COMMENTARY

Why Is Mistreatment in Medicine Still Rampant?

Alok S. Patel, MD

Disclosures

November 15, 2019

This transcript has been edited for clarity.

I'm going to be uncharacteristically serious in this video—sorry. But I want to talk about mistreatment in medicine and why, even with all of the awareness, it's still rampant.

The Association of American Medical Colleges (AAMC) has a list of behaviors that qualify as mistreatment, and they range from public humiliation to racist remarks to unwanted sexual advances. According to a survey by the AAMC, 42% of medical school graduates in 2018 reported receiving at least one form of mistreatment. This number is actually slightly increased from 2017 and hasn't changed that much in the past 5 years.

You can even see reports of this in the news, like the recent allegations of sexual harassment from surgeons at the University of Maryland. Now, don't get me wrong; we've made a lot of progress. People have made policy changes, started campaigns, and there have been many articles published, but clearly, it's not enough.

In that same AAMC questionnaire, students who said they had been mistreated were asked if they filed a report. Of these, 77% did not. The Medscape Residents Lifestyle & Happiness Report falls right in line with this: Eighty-two percent of residents who indicated they'd been sexually harassed or abused never reported the abuse.

Some commonly cited reasons for not coming forward are fear of retaliation, potential impact on career, or the thought that the administration wouldn't do anything. We have this culture in which people don't want to come forward about mistreatment because they feel powerless or because they're afraid it could hurt their career.

Fortunately, many institutions are tackling this problem head-on. Rush University created the Special Committee on the Rush Medical College Environment (SCORE). Stanford created the Respectful Environment and Mistreatment Committee (REMC). The University of Wisconsin has the Student Mistreatment Triage Committee, and there are many others.

The point is not only to spread awareness but also to create a safe space and empower people who feel like they've been harassed or abused to come forward and speak out.

Here's how it goes. We know that mental illness, burnout, and harassment are big problems faced by medical trainees and doctors. We need to applaud those who come forward and ask for help.

Marcia Frellick, a healthcare journalist, nailed it when she said, "Changes to policy don't outweigh problems in culture. "We can have all of the awareness and institutional regulations we want, but unless we have a top-down approach, we're not going to be able to effectively fight this problem.

We want to hear from you. What do you think we can do to get more people who have faced harassment or abuse to come forward? How do we make the cultural changes we need?

Comment below. This is a big one.

Dr Alok S. Patel is a pediatric hospitalist, television producer, media contributor, and a digital health enthusiast. He splits his time between New York City and San Francisco as he is on faculty at both Columbia University/Morgan Stanley Children's Hospital and the University of California San Francisco, Benioff Children's Hospital. Alok hosts The Hospitalist Retort video blog on Medscape and is a medical producer at CNN.

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