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Sexual harassment hit a peak of cultural awareness over the past year. Will medicine be the next field to experience a reckoning?
In 2017, Time magazine’s Person of the Year Award went to the Silence Breakers who spoke out against sexual assault and harassment.1 The exposure of predatory behavior exhibited by once-celebrated movie producers, newscasters, and actors has given rise to a powerful change. The #MeToo movement has risen to support survivors and end sexual violence.
Just like show business, other industries have rich histories of discrimination and power. Think Wall Street, Silicon Valley, hospitality services, and the list goes on and on.2 But what about medicine? To answer this question, this article aims to:
- review the dilemma
- explore our duty to our patients and each other
- discuss solutions to address the problem.
Sexual harassment: A brief history
Decades ago, Anita Hill accused U.S. Supreme Court nominee Clarence Thomas, her boss at the U.S. Department of Education and the Equal Employment Opportunity Commission (EEOC), of sexual harassment.3
The year was 1991, and President George H. W. Bush had nominated Thomas, a federal Circuit Judge, to succeed retiring Associate Supreme Court Justice Thurgood Marshall. With Thomas’s good character presented as a primary qualification, he appeared to be a sure thing.
Continue to: That was until an FBI interview...
That was until an FBI interview of Hill was leaked to the press. Hill asserted that Thomas had sexually harassed her while he was her supervisor at the Department of Education and the EEOC.4 Heavily scrutinized for her choice to follow Thomas to a second job after he had already allegedly harassed her, Hill was in a conundrum shared by many women—putting up with abuse in exchange for a reputable position and the opportunity to fulfill a career ambition.
Hill is a trailblazer for women yearning to speak the truth, and she brought national attention to sexual harassment in the early 1990s. On December 16, 2017, the Commission on Sexual Harassment and Advancing Equality in the Workplace was formed. Hill was selected to lead the charge against sexual harassment in the entertainment industry.5
A forensic assessment of harassment
Hill’s courageous story is one of many touched upon in the 2016 book Because of Sex.6 Author Gillian Thomas, a senior staff attorney with the American Civil Liberties Union’s Women’s Rights Project, explores how Title VII of the Civil Rights Act of 1964 made it illegal to discriminate “because of sex.”
The field of forensic psychiatry has long been attentive to themes of sexual harassment and discrimination. The American Academy of Psychiatry and Law has a robust list of landmark cases thought to be especially important and significant for forensic psychiatry.7 This list includes cases brought forth by tenacious, yet ordinary women who used the law to advocate, and some have taken their fight all the way to the Supreme Court. Let’s consider 2 such cases:
Meritor Savings Bank, FSB v Vinson (1986).8 This was a U.S. labor law case. Michelle Vinson rose through the ranks at Meritor Savings Bank, only to be fired for excessive sick leave. She filed a Title VII suit against the bank. Vinson alleged that the bank was liable for sexual harassment perpetrated by its employee and vice president, Sidney Taylor. Vinson claimed that there had been 40 to 50 sexual encounters over 4 years, ranging from fondling to indecent exposure to rape. Vinson asserted that she never reported these events for fear of losing her job. The Supreme Court, in a 9-to-0 decision, recognized sexual harassment as a violation of Title VII of the Civil Rights Act of 1964.
Continue to: Harris v Forklift Systems, Inc. (1993)
Harris v Forklift Systems, Inc. (1993).9 Teresa Harris, a manager at Forklift Systems, Inc., claimed that the company’s president frequently directed offensive remarks at her that were sexual and discriminatory. The Supreme Court clarified the definition of a “hostile” or “abusive” work environment under Title VII of the Civil Rights Act of 1964. Associate Justice Sandra Day O’Connor was joined by a unanimous majority opinion in agreement with Harris.
