Sexual harassment in the workplace has existed from time immemorial. Increased exposure of the problem arose in 2017 with the very public allegations of sexual harassment in the entertainment industry, which quickly spread to charges of impropriety and ousters of high-level leaders in multiple other settings. Studies have identified that the medical field is not immune from sexual harassment, despite our focus on improving health, advancing science, and curing disease. 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. With their article in this issue of Mayo Clinic Proceedings, Rihal et al
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are to be commended for taking this bold step in reporting their institutional experience with sexual harassment, including steps to create a culture intolerant of such behavior.Sexual harassment in the medical environment cannot be uncoupled from issues seen in larger society. Some form of sexual harassment or sexual assault has been reported to have occurred in 80% of women.
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Issues of sexual harassment occur in industries outside of medicine as well.3
The 2015 Association of American Universities study revealed that 44% of female graduate students and 62% of female undergraduate students reported experiencing sexual harassment.4
In a tertiary referral center in Germany, 70% of physicians experienced sexual harassment, including those who identify as male and all 4 physicians who self-report as transgender, nonbinary, or intersex.5
Likewise, 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.6
Other professions of highly educated individuals are not immune either. In the legal profession, in a survey of nearly 7000 lawyers in 135 countries, it has been reported that 1 in 2 women and 1 in 14 men have been sexually harassed.7
Although much of the focus has centered on the workplace environment and paid employees, there is a significant amount of literature that indicates that medical students, trainees, and other health care learners are at risk for sexual harassment. These important members of our health care system are particularly vulnerable because of the unequal power dynamic between learners and their evaluators or between learners and their patients. 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.
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A 2016 survey from all 17 Canadian universities with associated medical schools revealed experiences of sexual harassment coming from not only faculty and preceptors but also other students and patients.9
Although most students experiencing harassment were female, male students were affected as well. Freedman-Weiss et al10
published the prevalence of sexual harassment in surgical trainees. More than 70% of female respondents and 31% of male respondents experienced some form of sexual harassment.10
Clearly, this has a great effect on our workforce of the future, leaving many learners feeling fearful, immobilized, and, worst of all, silenced.As noted in the article by Rihal et al
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in this issue of Mayo Clinic Proceedings, the effects of sexual harassment are far-reaching and deep. Those experiencing harassment may suffer psychological harm, which may lead to depression, anxiety, and burnout. In addition, uncertainty as to how to mentor individuals of different sexes may also affect an employee’s or learner’s ability to receive the mentorship and sponsorship needed for career advancement. Hill and Laguado11
offered guidance for males who mentor females based on a significant amount of discomfort reported in males mentoring women at work as a result of the #MeToo movement. Recommendations included establishing a safe environment for interaction and being mindful before speaking to or touching a mentee.As stressed by Rihal et al,
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the institutional environment sets the tone starting from the top. Leadership modeling the expected behavior (including not participating in sexual harassment), not condoning or tolerating sexual harassment in the work and educational space, and ensuring that effective policies and procedures are in place to address sexual harassment are critical to avoiding skepticism that nothing will be done to deal with harassment. Mayo Clinic is a Time’s Up Healthcare Signatory to express strong support for the efforts of this group devoted to addressing sexual harassment and sex discrimination in health care.12
Patients may also be the perpetrators of sexual harassment, and unacceptable behavior must be addressed in an unambiguous way. A survey of more than 6000 health care providers revealed that 27% of physicians were actually harassed by patients compared with 7% by others employed in the workplace.Meet our health care signatories. TIME’S UP Healthcare website.
