Some Aggressive and Distressing Sexual Behavior
Medscape: Some of the incidents of harassment that physicians, nurses, and PAs described were rather extreme. A couple described physical assault—someone grabbing their breast. In one case, another physician held a female physician while he fondled himself. Some physicians say they were offered a promotion in exchange for sex and were threatened if they didn't comply. Many nurses reported aggressive and distressing sexual behavior from physicians and also colleagues. Do you find it surprising that healthcare professionals would do things like this, especially at their place of work?
Strauss: No, I don't. Those are the same kinds of behaviors that we've seen outside of healthcare as well. It goes on in every industry. I would like to say that maybe because physicians are highly educated, they should have a better idea of appropriate behavior. That's an ideal answer, but I don't think education has much to do with it. I'm not surprised by the severity of these behaviors; I've heard these stories before. They are more likely to occur in a toxic environment.
Medscape: Most people don't typically consider a hospital or medical practice a toxic environment. What is it that makes them toxic?
Strauss: A toxic environment pertains to how people treat each other, and it comes from the top. If arrogance, rudeness, disrespect, and incivility, sometimes referred to as bullying, are tolerated, physicians, nurses, administrators, and other healthcare professionals see that they have tacit approval for that type of behavior. It's not too far of a leap for that behavior to bounce over to the sexual arena.
Medscape: For physicians who were sexually harassed or abused, 60% said the experience was either upsetting or very upsetting; 34% said it ultimately interfered with their ability to do their job; 39% said they avoid working with certain colleagues when possible; and 27% said they were less engaged with colleagues. Also, 22% thought about quitting their job, and 14% actually did quit their job. There were similar statistics for nurses and PAs: 56% said it was either upsetting or very upsetting. So, what would you say about the impact of sexual harassment on physicians' or nurses' ability to do their job or function well within their position?
Strauss: This speaks to the negative impact of harassment. I am not at all surprised at the high percentage who find it upsetting. Having 34% of physicians say that it ultimately interfered with their ability to do their job—this is a particularly alarming percentage, considering the responsibility that physicians carry for patient care: diagnosing, determining appropriate treatment, ordering medication, doing surgery, and more. Interfering with a physician's ability to do her or his job could make the difference, hypothetically and in the extreme, between a patient's life or death. About the same percentage of nurses and physician assistants said it interfered with their ability to do their job, which is also alarming.
And given that 22% of physicians thought about quitting their job and 14% actually did quit their job—these percentages speak to the severe consequences of sexual harassment. And 30% of nurses and physician assistants said they thought about quitting their job, and 16% actually did so. That the sexual misconduct is so severe and/or pervasive, and the healthcare organization fails to follow its legal and ethical responsibilities to intervene and stop it, resulting in clinicians no longer working in that organization, is inexcusable.
Medscape: The most frequently reported incidents of sexual harassment were leering, sexual comments, standing too close (ie, invading someone's personal space), and making comments about body parts. Some physicians said these behaviors were really distressing; others said they were just annoying. Why do some respondents get very upset and others see this as just a nuisance?
Strauss: I think it's going to vary; it very much depends on the target of the behavior. What is the target's relationship with the harasser? Have they had a toxic relationship? Has [the harasser] been a mentor, meaning that they have more power? Some people see it as a boundary issue.
What makes harassment different in healthcare is the type of service we render to patients. We have different personal boundaries than in other industries because of the work we do, and we talk about nudity, blood, urine, body parts. In healthcare, we are used to those topics being acceptable, and some people go beyond those boundaries.
Or if the physician is new in her career with her whole career ahead of her, she feels like a prisoner; she would not feel safe to confront the harasser.
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Cite this: Leslie Kane, Susan Strauss. Sexual Harassment in Healthcare: Doctors and Nurses - Medscape - Jun 27, 2018.