Physicians are not immune
Clinicians are affected by sexual harassment, too. We have a duty to protect our patients, colleagues, and ourselves. Psychiatrists in particular often are on the frontlines of helping victims process their trauma.10
But will the field of medicine also face a reckoning when it comes to perpetrating harassment? It seems likely that the medical field would be ripe with harassment when you consider its history of male domination and a hierarchical structure with strong power differentials—not to mention the late nights, exhaustion, easy access to beds, and late-night encounters where inhibitions may be lowered.11
A shocking number of female doctors are sexually harassed. Thirty percent of the top female clinician-researchers have experienced blatant sexual harassment on the job, according to a survey of 573 men and 493 women who received career development awards from the National Institutes of Health in 2006 to 2009.12 In this survey, harassment covered the scope of sexist remarks or behavior, unwanted sexual advances, bribery, threats, and coercion. The majority of those affected said the experience undermined their confidence as professionals, and many said the harassment negatively affected their career advancement.12
Continue to: But what about the progress women have made...
But what about the progress women have made in medicine? Women are surpassing men in terms of admittance to medical school. Last year, for the first time, women accounted for more than half of the enrollees in U.S. medical schools, according to the Association of American Medical Colleges.13 Yet there has been a stalling in terms of change when it comes to harassment.12 Women may be more vulnerable to harassment, both when they’re perceived as weak and when they’re so strong that they challenge traditional hierarchies.
Perpetuating the problem is the trouble with reporting sexual harassment. Victims do not fare well in our society. Even in the #MeToo era, reporting such behavior is far from straightforward.11 Women fear that reporting any harassment will make them a target. Think of Anita Hill—her testimony against Clarence Thomas during his confirmation hearings for the Supreme Court showed that women who report sexual harassment experience marginalization, retaliation, stigmatization, and worse.
The result is that medical professionals tend to suppress the recognition of harassment. We make excuses for it, blame ourselves, or just take it on the chin and move on. There’s also confusion regarding what constitutes harassment. As doctors, especially psychiatrists, we hear harrowing stories. It’s reasonable to downplay our own experiences. Turning everyone into a victim of sexual harassment could detract from the stories of women who were raped, molested, and severely taken advantage of. There is a reasonable fear that diluting their message could be further damaging.14
Time for action
The field of medicine needs to do better in terms of education, support, anticipation, prevention, and reaction to harassment. We have the awareness. Now, we need action.
Continue to: One way to change any culture...
One way to change any culture of harassment or discrimination would be the advancement of more female physicians into leadership positions. The Association of American Medical Colleges has reported that fewer women than men hold faculty positions and full professorships.15,16 There’s also a striking imbalance among fields of medicine practiced by men and women, with more women seen in pediatrics, obstetrics, and gynecology as opposed to surgery. Advancement into policy-setting echelons of medicine is essential for change. Sexual harassment can be a silent problem that will be corrected only when institutions and leaders put it on the forefront of discussions.17
Another possible solution would be to shift problem-solving from punishment to prevention. Many institutions set expectations about intolerance of sexual harassment and conduct occasional lectures about it. However, enforcing protocols and safeguards that support and enforce policy are difficult on the ground level. In any event, punishment alone won’t change a culture.17
Working with students until they are comfortable disclosing details of incidents can be helpful. For example, the University of Wisconsin-Madison employs an ombuds to help with this process.18 All institutions should encourage reporting along confidential pathways and have multiple ways to report.17 Tracking complaints, even seemingly minor infractions, can help identify patterns of behavior and anticipate future incidents.
Some solutions seem obvious, such as informal and retaliation-free reporting that allows institutions to track perpetrators’ behavior; mandatory training that includes bystander training; and disciplining and monitoring transgressors and terminating their employment when appropriate—something along the lines of a zero-tolerance policy. There needs to be more research on the prevalence, severity, and outcomes of sexual harassment, and subsequent investigations, along with research into evidence-based prevention and intervention strategies.17
Continue to: Although this article focuses...
Although this article focuses on harassment of women, men are equally important to this conversation because they, too, can be victims. Men also can serve a pivotal role in mentoring and championing their female counterparts as they strive for advancement, equality, and respect.
