Many physicians experience — but do not report — sexual harassment

Sexual harassment is common among physicians, but many do not report incidents even though they negatively affect their personal and professional lives, according to research presented during the virtual Women in Medicine Summit.

When physicians did report sexual harassment, survey data indicated that the institution or supervisor responses were “inconsistent and often inadequate,” Shirin Hemmat, MD, MPH, chief medical resident at the University of California, San Francisco, said.

Sexual harassment in practice

Previous research has shown that one-third of physicians report being sexually harassed by patients at some point in their career, according to Hemmat.

To learn more about these incidents, Hemmat and colleagues used a web-based questionnaire to assess the characteristics of and responses to sexual harassment of physicians by patients. The questionnaire included 17 free-text and multiple-choice questions. It was advertised through social media, emails, physician vlogs and an academic journal.

Fifty-two physicians across multiple specialties, including family medicine, internal medicine, emergency medicine, pediatrics, neurology and psychiatry, who experienced sexual harassment responded to the questionnaire. Among them, 90% were women, 25% were Asian, 2% were Black, 8% were Latino, Hispanic or Spanish, and 73% were white. Their length of career ranged from residency to more than 15 years of practice, Hemmat said.

The sexual harassment incidents occurred in inpatient (39%), outpatient (44%) and emergency or urgent care (17%) settings. Most physicians had just met (40%) or were somewhat familiar (40%) with the patient, Hemmat said. More than 60% continued to see the patient after the incident.

Most incidents (98%) were verbal, which Hemmat defined as “inappropriate or unwanted remarks.” Twenty-three percent of incidents included physical harassment such as exposure or unwanted physical conduct.

About half of respondents said the incident had a negative professional or personal impact. Professional outcomes included a decline in job performance, satisfaction or withdrawal from work, whereas personal outcomes included a negative impact on mental health, self-worth or personal behaviors.

Approximately 32% of respondents told a supervisor or colleague about the incident, Hemmat said. Meanwhile, 31% did not take any action, 21% addressed the behavior directly with the patient and 19% formally reported the incident. Four percent of incidents required security or law enforcement involvement.

Many physicians (54%) said they did not report the incident because they did not feel it was significant enough. However, many also did not know who to report the incident to (42%) or how to report it (19%). In addition, some respondents said they did not think that reporting would be impactful (40%), did not want the patient to be reprimanded (25%), felt ashamed or embarrassed (21%) or did not have the time to report the incident (17%).

The most common institution or supervisor response to the incident was to dismiss or reassign the provider from the clinic (23%), according to Hemmat. Few institutions or supervisors addressed the behavior with the patient (4%). Some also normalized or minimized the patient’s behavior (4%) and discouraged the provider from pursuing a formal report or retaliation (4%).

“Our conclusions are sexual harassment of physicians is common,” Hemmat said. “Many do not formally report despite having negative experiences that impacted their ability to perform their job.”

Sexual harassment in academic medicine

Results of another survey showed that sexual harassment is also common among physicians in academic settings.

Diana M. Lautenberger, MA, director of Faculty and Staff Studies and Services at the Association of American Medical Colleges (AAMC), and colleagues examined data from the AAMC’s Standpoint Faculty Engagement Survey, which is administered to medical school faculty across the United States. Their analysis included data from 8,218 faculty members who responded to questions about sexual harassment between February 2019 and May 2020.

Lautenberger reported that one in three women and one in eight men experienced at least one incident of sexual harassment in the last year. Rates of sexual harassment were more than twice as high for women than men (34.8% vs. 13.3%), she said. The highest rates were among senior women, 40% of whom experienced harassment in the past year compared with 32% of junior women. Data also showed that nearly 36% of minority women experienced harassment.

The most common behaviors of sexual harassment were sexist storytelling or jokes and put downs, “or acting in a way that is condescending toward your gender,” Lautenberger said.

