Career

Patient Care in the #MeToo Era

Sexual harassment is rampant in virtually every career field, including medicine, but doctors, nurses and other medical personnel endure harassment from patients as much as, if not more than, their employers and colleagues. Whereas many people cope with inappropriate contact and verbal abuse from those who work above them, healthcare workers are faced with harassment from the people that they help and treat. A staggering amount of women, and some men, report that they have been on the receiving end of inappropriate remarks or touching at the workplace and until recently this has been a muted conversation in medicine. With help from the online “#MeToo” Movement, where victims of harassment and abuse of a sexual nature have told their personal stories on social media to demonstrate exactly how rampant harassment actually is,  medical staff and faculty have been able to come forward and take the steps to end this misconduct from patients, colleagues and administration. Leaders in the fight to end this form of gender-based discrimination advocate for a “zero- tolerance” policy, complete accountability of the harasser and a stronger voice for healthcare workers.

Molly Walker, a staff writer for MedPage and author of “Treat Sexual Harassment in Medicine on a Systemic Level”, states that harassment in healthcare is likened to a disease that needs to prevented on a large scale instead of episodically¹. Doctors Susan Phillips, MD, CCFP and Margaret Schneider, PhD penned the paper “Sexual Harassment of Female Doctors by Patients” for the New England Journal of Medicine in 1993 and, while statistics and particular numbers have changed over the past two decades, the themes are no different today; the doctors were explicit in writing that speech and banal actions are not enough to be deemed as sexual harassment, but that the context and interpretation of the recipient are what classify it as such². Associate professor at Oregon Health & Science University Esther Choo, MD defines sexual harassment as “an array of verbal and non-verbal behaviors that covey hostility, objectification, exclusion or second- class status about members of one gender”¹.

Studies have revealed that about half of all female medical students have been a victim of sexual harassment by members of the staff or faculty in the institutions where they have studied¹ while about 60% of all female staff and faculty in medicine have reported incidences of harassments³. About a third of physicians reported sexual harassment from patients but are also less likely to realize that their staff members are being harassed by patients⁴. This could be caused by patients who draw a line of professionalism between assistant or nurse and doctor but this could also be because MAs and RNs are occupations with a higher population of women, whereas MDs where traditionally more male than female until recently.  Of note, women in medicine are far more likely to experience harassment at work than their peers in other academic fields such as engineering and other sciences³.
In his 2018 article “What to Do? Elderly Patients Sexually Harass Healthcare Staff”, Greg Hood, MD points out that the rare incidences of  abuse from medical staff and physicians is often highly publicized while the everyday abuse that staff and faculty endure from patients is virtually unreported and seldom makes the news⁵. Citing a Medscape article, Elizabeth Chuck reported in her 2018 article “For Nurses, Sexual Harassment from Patients is ‘Par for the Course’” that 71% of nurses have experienced sexual harassment from patients, many of whom are drunk, high or sick⁶. Not including the unintentional abuse from patients with dementia, neurologic or psychological disorders, medical personnel endure harassment by patients from pestering staff for dates to inappropriate name calling and even groping or grabbing at staff members⁴’⁶.

According to Shelly Reese, author of “Sexual Harassment by Patients: How Doctors Handle It”, about 60% of those who reported abuse at work were women, with the overwhelming majority of abusers being men for both male and female respondents⁴. In an interview conducted with ophthalmic assistant George Petner, COA, the healthcare worker revealed that, although men are harassed at work, he feels that the abuse towards his female colleagues can be much worse. “When a female patient says something inappropriate to me during an exam, the mood might change and things are temporarily awkward, but I definitely don’t feel threatened”, noting that women in the medical field are too often physically violated⁷. Aside from the feelings of vulnerability and physical abuse, women who speak out against sexual harassment are sometimes ignored or worse. In research conducted for the National Academy of Science, Engineering and Medicine, Dr. Choo and several of her colleagues revealed that sexual harassment, paired with gender-based discrimination, is a factor that hinders the potential progress of a female health care worker’s career path¹. Simply put, victims who come forward with their stories of harassment are more likely to be retaliated against and stigmatized⁸.

Harassment and abuse within healthcare organizations leads to questioning of the organization and, in turn, the medical field as a whole³. Victor Dzau, MD and Paula Johnson, MD wrote, in their research, that “sexual harassment in academic medicine is a symptom of systematic failures that prevent the medical work force from operating at its fullest potential”¹. Nurses and staff are in a unique situation where they have to treat sick patients and therefore endure this kind of abuse; health care organizations are obligated to protect their workers, but it is hard to protect them when the patients who are harassing need to be treated⁶.

Abusive behavior of staff and faculty has become the norm for many in medicine and the only proven ways to cut this problem out of medicine and academia is by implementing no tolerance policies, enforcing accountability and giving women a voice in the work place⁵. A zero-tolerance policy is a protocol where victims speak up if they have been harassed, even in cases where the harassment was by an impaired patient, so that action can swiftly be taken against the abuser to ensure that the behaviors are corrected or a system can be put in place to prevent further problems; by implementing this policy, incidences of harassment will shrink drastically⁴. If an offender continues to cause trouble despite having been warned and held accountable for his or her behavior, the final option for a physician or practice is to dismiss the patient. While patients can be dismissed from practices, which may occur about a tenth of the time, more physicians are willing to see the patients, as long as they have a family member and/ or staff member in the room to accompany them⁴.

            Over the past several decades, America has come a long way in reducing sexual harassment. In medicine, physicians and staff have continued to be affected by abuse and harassment, not only from peers and faculty, but also from the very people we are trained to help. Hospitals and private practices take harassment allegations very seriously when an employee is at fault but handling sexual harassment from patients can be a difficult task for all parties involved. Habitual offenders risk being expulsed from care but physicians are cautious when doing so; patients are in the care of doctors because they are sick and discharging them from practice could be detrimental to his or her health. Establishing policies within the workplace for healthcare workers who have been harassed or abused by patients optimal for employees and enforcing the rules in a zero tolerance atmosphere lets staff members know that patients who make lewd remarks or grope them will be held accountable.

  1. Walker, M. “Treat sexual harassment in medicine on a systemic level.” 12 September 2018. Medpage Today. <https://www.medpagetoday.com/publichealthpolicy/medicaleducation/75064&gt;.
  2. Phillips, S & Schneider, M. “Sexual harassment of female doctors by patients.” The New England Journal of medicine 329.26 (1993): 1936-1939.
  3. “Time’s up for sexual harassment in medicine.” The Lancet 391 (2018): 2576.
  4. Reese, S. “Sexual harassment by patients: How doctors handle it.” 13 July 2018. Medscape. <https://www.medscape.com/viewarticle/899311_1&gt;.
  5. Hood, G. “What to do? Elderly patients sexually harass healthcare staff.” 31 January 2018. Medscape. <https://www.medscape.com/viewarticle/891598&gt;.
  6. Chuck, E. “For nurses, sexual harassment from patients is ‘par for the course’.” 21 February 2018. NBC News. <https://www.nbcnews.com/storyline/sexual-misconduct/nurses-sexual-harassment-patients-par-course-n848086&gt;.
  7. Petner, G. Personal Interview. K. O’Connor. 19 November 2018.
  8. Jagsi, R & Phil, D. “Sexual harassment in medicine– #MeToo.” The New England Journal of Medicine (2018): 209-211.

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