The task ahead is large, and this discussion is not over.
1. Felsenthal E. TIME’s 2017 Person of the Year: the Silence Breakers. TIME. http://time.com/magazine/us/5055335/december-18th-2017-vol-190-no-25-u-s/. Published December 18, 2017. Accessed April 23, 2018.
2. Hiltzik M. Los Angeles Times. Will medicine be the next field to face a sexual harassment reckoning? http://www.latimes.com/business/hiltzik/la-fi-hiltzik-medicine-harassment-20180110-story.html. Published January 10, 2018. Accessed April 23, 2018.
3. Thompson K. For Anita Hill, the Clarence Thomas hearings haven’t really ended. The Washington Post. https://www.washingtonpost.com/politics/for-anita-hill-the-clarence-thomas-hearings-havent-really-ended/2011/10/05/gIQAy2b5QL_story.html. Published October 6, 2011. Accessed April 23, 2018.
4. Toobin J. Good versus evil. In: Toobin J. The nine: inside the secret world of the Supreme Court. New York, NY: Doubleday; 2007:30-32.
5. Barnes B. Motion picture academy finds no merit to accusations against its president. https://www.nytimes.com/2018/03/28/business/media/john-bailey-sexual-harassment-academy.html. The New York Times. Published March 28, 2018. Accessed April 23, 2018.
6. Thomas G. Because of sex: one law, ten cases, and fifty years that changed American women’s lives at work. New York, NY: Picador; 2016.
7. Landmark cases 2014. American Academy of Psychiatry and Law. http://www.aapl.org/landmark_list.htm. 2014. Accessed April 22, 2018.
8. Meritor Savings Bank v Vinson, 477 US 57 (1986).
9. Harris v Forklift Systems, Inc., 114 S Ct 367 (1993).
10. Okwerekwu JA. #MeToo: so many of my patients have a story. And absorbing them is taking its toll. STAT. https://www.scribd.com/article/367482959/Me-Too-So-Many-Of-My-Patients-Have-A-Story-And-Absorbing-Them-Is-Taking-Its-Toll. Published December 18, 2017. Accessed April 23, 2018.
11. Jagsi R. Sexual harassment in medicine—#MeToo. N Engl J Med. 2018;378:209-211.
12. Jagsi R, Griffith KA, Jones R. et al. Sexual harassment and discrimination experiences of academic medical faculty. JAMA. 2016;315(19):2120-2121.
13. AAMCNEWS. More women than men enrolled in U.S. medical schools in 2017. https://news.aamc.org/press-releases/article/applicant-enrollment-2017/. Published December 18, 2017. Accessed May 4, 2018.
14. Miller D. #MeToo: does it help? Clinical Psychiatry News. https://www.mdedge.com/psychiatry/article/150148/depression/metoo-does-it-help. Published October 24, 2017. Accessed April 23, 2018.
15. Chang S, Morahan PS, Magrane D, et al. Retaining faculty in academic medicine: the impact of career development programs for women. J Womens Health (Larchmt). 2016;25(7):687-696.
16. Lautenberger DM, Dandar, VM, Raezer CL, et al. The state of women in academic medicine: the pipeline and pathways to leadership, 2013-2014. AAMC. https://members.aamc.org/eweb/upload/The%20State%20of%20Women%20in%20Academic%20Medicine%202013-2014%20FINAL.pdf. Published 2014. Accessed May 4, 2018.
17. Jablow M. Zero tolerance: combating sexual harassment in academic medicine. AAMCNews. https://news.aamc.org/diversity/article/combating-sexual-harassment-academic-medicine. Published April 4, 2017. Accessed April 23, 2018.
18. University of Wisconsin-Madison, the School of Medicine and Public Health. UW-Madison Policy on Sexual Harassment and Sexual Violence. https://compliance.wiscweb.wisc.edu/wp-content/uploads/sites/102/2018/01/UW-Madison-Policy-on-Sexual-Harassment-And-Sexual-Violence-January-2018.pdf. Published January 2018. Accessed April 22, 2018.
