Medicine's #MeToo Movement

(from the May 2018 ACP Internist)

Experts see the increase of women involved in medicine as an opportunity to investigate and then implement solutions to combat sexual harassment.

By Mollie Durkin

Sexual harassment and assault grabbed the spotlight in 2017 when actress Alyssa Milano promoted the hashtag #MeToo on social media as a way for victims to share their experiences (although the “Me Too” movement actually goes back 10 years earlier, to the credit of activist Tarana Burke).

The medical profession and its places of healing may seem shielded from these problems, but the recent focus has led some physicians to share troubling stories.

If the prospect of doctors behaving badly seems hard to believe, consider the evidence. In a survey of 1,066 clinician-researchers, of women reported personally experiencing sexual harassment from a colleague or superior, compared to 4% of menaccording to results published in May 2016 by JAMA.

“Unfortunately, what we found was that experiences of sexual harassment continue to be strikingly common, even today,” said lead author Reshma Jagsi, MD, DPhil.

Of the 150 women who said they had experienced harassment, 92% reported sexist remarks or behavior, 41% reported unwanted sexual advances, and 9% reported coercive advances. Regarding gender bias, 66% of women reported being left out of opportunities for professional career advancement based on their gender, compared to 10% of men.

At the same time, the Association of American Medical Colleges (AAMC) announced in December 2017 that, for the first time, the number of women enrolling in U.S. medical schools had eclipsed (albeit slightly) the number of men. Since 2015, the number of female enrollees grew by nearly 10%, while that of men declined by 2.3%, the AAMC reported.

With more women in medicine than ever before, experts see an opportunity to investigate and then implement solutions to combat sexual harassment in medicine.

The reporting problem

Despite the well-documented prevalence of sexual harassment, Dr. Jagsi said she'd hoped to find a lower incidence of sexual harassment in medicine “because an altruistic impulse drives us to the field.” But she also suspected that academic medicine's hierarchical power structure might abet such misbehavior. In a January 2018 New England Journal of Medicine perspective, she recounted experiences of harassment that female physicians shared with her after her study was published, ranging from unwanted touching of breasts and backsides to rape by a superior.

None of the women who shared their experiences reported them to authorities, said Dr. Jagsi, who is professor and deputy chair in the department of radiation oncology and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan in Ann Arbor. “This idea that if one reports, one will be marginalized or stigmatized or face retaliation—those are very real considerations,” she said.

The potential repercussions of speaking up are particularly daunting for trainees, said Fatima Zahara Syed, MD, MSc, FACP, immediate past chair of ACP's Council of Resident/Fellow Members and a second-year fellow in endocrinology at Thomas Jefferson University Hospital in Philadelphia. “From a resident and fellow perspective, you're especially frightened because you're the lowest of the lowest on the totem pole,” she said. “Your job is to get the work done and to deal with the hardships of residency, and some people think that these issues are part of those hardships, and it's unfortunate because they shouldn't be.”

Learners may need letters of recommendation from faculty (potentially even from the perpetrator) or want to stay on after training to become faculty themselves, noted Francis Nuthalapaty, MD, professor of obstetrics and gynecology at the University of South Carolina School of Medicine in Greenville. “All of those things make it very, very difficult for them to feel confident in reporting and following through on having these issues addressed,” he said.

In similar fashion to Dr. Jagsi, Dr. Nuthalapaty wrote an editorial detailing several real examples of sexual harassment in academic medicine, published in March 2018 by Obstetrics & Gynecology. One example included a senior faculty member who made regular sexual comments about a senior female resident, both in her presence and around male residents. Another report of a male faculty member also included comments on the female residents' appearances—in addition to sexual jokes about anesthetized patients in the operating room.

“The reason I know about those concerns is that in many cases, people came to me as someone that they could trust,” said Dr. Nuthalapaty, a 25-year veteran educator.

Read the full article in ACP Internist.

ACP Internist provides news and information for internists about the practice of medicine and reports on the policies, products, and activities of ACP.

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