber adds that "busy clinicians are running back and forth between patients and may not see all of what is happening. Sometimes, too, things happen and at the time, you think that something is off but are unsure."
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Female doctors were likelier to report they personally experienced sexual abuse, harassment, or misconduct from a coworker sometime within the past 4 years. In our 2018 report, 14% of male physicians and 13% of their female counterparts said that they had personal experience.
Also, men more often said that coworker misbehavior never hit their radar screen — via witnessing or experiencing, or being accused themselves. Four years ago, the gap was much narrower (81% of men, 79% of women).
"The gender differences…reflect the realities of hierarchy and power and control" in medical workplaces, Jagsi believes.
Also, she said she supports a broader definition of "harassment" that would cover "more activities that systematically demean or derogate" and would increase some percentages shown above.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
The four types of misbehavior that physicians said they have experienced most often from a coworker were the same as when patients were the offender. However, with each type of harassment, doctors reported that they experienced it more often from a coworker.
"Relationships with coworkers might be more nuanced and ambiguous" than those with patients, Cyrus observes. "Friendships with coworkers can put you in a situation where people misperceive that closeness and familiarity."
"Also, if your office culture is one where this kind of behavior has happened before, someone might feel less inhibited to do the same thing," she notes.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
The leading types of coworker behaviors that doctors said they only saw in recent years line up pretty well with the types of harassment that they personally experienced. So do the frequencies of the behaviors that top these lists.
"Propositions for sex and these other behaviors definitely still happen" in medical workplaces, Rohr-Kirchgraber says. "As more women get into medicine, hopefully you won't see this happen as much, not as much talking about another person's body in a sexual way. Hopefully folks are learning what makes for poor jokes."
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Over the past 4 years, doctors told Medscape that they experienced an average 10 inappropriate comments about their body and the same number of instances when they felt uncomfortably crowded.
"Each and every one of those experiences systematically accumulates and affects an employee's sense of belonging in the workplace," Jagsi says. "When that employee is a physician, it affects their ability to contribute to their very important mission. So, these are pretty bad statistics."
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Lewd comments, groping, and crowding by a coworker had bigger impacts on a doctor's psyche than did inappropriate social media posts, invitations for a date, or even propositions for sex.
Unwanted messages by social media and text can be deleted with no one else knowing, Cyrus points out, and invitations for a date can be rejected quickly.
"But commenting about your anatomy induces a great deal of self-consciousness, even if it is a compliment," she says. "You can definitely go down the rabbit hole of insecurity: How did they mean what they said? What does it mean for me? It even influences what you decide to wear to work the next day, how you think about clothing.
"And groping and hugging can definitely take you by surprise and make you feel uncomfortable," Cyrus notes.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
When a physician is the target of harassing behavior, by far most often another doctor is cited as the offender. In our 2018 report, 47% of respondents named another doctor, 4% said a medical resident or fellow, and 16% pointed to a nurse.
"Perhaps it is the competitive nature [of practicing medicine] and the balance of power" that lead to physician harassment of other doctors, Rohr-Kirchgraber speculates. Adds Vogel, "I think it's the power dynamic and the hierarchy in the hospital."
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
In our 2018 report, physicians least often said their harasser was a peer (26% of the time).
"Regardless of who is the perpetrator, it's important to remember that sexual harassment is about power and power dynamics, and the fact is that women in medicine, simply by being physicians, are challenging existing hierarchies," Jagsi says.
"It's possible that COVID-19 had an effect, given how much patient treatment went to telemedicine. Doctors definitely had to be more self-reliant and take care of their own support. Oftentimes, they were interacting only with peers" as work went increasingly virtual, she further notes.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Nearly 4 in 10 doctors said that they took no action in response to harassment. Among those who took action, telling the offender to stop was the most frequent response.
Cyrus says she hoped more physicians would turn to others for help or report the incident. "The culture in medicine is still one where there's a lot of fear of reporting: Will you lose your job, or will you still be stuck here with the other person who hasn't lost their job?"
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
If they told someone (and many did not), physicians who had been harassed were more likely to confide in a colleague or their immediate boss than to take the more formal step of complaining to HR, corporate security, or law enforcement.
As to why doctors might prefer an informal back channel, Rohr-Kirchgraber said they might not "want to get people in trouble and also might be reluctant to be seen as a tattletale, especially if there's a power dynamic to consider. I once reported a situation directly to the CMO for their advice even though I wasn't filing a formal complaint, just to let them know that if they got more reports, they were probably true."
Also, "lamenting among colleagues or people who have been in similar situations gives you confidence to either make a report or screen about whether this was really inappropriate behavior," Vogel adds.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Physicians told Medscape that in effect, most of them did not trust their employer to act on their harassment allegation or investigate it without suggesting that they had overreacted.
"These are incredibly important findings," Jagsi says. "They suggest medical employers over-rely on [complaint] reporting systems. Making reporting easier is not necessarily going to suffice.
"What we need is a cultural transformation to prevent people from engaging in the behaviors that cause harassment in the first place."
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
It's discouraging that 6 in 10 physicians who reported harassment said their employer did not investigate their complaint.
"It's really sad, given how much attention has been paid to this issue and how many lawsuits have been filed, that we still have the majority of cases not being followed up on," Cyrus says.
She believes that many department chairs, directors of academic medical centers, and others in authority want "clear evidence" of harassment and a track record of misbehavior by the offender before they will act. It's not easy to provide that clear evidence when "a lot of these behaviors can fall into an ambiguous zone, even if they're repeated," she adds.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Unfortunately, negative responses from the workplace or retaliation by the offender were the most frequent outcomes when a doctor decided to report harassment. What the physician saw as trivialization by management happened more often than a reprimand of the coworker, termination, or reassignment combined.
"I'm not surprised," Rohr-Kirchgraber says simply.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
One in 50 doctors responding to our survey admitted being accused of these offenses, the same rate as in our 2018 report.
Jagsi speculates that this may understate the problem because some physician offenders may be unwilling to complete a survey on this topic or answer that question, and because formal complaints about sexual harassment often are never filed.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Although only 6% of doctors who acknowledged they personally were accused of misbehavior conceded that the allegation was true, that's more frequent than in our 2018 report (2%). Far more often, physicians said the incident was fabricated, exaggerated, or misconstrued.
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
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Sexual Harassment of Physicians: When Patients or Coworkers Cause Problems
Jon McKenna | December 29, 2022 | Contributor Information
Physicians Behaving Badly: Stress and Hardship Trigger Misconduct
Physicians reveal how often they see fellow doctors misbehaving in person or on social media, and recount some of the worst physician behavior they have witnessed.Medscape Features Slideshows, Aug 2022
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