Sexual harassment hit a peak of cultural awareness over the past year. Will medicine be the next field to experience a reckoning?
In 2017, Time magazine’s Person of the Year Award went to the Silence Breakers who spoke out against sexual assault and harassment.1 The exposure of predatory behavior exhibited by once-celebrated movie producers, newscasters, and actors has given rise to a powerful change. The #MeToo movement has risen to support survivors and end sexual violence.
Just like show business, other industries have rich histories of discrimination and power. Think Wall Street, Silicon Valley, hospitality services, and the list goes on and on.2 But what about medicine? To answer this question, this article aims to:
- review the dilemma
- explore our duty to our patients and each other
- discuss solutions to address the problem.
Sexual harassment: A brief history
Decades ago, Anita Hill accused U.S. Supreme Court nominee Clarence Thomas, her boss at the U.S. Department of Education and the Equal Employment Opportunity Commission (EEOC), of sexual harassment.3
The year was 1991, and President George H. W. Bush had nominated Thomas, a federal Circuit Judge, to succeed retiring Associate Supreme Court Justice Thurgood Marshall. With Thomas’s good character presented as a primary qualification, he appeared to be a sure thing.
Continue to: That was until an FBI interview...
That was until an FBI interview of Hill was leaked to the press. Hill asserted that Thomas had sexually harassed her while he was her supervisor at the Department of Education and the EEOC.4 Heavily scrutinized for her choice to follow Thomas to a second job after he had already allegedly harassed her, Hill was in a conundrum shared by many women—putting up with abuse in exchange for a reputable position and the opportunity to fulfill a career ambition.
Hill is a trailblazer for women yearning to speak the truth, and she brought national attention to sexual harassment in the early 1990s. On December 16, 2017, the Commission on Sexual Harassment and Advancing Equality in the Workplace was formed. Hill was selected to lead the charge against sexual harassment in the entertainment industry.5
A forensic assessment of harassment
Hill’s courageous story is one of many touched upon in the 2016 book Because of Sex.6 Author Gillian Thomas, a senior staff attorney with the American Civil Liberties Union’s Women’s Rights Project, explores how Title VII of the Civil Rights Act of 1964 made it illegal to discriminate “because of sex.”
The field of forensic psychiatry has long been attentive to themes of sexual harassment and discrimination. The American Academy of Psychiatry and Law has a robust list of landmark cases thought to be especially important and significant for forensic psychiatry.7 This list includes cases brought forth by tenacious, yet ordinary women who used the law to advocate, and some have taken their fight all the way to the Supreme Court. Let’s consider 2 such cases:
Meritor Savings Bank, FSB v Vinson (1986).8 This was a U.S. labor law case. Michelle Vinson rose through the ranks at Meritor Savings Bank, only to be fired for excessive sick leave. She filed a Title VII suit against the bank. Vinson alleged that the bank was liable for sexual harassment perpetrated by its employee and vice president, Sidney Taylor. Vinson claimed that there had been 40 to 50 sexual encounters over 4 years, ranging from fondling to indecent exposure to rape. Vinson asserted that she never reported these events for fear of losing her job. The Supreme Court, in a 9-to-0 decision, recognized sexual harassment as a violation of Title VII of the Civil Rights Act of 1964.
Continue to: Harris v Forklift Systems, Inc. (1993)
Harris v Forklift Systems, Inc. (1993).9 Teresa Harris, a manager at Forklift Systems, Inc., claimed that the company’s president frequently directed offensive remarks at her that were sexual and discriminatory. The Supreme Court clarified the definition of a “hostile” or “abusive” work environment under Title VII of the Civil Rights Act of 1964. Associate Justice Sandra Day O’Connor was joined by a unanimous majority opinion in agreement with Harris.
