She was almost done spreading apart the patient’s staples when the attending physician leaned over so his face was uncomfortably close to hers.

“You know how to spread good,” he whispered through his surgical mask over their anesthetized patient. “That will teach you how to spread.”

Dr Christina Jenkins was sexually harassed in the operating room, where there were nurses, other interns, an anaesthesiologist present, and yet the surgeon who passed that vulgar comment had no fear that there would be any clapback from the system.

And why would there be in a male dominated field where women, the minority, are talked over, pushed down the corporate ladder, touched without consent, and objectified time and again?

Reading about Dr Jenkins made my heart sink into the pit of my stomach, my anger bubbling as I recalled every instance that I had stayed silent when my superiors leered, when my colleague passed an offhand sexist remark, for all the times I was told a girl cannot be a surgeon, when I had to scrub in on cases of female genital mutilation and hold my tears back for the fear of appearing “weak”. I felt ashamed, that I didn’t do enough for us, to protect us, to demand our voices be heard.

Did you know that 50% of female medical students experience sexual harassment before they have even graduated from school, before they even started their careers? I feel sick because I know it to be true, I feel horrified that it’s happened to so many of us, so many times that it has almost been normalised. My heart breaks for every girl with tear-stained pillows, who cried herself to sleep and woke up the next day to attend the same lectures and anatomical dissections with the perpetrators.

 #MeToo hashtag had been used approximately 19 million times on Twitter alone in the 2018 when the movement began, often by women and men who were inspired — in the wake of high-profile abuse allegations — to speak out about their own traumatic experiences. However, Medicine is still fighting to have its own #MeToo movement.

The impacts of harassment trickles down into other aspects of life as it induces symptoms of anxiety, depression, post-traumatic stress disorder, as well as diminished self-esteem, self-confidence, and psychological well-being. Sexual harassment is the number one factor in determining a woman’s workplace wellbeing. It has profound impacts on their longevity in their jobs, in productivity, and even in their mental and physical health. 60% to 80% of the health care workforce was reported to have experienced some form of sexual harassment in a report from the University of Michigan Medical School. The National Academy of Sciences, Engineering, and Medicine reported that female medical students were the subject of sexual harassment in greater proportions compared with students in other disciplines, such as science, technology, engineering, and mathematics. Although many studies have addressed the magnitude of sexual harassment in the medical field, few institutions have put forward their experience with addressing the problem.

Why is it that women stay silent? Why aren’t checks and balances in place to protect healthcare professionals by institutions that supposedly have strict ethical codes?  This is a symptom of deeply entrenched hierarchies and a climate of intimidation, retaliation, and fear discourage targets from reporting sexual harassment in hospitals and medical institutions. Many factors make an organization prone to sexual harassment: a hierarchical structure, a male-dominated environment, a lack of leadership to address the issue and a climate that tolerates transgressions— particularly when they are committed by those with power. Medicine has all four of these elements. 

In my university’s White Coat Ceremony for the class of 2020, I had quoted a take on urban legend that incoming students of Harvard are told to “Look to your left, look to your right. Chances are neither one of them are going to be doctors.” I said this to my batchmates not out of spite, but because we were aware of the stark reality of the dropout rate of medical school, the academic pressures, the toxic and unnecessary competitiveness. I said this with hope that we would be able to address the elephant in the room before we even began the rat race, and overcome the obstacles together in the six years of medical school. But never did I imagine that I had to add on this particular reason onto the list of causes of dropout in Medicine.

I came across a New England Journal of Medicine article that stated: Imagine a medical-school dean addressing the incoming class with this demoralizing prediction: ‘Look at the woman to your left and then at the woman to your right. On average, one of them will be sexually harassed during the next 4 years, before she has even begun her career as a physician’.

The efforts of many healthcare institutions have been feeble at best, for prioritising a hushed settlement and avoiding litigation, instead of committing to understand the root cause of the problem and perform quantitative and qualitative assessments of harassment and discrimination. Most harassment wouldn’t qualify as criminal behaviour, but the daily microaggressions that target experience can have terrible consequences for women in academic medicine. There are already rules in place about not harassing people, not discriminating based on gender or race, and so the question is … how do you make the culture change so that those rules are enforced?