“Interestingly, both men and women experienced sexist jokes, although women experienced at double the rate — 10% and 20%, respectively,” Lautenberger said. “The highest rates of experiencing sexist jokes was among senior women, at 24.2% compared with only 11% of senior men.”

Another common but less prevalent behavior was referring to another gender in offensive terms.

“There was a much larger gap between men and women regarding gender put downs, with a quarter of women and only 3% of men having this experience,” Lautenberger said. “The highest rate of gender put downs was, again, among senior women, at 28.1% compared with 3% of their senior men counterparts.”

Women who were sexually harassed felt less safe in reporting the incident than men who were sexually harassed (54.6% vs. 67.6%). They also felt less confident that the institution would resolve the incident (33.7% vs. 50.4%).

Results further showed that women who were sexually harassed were less satisfied than women who were not sexually harassed with their department (63.1% vs. 83.8%) and institution (58.1% vs. 78.9%). They were also less likely to remain at their institution (56.6% vs. 75.5%). Similar trends were observed among men, according to Lautenberger.

“All in all, faculty who experienced harassment are less satisfied with their workplace and less likely to stay at their school,” she said. “These data show us that sexual harassment is common, both men and women experience it, and it impacts everything from individuals to organizational effectiveness.”

Efforts to raise awareness

Both Lautenberger and Hemmat said their data will help with future efforts to provide support, training and policies against sexual harassment.

During another presentation, Nazineen Kandahari, a medical student in the University of California, Berkeley, and the University of California, San Francisco, joint program, talked about the need to raise more awareness of gender-based violence (GBV) in health care.

“GBV is any type of violence that exploits unequal power relationships between genders,” she said. “It includes but is not limited to sexual, physical or psychological violence, as well as microaggressions and certain gender norms and trans- and homophobias.”

Kandahari said the medical field has many elements that “perpetuate GBV, such as its historical male dominance, strong hierarchies, lack of accountability at the leadership level and culture that tolerates mistreatment.”

“Though there is plenty of evidence demonstrating the negative effect of GBV on individuals’ wellbeing, confidence and career advancement, there remains a lack of awareness about GBV among health care professionals and trainees, and more importantly, a lack of accountability from institutions to effectuate change,” she added.

Kandahari and colleagues organized a first-ever event at UCSF for health care professionals in the San Francisco Bay area who experienced GBV. The 1-day conference included a storytelling session, during which trained storytellers performed narratives of GBV victims who anonymously submitted their experiences during a call for submissions prior to the conference. There also was a training session on how to respond to GBV, as well as a Q&A forum to demystify the process for reporting sexual discrimination.

Among 51 attendees who were surveyed after the event, 80% said they agreed or strongly agreed that they felt more comfortable speaking up against GBV, and 90% agreed or strongly agreed that the conference taught them how to respond to future incidents, according to Kandahari.

“Most participants expressed gratitude for finally having an institutional space dedicated to the topic of discussing and addressing GBV,” she said. “In conclusion, we found that storytelling is a powerful medium to raise awareness, enlist institutional accountability and inspire change about a sensitive topic such as GBV.”

Since the conference, Kandahari and colleagues have launched a nationwide initiative to collect more stories about GBV in health care. They will hold a second conference on GBV in the spring, Kandahari said.

“To join the discussion, visit us at MeTooInMedicine.org,” she said.

References:

Hemmat S, et al. Sexual harassment and reporting for physicians (SHARE): Using incident reporting to understand the characteristics, response and implications among physicians who are sexually harassed by patients. Presented at: Women in Medicine Summit; Oct. 9-10, 2020 (virtual).

Kandahari NN, et al. #MeTooInMedicine. Presented at: Women in Medicine Summit; Oct. 9-10, 2020 (virtual).

Lautenberger DM, et al. Sexual and gender harassment and engagement among U.S. medical school faculty. Presented at: Women in Medicine Summit; Oct. 9-10, 2020 (virtual).