Physicians are not immune
Clinicians are affected by sexual harassment, too. We have a duty to protect our patients, colleagues, and ourselves. Psychiatrists in particular often are on the frontlines of helping victims process their trauma.10
But will the field of medicine also face a reckoning when it comes to perpetrating harassment? It seems likely that the medical field would be ripe with harassment when you consider its history of male domination and a hierarchical structure with strong power differentials—not to mention the late nights, exhaustion, easy access to beds, and late-night encounters where inhibitions may be lowered.11
A shocking number of female doctors are sexually harassed. Thirty percent of the top female clinician-researchers have experienced blatant sexual harassment on the job, according to a survey of 573 men and 493 women who received career development awards from the National Institutes of Health in 2006 to 2009.12 In this survey, harassment covered the scope of sexist remarks or behavior, unwanted sexual advances, bribery, threats, and coercion. The majority of those affected said the experience undermined their confidence as professionals, and many said the harassment negatively affected their career advancement.12
Continue to: But what about the progress women have made...
But what about the progress women have made in medicine? Women are surpassing men in terms of admittance to medical school. Last year, for the first time, women accounted for more than half of the enrollees in U.S. medical schools, according to the Association of American Medical Colleges.13 Yet there has been a stalling in terms of change when it comes to harassment.12 Women may be more vulnerable to harassment, both when they’re perceived as weak and when they’re so strong that they challenge traditional hierarchies.
Perpetuating the problem is the trouble with reporting sexual harassment. Victims do not fare well in our society. Even in the #MeToo era, reporting such behavior is far from straightforward.11 Women fear that reporting any harassment will make them a target. Think of Anita Hill—her testimony against Clarence Thomas during his confirmation hearings for the Supreme Court showed that women who report sexual harassment experience marginalization, retaliation, stigmatization, and worse.
The result is that medical professionals tend to suppress the recognition of harassment. We make excuses for it, blame ourselves, or just take it on the chin and move on. There’s also confusion regarding what constitutes harassment. As doctors, especially psychiatrists, we hear harrowing stories. It’s reasonable to downplay our own experiences. Turning everyone into a victim of sexual harassment could detract from the stories of women who were raped, molested, and severely taken advantage of. There is a reasonable fear that diluting their message could be further damaging.14
Time for action
The field of medicine needs to do better in terms of education, support, anticipation, prevention, and reaction to harassment. We have the awareness. Now, we need action.
Continue to: One way to change any culture...
One way to change any culture of harassment or discrimination would be the advancement of more female physicians into leadership positions. The Association of American Medical Colleges has reported that fewer women than men hold faculty positions and full professorships.15,16 There’s also a striking imbalance among fields of medicine practiced by men and women, with more women seen in pediatrics, obstetrics, and gynecology as opposed to surgery. Advancement into policy-setting echelons of medicine is essential for change. Sexual harassment can be a silent problem that will be corrected only when institutions and leaders put it on the forefront of discussions.17
Another possible solution would be to shift problem-solving from punishment to prevention. Many institutions set expectations about intolerance of sexual harassment and conduct occasional lectures about it. However, enforcing protocols and safeguards that support and enforce policy are difficult on the ground level. In any event, punishment alone won’t change a culture.17
Working with students until they are comfortable disclosing details of incidents can be helpful. For example, the University of Wisconsin-Madison employs an ombuds to help with this process.18 All institutions should encourage reporting along confidential pathways and have multiple ways to report.17 Tracking complaints, even seemingly minor infractions, can help identify patterns of behavior and anticipate future incidents.
Some solutions seem obvious, such as informal and retaliation-free reporting that allows institutions to track perpetrators’ behavior; mandatory training that includes bystander training; and disciplining and monitoring transgressors and terminating their employment when appropriate—something along the lines of a zero-tolerance policy. There needs to be more research on the prevalence, severity, and outcomes of sexual harassment, and subsequent investigations, along with research into evidence-based prevention and intervention strategies.17
Continue to: Although this article focuses...
