Me Too movement 'long overdue' in medicine, psychiatry

Problematic sexual behaviors occur often among physicians and in medicine and need to be addressed, according to a presenter at the American Psychiatric Association’s annual meeting.

“One of the reasons that sexual abuse among physicians has only recently been recognized is in part due to the inherent factors that are our culture of medicine,” Renee M. Sorrentino, MD, of the department of psychiatry at Massachusetts General Hospital, said during a presentation. “Organizational factors that lead to unprofessional behavior in medicine include poor leadership, power imbalance and this culture of silence. Only recently has physician wellness been paid attention to, and perhaps physician unwellness may increase risk for engaging in problematic sexual behaviors.”

The “culture of silence” is defined as a perceived tolerance for the conditions that can lead to problematic sexual behaviors, according to Sorrentino. Other factors that contribute to the conditions under which sexual harassment is likely to occur in medicine programs and departments include the dependency on hierarchies to advance the outward appearance of compliance with professionalism, as well as leaders who are ill-equipped to address the problem.

Sorrentino noted that problematic sexual behaviors are the most common cause of disciplinary action by medical boards, with sexual misconduct, such as boundary violations and sexually abusive behaviors, the most common. Most studies that sought to pinpoint factors linked to sexual misconduct in medicine have been limited, since data are not available about the physicians themselves or the practice context in which the abuse occurred, and they don’t differentiate between boundary violations and more serious sexually abusive behaviors, according to Sorrentino. Factors that have been consistently identified as being associated with sexual misconduct include male gender and middle age, and specialties with more reports of sexual misconduct include psychiatry and obstetrics-gynecology.

Sorrentino emphasized that as people consider the Me Too movement in medicine, it is important to consider the power differential between physicians and patients, and senior and junior physicians.

“In order to know what works, we need to adopt a standard of care that we can measure, we can consider an algorithm to measure state protections as one method and we need to have ongoing measurements,” Sorrentino said. “The sex offender literature has made considerable progress in predicting risks through rigorous science, so certainly we can do this in a physician population. It's time to make medical boards, medical schools and health care institutions review their performance and regulation, and this includes asking questions about whether regulators have been informed by the latest evidence, whether interventions are decreasing sexual misconduct and whether impaired physicians are getting the treatment that appropriately decreases their risk.

“The Me Too movement is about physicians, and it's long overdue that we identify and approach the problem,” Sorrentino added.

Reference:

Sorrentino RM. The #MeToo Movement: Implications for psychiatrists. Presented at: American Psychiatric Association Annual Meeting; May 1-3, 2021 (virtual meeting).