We need to send out a clear signal that we do not tolerate:

1. Gender bias in patient care:

Studies show that women’s perceptions of gender bias are correct. Compared with male patients, women who present with the same condition may not receive the same evidence-based care. In several key areas, such as cardiac care and pain management, women may get different treatment, leading to poorer outcomes.

Ensuring equity in access to healthcare is paramount to bridge the gap in medical care received.

2. Challenges Faced by Female Healthcare Professionals in the Workforce

-Challenges faced in balancing work and family responsibilities

-Challenges faced due to workplace issues such as lack of supportive policies and gender equality

-Challenges faced in stereotyping of working women

We cannot remain blind to unique challenges that women face due to long withstanding views on a woman’s role in society. Many leaders make the mistake of trying to solve the problem with “one-off” solutions. For instance, sexual harassment training isn’t effective when only web-based or done just once a year. Instead, it has to be ongoing and part of a broader culture change to narrow the pay gaps, to account for maternity and family leaves, instead of punishing female professionals for it.

3. Underrepresentation of Women in Medicine

– Exclusion from or underrepresentation in clinical studies can lead to significant gaps in knowledge and in health services for women.

– Reflected in gender differences in morbidity and mortality; in gender differences in patterns of diagnosis and treatment for key conditions; in gender differences in survival or outcomes of treatments; or in providers’ perceptions that their ability to provide optimal care to women patients is compromised

– Underrepresentation in Medical education/ research

It is essential to increase representation of women in leadership roles and assure accompanying equity in salary and power. Among the initiatives that can help are mentorship and sponsorship programs, which are essential to career progression.

4. Abuse of female patients or/and healthcare professionals

-Sexual abuse

-Physical abuse

We must support and strengthen women physicians, and build a climate where transgressions are unacceptable. There needs to be a transparent pairing of policy with consistent action, where there are strong repercussions for perpetrators. We calculate the both the monetary cost (litigations) and the human cost of sexual harassment. There should not be a price for a woman’s dignity, and no one should be able to walk off after signing a cheque.

In Mar 2019, more than 50 women launched the TIME’S UP Healthcare movement to foster the development of “more balanced, diverse, and accountable leadership” while at the same time responding to workplace discrimination, harassment, and abuse, and promoting “equitable and safe cultures.” AMA adopted new policies to better respond to and prevent harassment. There is hope. There is collective effort to address sexual harassment and have a zero-tolerance policy.  Institutions must learn from mistakes when sexual harassment has gone unaddressed and strive to do better in the future.

The hospital is a place every healthcare professional has dreamed of when they decided becoming a doctor/nurse was their calling. In our heads, this is the arena we claim our power, where we would realise our full potential as we receive incredible opportunities to participate in the care of other human beings: Diagnose, treat, cut, console, and palliate. Our days in the hospital are meant to witness the miracle of childbirth, the adrenaline from assisting in our first surgery, the profound lows of making an error, not knowing an answer, or losing a patient. Then there’s the moment where we feel like a deer caught in the headlights, in a situation where we never imagined we would have to deal with in our nightmares.

Dr Timothy Johnson, a professor of women studies at the University of Michigan, said if he had to design a system de novo that would allow sexual harassment to thrive, he would design a hospital, as it has all the critical elements for sexual harassment: male-dominated, male led, it has steep vertical hierarchies, and has plenty of dark quiet corners where behaviours are not held to much accountability.

This cannot go on. We have to reclaim our hospitals and not be afraid to raise our voices when threatened to be stamped out. We have worked too hard to give up on our dreams, to be afraid of our very own workplace, to quit now.

If you’ve been harassed in any form or way, I believe you, and I will hold your hand every step of the way. I know how much it hurts. Even if you can’t describe what that “it” is. There’s a pain within your soul you can’t shake. I will be by your side if you choose to fight for the justice you deserve. I will be by your side if you decide to live with something you didn’t choose but was forced upon you, and to remind you that you cannot blame yourself no matter what society shouts from the rooftops. I promise to fight for a better world, a better healthcare system that protects us, a better tomorrow.

From,

A woman in healthcare

Minority Mental Health/ #MeToo in Medicine

Vyshnavi

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