Although this article focuses on harassment of women, men are equally important to this conversation because they, too, can be victims. Men also can serve a pivotal role in mentoring and championing their female counterparts as they strive for advancement, equality, and respect.
The task ahead is large, and this discussion is not over.
Sexual harassment hit a peak of cultural awareness over the past year. Will medicine be the next field to experience a reckoning?
In 2017, Time magazine’s Person of the Year Award went to the Silence Breakers who spoke out against sexual assault and harassment.1 The exposure of predatory behavior exhibited by once-celebrated movie producers, newscasters, and actors has given rise to a powerful change. The #MeToo movement has risen to support survivors and end sexual violence.
Just like show business, other industries have rich histories of discrimination and power. Think Wall Street, Silicon Valley, hospitality services, and the list goes on and on.2 But what about medicine? To answer this question, this article aims to:
- review the dilemma
- explore our duty to our patients and each other
- discuss solutions to address the problem.
Sexual harassment: A brief history
Decades ago, Anita Hill accused U.S. Supreme Court nominee Clarence Thomas, her boss at the U.S. Department of Education and the Equal Employment Opportunity Commission (EEOC), of sexual harassment.3
The year was 1991, and President George H. W. Bush had nominated Thomas, a federal Circuit Judge, to succeed retiring Associate Supreme Court Justice Thurgood Marshall. With Thomas’s good character presented as a primary qualification, he appeared to be a sure thing.
Continue to: That was until an FBI interview...
That was until an FBI interview of Hill was leaked to the press. Hill asserted that Thomas had sexually harassed her while he was her supervisor at the Department of Education and the EEOC.4 Heavily scrutinized for her choice to follow Thomas to a second job after he had already allegedly harassed her, Hill was in a conundrum shared by many women—putting up with abuse in exchange for a reputable position and the opportunity to fulfill a career ambition.
Hill is a trailblazer for women yearning to speak the truth, and she brought national attention to sexual harassment in the early 1990s. On December 16, 2017, the Commission on Sexual Harassment and Advancing Equality in the Workplace was formed. Hill was selected to lead the charge against sexual harassment in the entertainment industry.5
A forensic assessment of harassment
Hill’s courageous story is one of many touched upon in the 2016 book Because of Sex.6 Author Gillian Thomas, a senior staff attorney with the American Civil Liberties Union’s Women’s Rights Project, explores how Title VII of the Civil Rights Act of 1964 made it illegal to discriminate “because of sex.”
The field of forensic psychiatry has long been attentive to themes of sexual harassment and discrimination. The American Academy of Psychiatry and Law has a robust list of landmark cases thought to be especially important and significant for forensic psychiatry.7 This list includes cases brought forth by tenacious, yet ordinary women who used the law to advocate, and some have taken their fight all the way to the Supreme Court. Let’s consider 2 such cases:
Meritor Savings Bank, FSB v Vinson (1986).8 This was a U.S. labor law case. Michelle Vinson rose through the ranks at Meritor Savings Bank, only to be fired for excessive sick leave. She filed a Title VII suit against the bank. Vinson alleged that the bank was liable for sexual harassment perpetrated by its employee and vice president, Sidney Taylor. Vinson claimed that there had been 40 to 50 sexual encounters over 4 years, ranging from fondling to indecent exposure to rape. Vinson asserted that she never reported these events for fear of losing her job. The Supreme Court, in a 9-to-0 decision, recognized sexual harassment as a violation of Title VII of the Civil Rights Act of 1964.
Continue to: Harris v Forklift Systems, Inc. (1993)
Harris v Forklift Systems, Inc. (1993).9 Teresa Harris, a manager at Forklift Systems, Inc., claimed that the company’s president frequently directed offensive remarks at her that were sexual and discriminatory. The Supreme Court clarified the definition of a “hostile” or “abusive” work environment under Title VII of the Civil Rights Act of 1964. Associate Justice Sandra Day O’Connor was joined by a unanimous majority opinion in agreement with Harris.