https://timesupfoundation.org/work/times-up-healthcare/meet-our-health-care-signatories
Date accessed: February 18, 2020
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Institutions must have effective policies that deal with patients who act in inappropriate ways, and those who supervise learners must intervene if such behavior is witnessed. Without swift actions to investigate and deal with sexual harassment, underreporting will continue to occur and sexual harassment will remain normalized in the health care environment as it has for so long become normalized in the greater society.Yet, there is a challenge in demonstrating that institutional policies actually have consequences. When charges of sexual harassment are initiated, a fair and equitable investigation must be undertaken that respects the rights of both the accuser and the accused, and appropriate action must ensue. An employee, learner, or patient found to have committed sexual harassment may be dismissed, which may be highly visible to others, including the accuser. Yet, if individuals accused of sexual harassment face consequences or interventions short of dismissal that are not visible to others because of privacy issues, or if there is a perception that the consequences are not severe enough, cynicism and distrust may ensue. As well, organizations face challenges of when to act on a charge of sexual harassment if it does not happen in the work or learning environment but, instead, happens in a social context, when the impact in the work or educational setting is less clear. Each institution must work through these scenarios on a case-by-case basis and try their best to adhere to their policies and procedures.
So where do we go from here in our health care institutions? Transparency and sharing lessons learned to come up with a collective way to stamp out sexual harassment are critical. We must continually and steadfastly address sexual harassment and have a zero tolerance policy. We must be willing to investigate reported instances in a fair and consistent way, respecting the rights of both the accuser and the accused. Institutions must learn from mistakes when sexual harassment has gone unaddressed and strive to do better in the future. Expectations for appropriate behavior must be set for all who are part of the health care ecosystem. Tools for providers and learners must be given to help employees and learners proactively handle these situations, including how to report sexual harassment, how to handle the harasser, and how to effectively develop working relationships with coworkers, mentees, and, especially, those of different sexes. Last, this problem will not go away without the continued relentless focus from the greater society as a whole on this societal problem. We owe a debt of gratitude to the #MeToo movement for sparking the conversations we are now all engaged in in multiple arenas.
References
- Addressing sexual harassment in the #MeToo era: an institutional approach.Mayo Clin Proc. 2020; 95: 749-757
- The Facts Behind the #MeToo Movement: A National Study on Sexual Harassment and Assault.Stop Street Harassment, Reston, VA2018
- Sexual harassment is an occupational hazard.J Womens Health (Larchmt). 2020; 29: 1-2
- Report on the AAU Campus Climate Survey on Sexual Assault and Sexual Misconduct.University of Pennsylvania, Philadelphia, PA2015
- Prevalence of sexual harassment in academic medicine.JAMA Intern Med. 2019; 179: 108-111
- #MedToo: a large-scale examination of the incidence and impact of sexual harassment of physicians and other faculty at an academic medical center.J Womens Health (Larchmt). 2020; 29: 13-20
- Us too? bullying and sexual harrassment in the legal profession. International Bar Association website.(Published 2019. Accessed February 18, 2020)
- Engineering, and Medicine. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine.The National Academies Press, Washington, DC2018
- Sexual harassment of Canadian medical students: a national survey.EClinicalMedicine. 2019; 7: 15-20
- Understanding the barriers to reporting sexual harassment in surgical training [published online April 2, 2019]. Ann Surg.https://doi.org/10.1097/SLA.0000000000003295
- Guidance for male mentors to support the safety and success of female mentees.Am J Pharm Educ. 2019; 83: 7533
- Meet our health care signatories. TIME’S UP Healthcare website.https://timesupfoundation.org/work/times-up-healthcare/meet-our-health-care-signatoriesDate accessed: February 18, 2020
- Patients sexually harassing physicians: report 2018.(Published July 11, 2018)
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See also page 749
Potential Competing Interests: The authors report no competing interests.
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- Addressing Sexual Harassment in the #MeToo Era: An Institutional ApproachMayo Clinic ProceedingsVol. 95Issue 4
- PreviewSexual harassment is a particularly pernicious form of harassment that can result in long-lasting psychological damage to victims. In health care, it has deleterious effects on teamwork and communication and may affect patient care. Although concerns regarding sexual harassment in the workplace, including within health care, are not new, increased attention has been focused on this topic since late 2017 as a result of the #MeToo movement. As in other sectors, health care centers have experienced instances of sexual harassment.
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