Sexual Harassment Common in Ophthalmology, Survey Finds

Laird Harrison

November 01, 2018

CHICAGO — Ophthalmology is no exception to the broad pattern of sexual harassment in medicine and in American society in general, according to results from a survey that showed that most respondents had experienced incidents at work, often with consequences detrimental to their careers.

"It was eye-opening to hear that all these things are happening," said Michelle Cabrera, MD, from the University of Washington in Seattle.

Eye-opening, but not surprising. The #MeToo movement shone a spotlight on sexual harassment at the highest levels of ophthalmology last year when ophthalmologist Rohit Varma, MD, MPH, resigned from his position as dean of the University of Southern California School of Medicine amid allegations of sexual harassment.

And when Cabrera herself was in training, a faculty member who was inappropriately touching trainees was warned to stop. "But he continued to sexually harass women at all levels for 10 years," she told Medscape Medical News.

This year, though, "a few of us came forward and he stepped down," she said.

This experience, combined with stories she heard when she attended a Women in Ophthalmology meeting, moved Cabrera to find out just how widespread the problem was.

She and her colleagues developed a survey and sent it out through the Women in Ophthalmology listserv. She presented the findings, which were published online in advance of their presentation (Ophthalmology. Published online October 16, 2018), here at the American Academy of Ophthalmology (AAO) 2018 Annual Meeting.

The survey sample of primarily women was chosen rather than a representative sample of American ophthalmologists because research in other medical specialties has suggested that the majority of people who are sexually harassed are women and because the members of that organization seemed motivated to respond, Cabrera explained.

The listserv generated 1671 emails, and 447 of the 698 emails that the team opened resulted in responses. Of these, 99% were from women, and 59% of the respondents reported having experienced sexual harassment during their ophthalmology career.

The 47% of respondents who experienced at least one episode in the previous 5 years reported a median of 10 incidents of sexual harassment by a median of three harassers.

As is consistent with data from other medical specialties, 36% of respondents reported being harassed by someone other than a patient.

The experience affected the professional lives of 87% of respondents, almost one-quarter of whom said it interfered with their work and 15% of whom changed jobs or careers as a result.

Most respondents said the harassment occurred when they were medical students or residents, but fellows, research fellows, academic attendings, and ophthalmologists in private practice also reported incidents of harassment.

In contrast, academic attendings were most often accused of the harassment, followed by patients, residents, family members of patients, fellows, medical students, other, ophthalmic technicians, and hospital or practice administrators.

I was told by my department chair more than once that unless I was willing to engage in sexual activity with him he would fire me from my residency program.

Offensive comments were the most common form of harassment, followed by unwanted attention (such as flirtation, gifts, notes, or emails), unwelcome verbal advances (such as expressions of sexual interest or inquiries), unwanted persistent invitations, unwelcome explicit propositions, offensive displays (such as sexual pictures), offensive body language (such as leering or standing too close), and unwanted physical advances (such as kissing, pinching, patting or fondling).

Three people reported an attempted rape and one reported an actual rape.

Sexual bribery or blackmail — such as the offer of a better grade or promotion in return for a sexual favor or the threat of punishment in return for refusal of a sexual favor —was reported by 6% of respondents.

"I was told by my department chair more than once that unless I was willing to engage in sexual activity with him he would fire me from my residency program," one survey respondent reported.

Only 15% reported the harassment to an authority. Respondents cited barriers such as fear of retaliation, not wanting to be "labeled," not knowing how to report, and the assumption that reporting would have no impact. In fact, among those who reported, 55% said they were not aware of any repercussions for the harasser.

Such was the experience of another respondent: "During the second year of my ophthalmology residency, while rotating though the program director's subspecialty, the program director pinned me to the wall and told me to come to his house that weekend while his wife was out of town."

"I did not go to his house. Subsequently, he completed a very negative evaluation of my performance on his rotation, much lower than any prior evaluation I had," the respondent added.

Of the 42% of respondents who reported witnessing harassment, 49% provided support or empathy to the person being harassed, 33% took no action, 27% intervened in a "neutral" way (such as changing the topic of conversation), 13% intervened to express disapproval to the harasser, and 8% reported the incident to a supervisor.

Cabrera said she would like to see training provided to ophthalmologists so that they can intervene effectively when they witness harassment.

"There is good research showing that bystander intervention is one of the only ways to prevent sexual harassment," she explained. "A lot of times, just speaking up and saying, 'I don't think that's okay,' sends a message."

Fear of retaliation may limit people's willingness to report.

In January, David Parke II, MD, who is chief executive officer of the AAO, wrote an essay condemning sexual harassment, and in March, the AAO board of trustees approved a policy statement forbidding sexual harassment at gatherings it sponsors.

But Cabrera and her colleagues would like to see the academy expand that policy to other arenas. A representative for the AAO told Medscape Medical News that no one was available to comment on the issue by press time.

The researchers have proposed "professionalism mentors" and believe that enforcement of departmental sexual harassment policies should be a criterion for residency accreditation.

When Tina Rutar, MD, from the Cataract and Laser Institute in Medford, Oregon, experienced an unwanted flirtation at a national meeting, she said she dealt with the harassment with "avoidance."

"I think fear of retaliation may limit people's willingness to report," she explained.

The old-fashioned hierarchies that still exist in medicine make dealing with sexual harassment a challenge.

"I'm also wondering how much power ophthalmology departments have to punish harassers because many of these people are high up, with grants and tenure. Bureaucracy moves slowly," said Rutar.

Cabrera and Rutar have disclosed no relevant financial relationships.

American Academy of Ophthalmology (AAO) 2018 Annual Meeting: Abstract PO364. Presented October 29, 2018.

Follow Medscape on Twitter @Medscape and Laird Harrison @LairdH



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