Physicians are not immune
Clinicians are affected by sexual harassment, too. We have a duty to protect our patients, colleagues, and ourselves. Psychiatrists in particular often are on the frontlines of helping victims process their trauma.10
But will the field of medicine also face a reckoning when it comes to perpetrating harassment? It seems likely that the medical field would be ripe with harassment when you consider its history of male domination and a hierarchical structure with strong power differentials—not to mention the late nights, exhaustion, easy access to beds, and late-night encounters where inhibitions may be lowered.11
A shocking number of female doctors are sexually harassed. Thirty percent of the top female clinician-researchers have experienced blatant sexual harassment on the job, according to a survey of 573 men and 493 women who received career development awards from the National Institutes of Health in 2006 to 2009.12 In this survey, harassment covered the scope of sexist remarks or behavior, unwanted sexual advances, bribery, threats, and coercion. The majority of those affected said the experience undermined their confidence as professionals, and many said the harassment negatively affected their career advancement.12
Continue to: But what about the progress women have made...
But what about the progress women have made in medicine? Women are surpassing men in terms of admittance to medical school. Last year, for the first time, women accounted for more than half of the enrollees in U.S. medical schools, according to the Association of American Medical Colleges.13 Yet there has been a stalling in terms of change when it comes to harassment.12 Women may be more vulnerable to harassment, both when they’re perceived as weak and when they’re so strong that they challenge traditional hierarchies.
Perpetuating the problem is the trouble with reporting sexual harassment. Victims do not fare well in our society. Even in the #MeToo era, reporting such behavior is far from straightforward.11 Women fear that reporting any harassment will make them a target. Think of Anita Hill—her testimony against Clarence Thomas during his confirmation hearings for the Supreme Court showed that women who report sexual harassment experience marginalization, retaliation, stigmatization, and worse.
The result is that medical professionals tend to suppress the recognition of harassment. We make excuses for it, blame ourselves, or just take it on the chin and move on. There’s also confusion regarding what constitutes harassment. As doctors, especially psychiatrists, we hear harrowing stories. It’s reasonable to downplay our own experiences. Turning everyone into a victim of sexual harassment could detract from the stories of women who were raped, molested, and severely taken advantage of. There is a reasonable fear that diluting their message could be further damaging.14
Time for action
The field of medicine needs to do better in terms of education, support, anticipation, prevention, and reaction to harassment. We have the awareness. Now, we need action.
Continue to: One way to change any culture...
One way to change any culture of harassment or discrimination would be the advancement of more female physicians into leadership positions. The Association of American Medical Colleges has reported that fewer women than men hold faculty positions and full professorships.15,16 There’s also a striking imbalance among fields of medicine practiced by men and women, with more women seen in pediatrics, obstetrics, and gynecology as opposed to surgery. Advancement into policy-setting echelons of medicine is essential for change. Sexual harassment can be a silent problem that will be corrected only when institutions and leaders put it on the forefront of discussions.17
Another possible solution would be to shift problem-solving from punishment to prevention. Many institutions set expectations about intolerance of sexual harassment and conduct occasional lectures about it. However, enforcing protocols and safeguards that support and enforce policy are difficult on the ground level. In any event, punishment alone won’t change a culture.17
Working with students until they are comfortable disclosing details of incidents can be helpful. For example, the University of Wisconsin-Madison employs an ombuds to help with this process.18 All institutions should encourage reporting along confidential pathways and have multiple ways to report.17 Tracking complaints, even seemingly minor infractions, can help identify patterns of behavior and anticipate future incidents.
Some solutions seem obvious, such as informal and retaliation-free reporting that allows institutions to track perpetrators’ behavior; mandatory training that includes bystander training; and disciplining and monitoring transgressors and terminating their employment when appropriate—something along the lines of a zero-tolerance policy. There needs to be more research on the prevalence, severity, and outcomes of sexual harassment, and subsequent investigations, along with research into evidence-based prevention and intervention strategies.17
Continue to: Although this article focuses...
