Saturday, December 23, 2017

Sexual harassment in medicine

Jagsi R. Sexual Harassment in Medicine - #MeToo. N Engl J Med. 2017 Dec 13.
[no abstract]

The news is filled with stories of celebrities who have engaged in egregious sexual misconduct. A recent poll suggested that more than half of U.S. women have experienced “unwanted and inappropriate sexual advances” at some point in their lives.  Because I led a study of workplace sexual harassment in medicine,  I was not surprised when reporters contacted me for comments on the recent disclosures. When a secretary filling in for my usual assistant relayed one reporter’s request, she told me she presumed the story was about my personal experience of sexual harassment. Disturbed, I leapt to correct her misapprehension: I was being sought out as a scholarly expert, not a victim. Then I wondered why it seemed so urgent to make that distinction.

An easy explanation is that I feared she would assume that someone in my department had engaged in misconduct — I would never want anyone to think that of any of my upstanding colleagues. Indeed, when I published my research findings, my department chair expressed shock: “Thirty percent of the women had been harassed? Are you sure that’s right? I just would never . . . .” 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.

But that’s not the whole story. I rushed to correct the secretary partly because I worried that she might tell others that I’d been victimized and also that victims do not fare well in our society. I aspire to become a leader in academic medicine. Being cast as a victim would tarnish my narrative. Who cares if research suggests that women are more vulnerable to harassment both when they’re perceived as weak and when they’re so strong that they challenge traditional hierarchies? Having come of age in the era of Anita Hill’s testimony against Clarence Thomas during his confirmation hearings for the Supreme Court, I know that women who report sexual harassment experience marginalization, retaliation, stigmatization, and worse. Even in the #MeToo era, reporting such behavior is far from straightforward…

In fact, none of the women who’ve contacted me have reported their experiences. They speak of challenging institutional cultures, with workplaces dominated by men who openly engage in lewd “locker-room conversation” or exclude them from all-male social events, leaving them without allies in whom to confide after suffering an indignity or a crime…

One woman, whose experience indirectly came to the attention of her institution’s human resources group, consulted a lawyer who confirmed her suspicions that “making this an HR issue” could hurt her own career. “HR is about protecting the institution, not you,” the lawyer said. Fearing being labeled a troublemaker, she deflected the inquiry. Yet she felt guilty over not protecting younger women from the man who’d harassed her. Another woman asked my advice on convening a workshop on sexual harassment, wondering whether it would be career suicide…

But standing up to harassment is clearly hard. In one case, a talented physician researcher had engaged in a witnessed act of unwanted sexual contact with a trainee. Yet two department chairs in his field independently told me they were trying to recruit the transgressor, who was considered a hot prospect, even as sexual misconduct proceedings were under way at his home institution. “It was just a mistake; we need to forgive and forget,” said one. “I have both sons and daughters, so I can see both sides,” said the other. Both worried about fallout if the behavior were to recur, but neither wanted to forgo the opportunity to steal away a superstar…

It was a luminary who provided my sole personal experience with workplace-related sexual harassment. Because it was a more minor transgression than some other women have faced, until very recently I hadn’t thought of it as harassment, although it meets the criteria outlined by experts — a disconnect that’s remarkably common. After a group dinner at a professional society meeting where I spent my time politely rebuffing sexual advances from a prominent surgeon, I became concerned when he accosted me at the cloakroom, intent on walking me to my room. He winked at the attendant and said, “She loves surgeons.” Just then, a senior female surgeon happened by. I said, “I do adore surgeons, which is why I planned to walk home with her.” Wordlessly, the female surgeon sized up the situation and took me by the arm, rescuing me from what was rapidly evolving from an uncomfortable situation into something potentially worse. I now keep my distance from that male surgeon; I even gave up a valuable scholarly opportunity just to avoid him. And 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?...

Academic astronomers have formalized a rescue system like the one that fortuitously presented itself to me. Recognizing that mandatory reporting can dissuade people who need help, they maintain a list of “astronomy allies” — senior female astronomers, who wear prominent buttons at national society meetings and make themselves available to remove colleagues from problematic situations ( No questions are asked, although formal reporting is encouraged and facilitated where appropriate; the aim is to provide “judgment-free” help when someone believes it’s needed. It is a shameful statement about our society that such a system is required in a professional setting…

I wish I had brilliant insights about how our society can address the deep-rooted, pervasive causes of this behavior proactively rather than simply reactively. Nevertheless, I find it valuable to have the opportunity to participate in this now open conversation and draw from the example of innovators like the astronomy allies, whose website explains: “Seeing us wear those buttons tells you not only that there is someone friendly around should you need us, but reminds people who might think about committing harassment that there are always people holding beacons of light to shine in the corners they are hoping to keep dark.”

Courtesy of:
Jagsi R, Griffith KA, Jones R, Perumalswami CR, Ubel P, Stewart A. Sexual
Harassment and Discrimination Experiences of Academic Medical Faculty. JAMA. 2016
May 17;315(19):2120-1.[no abstract]

In this sample of clinician-researchers, 30% of women reported having experienced sexual harassment compared with 4% of men. Although a lower proportion reported these experiences than in a 1995 sample, the difference appears large given that the women began their careers after the proportion of female medical students exceeded 40%.

Limitations include nonresponse bias, which could inflate estimates of prevalence if those who experienced harassment were more motivated to respond; to minimize this risk, we placed these questions at the end of a 12-page instrument that otherwise focused on general career experiences. Our estimates were based on self-report, not documented cases.

Recognizing sexual harassment is important because perceptions that such experiences are rare may, ironically, increase stigmatization and discourage reporting. Efforts to mitigate the effect of unconscious bias in the workplace and eliminate more overtly inappropriate behaviors are needed.

No comments:

Post a Comment