Journal Series Amplifies Voices Against Sexual Harassment

Debra L. Beck

May 27, 2021

The most recent edition of JACC: Case Reports includes a new case report that is also an old story: a powerful male physician suggesting to a young female physician that her future employment is contingent on her acceptance of some special "conditions," namely cohabitating at conferences. He tells her he has the power to end her career if she does not.

In shock, the young physician immediately cancelled her contract, left her country of birth, took a job far away, and didn't talk about the experience for 6 years.

It was only years later, when talking with a colleague who had the same experience with the same person, that Julia Grapsa, MD, PhD, realized it was time to speak out.

Grapsa, who is the editor-in-chief of JACC: Case Reports, wrote her story as part of a series on sexual harassment. Her decision was not an easy one.

"I was hesitant to reveal something so personal, but at the end of January 2021, the #metoo movement started in my homeland Greece and it had an impact on me, rewinding to stories that had an impact on my career in the sense that if they hadn't taken place, maybe I would be working at a different place," says Grapsa, who said she is currently very happy practicing at Guy's and St. Thomas' NHS Hospital Trust in London, UK.

"Then, a few cardiologist friends were discussing similar experiences they had in the United States and other countries, and we realized that we all had the same 'voice,' and that this is the opportunity to speak out and to provide guidance to the younger generation."

Along with her personal story, the series includes two other articles on the topic: one examining sexual harassment and victim blaming and their impact on women in cardiology; and the second sharing data on harassment and efforts to advocate for its end.

Only 13%-14% of all practicing US cardiologists are women, according to a 2019 JAMA Cardiology article on demographics in the field, and surveys have shown that women trainees perceive cardiology as "unwelcoming to women, unsupportive of families, and a 'toxic climate' for trainees, including sex-based discrimination," write Kamala P. Tamirisa, MD, Texas Cardiac Arrhythmia Institute, Dallas, and colleagues.

These perceptions appear to be borne out in the data from those working in the field. Based on an American College of Cardiology (ACC) survey, two thirds of women working in the US in cardiology reported experiencing sex- and parenting-related discrimination.

Things don't appear much better elsewhere: in the UK, 62% of female cardiologists report discrimination and one third reported sexual harassment; in Germany, 32% report sexual harassment in the workplace.

Notably, according to the UK data, only 16.1% of those affected sought help or reported their experiences.

"So, in the US, we have Title IX and Title VII, both of which prohibit any gender discrimination, including sexual harassment, but people don't even know these laws exist and they're afraid of the repercussions of reporting bad behavior," said Tamirisa in an interview.

One potential solution they suggest is indirect reporting, where a third party who is outside the program or department is available to discuss issues.

"This could be, say, a pro bono lawyer or a group of lawyers who are outside the university and who can objectively assess the situation and provide guidance," she adds.

ACC Leads on Sexual Harassment and Diversity

That sexual harassment has made it into a prominent cardiology journal is partly by design, says Grapsa. The ACC, which publishes JACC: Case Reports, has taken an active leadership role in addressing sexual harassment, along with making concerted efforts to diversify the cardiology workforce.

"I'm very proud to be part of the American College of Cardiology because of the initiative they've taken since 2017 and even before to address these issues in the field," said Tamirisa.

"When we created this journal, together with the deputy editors, we felt that it was important to help colleagues from all levels to submit their stories under a special section called 'Voices in Cardiology.' This series is under 'Voices' and we encourage every colleague to write a 'Voices' piece and tell their story so that we can learn from each other."

So far, the reaction has been entirely positive. Grapsa and Tamirisa have heard from several individuals — women and men — who have shared their own stories of discrimination or harassment, some of whom need help managing ongoing issues.

"When we speak of these things, and tell our stories as Dr Grapsa did, it makes people feel safe to share their stories and to express their fears and self-doubts that have arisen from how they are treated," said Tamirisa.

The discussion on #medtwitter has been lively. "A lot of people have responded, quite a few in cardiology, but also women and men in other areas of medicine too," says Tamirisa. "In some cases, they've not just echoed the sentiment but have also shared their experiences and asked for help."

Ultimately, Grapsa hopes to contribute to the creation of a work environment in cardiology that is more inclusive and "balanced."

"We should be restless and forward thinking about this," says Grapsa. "The people who are hiding or are neutral to it are equally guilty. I often wonder if anything will have changed 5 years from now, and this is an important question to consider because the issues need to be addressed on many levels through ongoing discussion and a concerted effort to no long push these things under the carpet," she adds.

Asked whether cardiology might inherently be a subspecialty that fails to attract equal numbers of women and men, Tamirisa suggests that needn't be the case.

"I think if you make the field attractive, more flexible and with more role models for women, then I believe women will choose cardiology. This is what the ACC is trying to do and we're seeing the numbers creep up — slowly, but they're going up."

And she quoted the late Supreme Court Associate Justice Ruth Bader Ginsburg:

"When I'm sometimes asked when will there be enough [women on the Supreme Court] and I say, 'When there are nine,' people are shocked. But there'd been nine men, and nobody's ever raised a question about that."

The authors have disclosed no relevant financial relationships.  

J Am Coll Cardiol Case Rep. Published online May 19, 2021.
Viewpoint, Dr Grapsa; Mansour et al; Tamirisa et al

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