Although this article focuses on harassment of women, men are equally important to this conversation because they, too, can be victims. Men also can serve a pivotal role in mentoring and championing their female counterparts as they strive for advancement, equality, and respect.
The task ahead is large, and this discussion is not over.
1. Felsenthal E. TIME’s 2017 Person of the Year: the Silence Breakers. TIME. http://time.com/magazine/us/5055335/december-18th-2017-vol-190-no-25-u-s/. Published December 18, 2017. Accessed April 23, 2018.
2. Hiltzik M. Los Angeles Times. Will medicine be the next field to face a sexual harassment reckoning? http://www.latimes.com/business/hiltzik/la-fi-hiltzik-medicine-harassment-20180110-story.html. Published January 10, 2018. Accessed April 23, 2018.
3. Thompson K. For Anita Hill, the Clarence Thomas hearings haven’t really ended. The Washington Post. https://www.washingtonpost.com/politics/for-anita-hill-the-clarence-thomas-hearings-havent-really-ended/2011/10/05/gIQAy2b5QL_story.html. Published October 6, 2011. Accessed April 23, 2018.
4. Toobin J. Good versus evil. In: Toobin J. The nine: inside the secret world of the Supreme Court. New York, NY: Doubleday; 2007:30-32.
5. Barnes B. Motion picture academy finds no merit to accusations against its president. https://www.nytimes.com/2018/03/28/business/media/john-bailey-sexual-harassment-academy.html. The New York Times. Published March 28, 2018. Accessed April 23, 2018.
6. Thomas G. Because of sex: one law, ten cases, and fifty years that changed American women’s lives at work. New York, NY: Picador; 2016.
7. Landmark cases 2014. American Academy of Psychiatry and Law. http://www.aapl.org/landmark_list.htm. 2014. Accessed April 22, 2018.
8. Meritor Savings Bank v Vinson, 477 US 57 (1986).
9. Harris v Forklift Systems, Inc., 114 S Ct 367 (1993).
10. Okwerekwu JA. #MeToo: so many of my patients have a story. And absorbing them is taking its toll. STAT. https://www.scribd.com/article/367482959/Me-Too-So-Many-Of-My-Patients-Have-A-Story-And-Absorbing-Them-Is-Taking-Its-Toll. Published December 18, 2017. Accessed April 23, 2018.
11. Jagsi R. Sexual harassment in medicine—#MeToo. N Engl J Med. 2018;378:209-211.
12. Jagsi R, Griffith KA, Jones R. et al. Sexual harassment and discrimination experiences of academic medical faculty. JAMA. 2016;315(19):2120-2121.
13. AAMCNEWS. More women than men enrolled in U.S. medical schools in 2017. https://news.aamc.org/press-releases/article/applicant-enrollment-2017/. Published December 18, 2017. Accessed May 4, 2018.
14. Miller D. #MeToo: does it help? Clinical Psychiatry News. https://www.mdedge.com/psychiatry/article/150148/depression/metoo-does-it-help. Published October 24, 2017. Accessed April 23, 2018.
15. Chang S, Morahan PS, Magrane D, et al. Retaining faculty in academic medicine: the impact of career development programs for women. J Womens Health (Larchmt). 2016;25(7):687-696.
16. Lautenberger DM, Dandar, VM, Raezer CL, et al. The state of women in academic medicine: the pipeline and pathways to leadership, 2013-2014. AAMC. https://members.aamc.org/eweb/upload/The%20State%20of%20Women%20in%20Academic%20Medicine%202013-2014%20FINAL.pdf. Published 2014. Accessed May 4, 2018.
17. Jablow M. Zero tolerance: combating sexual harassment in academic medicine. AAMCNews. https://news.aamc.org/diversity/article/combating-sexual-harassment-academic-medicine. Published April 4, 2017. Accessed April 23, 2018.
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