#MeToo Stories: Sexual Harassment Pervasive in Medicine

Tara Haelle

December 18, 2017

When Reshma Jagsi, MD, DPhil, a physician at the University of Michigan in Ann Arbor, was about to leave a professional society dinner, she expected she had finally escaped the male surgeon who had been making sexual advances at her all evening — although she had rejected all of them, he had not been deterred, as predators often are not.

"He accosted me at the cloakroom, intent on walking me to my room," she recounts in a perspective article published online December 13 in the New England Journal of Medicine. She described how the surgeon winked at the cloakroom attendant, saying, "She loves surgeons." When a female surgeon arrived at that moment, Dr Jagsi used that line to escape with the female colleague. The female surgeon immediately understood what was happening and whisked Dr Jagsi away.

Dr Jagsi, who publishes research on sexual harassment, did not initially think of the experience as harassment. It fulfilled the legal criteria for harassment, but her "disconnect" between the behavior and the definition is "remarkably common," she writes.

And yet, she continues, she "gave up a valuable scholarly opportunity just to avoid him," a decision echoed in the words of many women currently coming forward to describe their experiences and participate in the #MeToo movement.

She also describes the feelings other women have shared about experiencing such incidents: "the experience did make me silently question my self-worth: Why was my scholarship not substantial enough for this man to see me as a colleague who has done important research and has worthy ideas, instead of objectifying me?"

Yet Dr Jagsi had remained silent — as most women do, the research shows — even as news reporters writing about #MeToo stories were reaching out for her comments as a result of her research.

She perceived the transgression as "minor" compared with what many others have experienced, but her reticence and anxiety about sharing her own experience stemmed largely from her ambitions in her field. "Being cast as a victim would tarnish my narrative," she writes. "I know that women who report sexual harassment experience marginalization, retaliation, stigmatization, and worse."

A recent article published in Academic Medicine and reported by Medscape Medical News argues the need for medical institutions to establish zero-tolerance policies against sexual harassment, along with the requisite protocols and safeguards that support and enforce that policy.

"Institutions should not sacrifice a safe culture for money," the authors write, and they outline both the scope of the problem and the six steps they recommend institutions take to address it. The first three steps include safe mechanisms for informal and retaliation-free reporting that allows institutions to track perpetrators' behavior, mandatory training with bystander training included, and disciplining and monitoring transgressors, terminating their employment when appropriate.

Their last three include reducing "locker room talk" and similar discussions that can lead to sexual harassment, zero-tolerance policies within medical societies and their events, and more research on the prevalence, severity, nature, and outcomes of sexual harassment and subsequent investigations, along with research into evidence-based prevention and intervention strategies.

But the task ahead of them is large if Dr Jagsi's essay is any indication. In discussing how pervasive the problem is, she recounts some of the many, many stories she has heard from female physicians who reached out to her after reading her research. The experiences ranged from the too-common groping of breasts and buttocks to a woman whose colleague unzipped her dress's front zipper at a conference social activity to a woman raped by her superior during training.

"Others noted remarkably consistent experiences in the operating room that ironically they thought were unique," she writes.

And none of the stories she heard came from women who had reported the incidents. The fear of harming their careers and reputations, which lawyers often confirm is likely, given that human resources departments exist to protect the institution itself, and not necessarily its employees, keeps them silent. That silence then leads to conflict and sometimes regret about the need to balance protecting and advancing their career against the desire to protect other women from their perpetrator.

The stories Dr Jagsi describes may surprise men who read her piece, but they will not surprise women. In fact, she relates early on how her own department chair reacted when he read her research findings that 30% of women have been harassed.

"Like many well-intentioned and normally highly articulate men who are astonished by the #MeToo movement's revelation that they're surrounded by women who've had such experiences, he was left speechless," she writes. Yet many of those same men left startled — ones who say they have not and would not engage in that behavior themselves — are often the same ones who dismiss, downplay, or excuse such behavior when they witness it themselves.

She describes a case where a witness observed a physician researcher giving unwanted sexual contact to a trainee, but two department chairs prioritized the researcher's recruitment over the trainee's violation, even though the researcher's home institution had already initiated sexual misconduct proceedings against him.

"Both worried about fallout if the behavior were to recur, but neither wanted to forgo the opportunity to steal away a superstar," Dr Jagsi writes. "These discussions highlighted how easy it can be to turn a blind eye to offenses by luminaries like Harvey Weinstein and Kevin Spacey," as well as the surgeon who accosted her.

"My intuition is that the problem is at least as bad in medicine as elsewhere, especially if one adds harassment by patients to that by colleagues and superiors," Dr Jagsi writes. "And the data show that the problem for female physicians is certainly bad enough that the profession must work together to correct it."

Dr Jagsi has disclosed no relevant financial relationships.

N Engl J Med. Published online December 13, 2017. Full text

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