It is telling that TIME Magazine’s Person of the Year honor was shared by “the silence breakers,” 61 women and men, from familiar actors to ordinary people, who came forward to report sexual assault and harassment, mostly in the workplace.1 Their stories are powerful and, sadly, not at all unfamiliar.
From the perspective of a female surgeon, one of the first female chairs of surgery, and now as one of a handful of female medical center chief executive officers and medical school deans, it appears that US society is on the cusp of a change in addressing sexual harassment and abuse.
Change often starts with the familiar basics: policies, education, and training. The harassment policy at Wake Forest Baptist Medical Center is clear and direct: Respectful behavior in the workplace is nonnegotiable. All staff members are responsible for making the medical center a safe, inclusive place where every individual feels valued, respected, and able to do his or her best work. There are no excuses and no exceptions to allow or enable anything less.
Similar policies are in place in hospitals across the country with similar important language: Discrimination or harassment of any employee or student based on sex, race, color, religion, national origin, sexual orientation, gender identity, age, or disability will not be tolerated. But policies are not always practiced and incidents are not always reported, due to fear of retaliation or harm to career advancement.
Health care workers in the United States are not alone with respect to sexual harassment. Around the world, there are reports of harassment, disrespect, and bullying in health care and science. In some countries, these behaviors border on unsafe. In a recent study, 83% (100/120) of physicians, nursing, and support staff at Bahrain Defense Force Hospital emergency departments, at 1-year follow-up, reported experiencing verbal abuse (78%), followed by physical abuse (11%), and sexual abuse (3%).2 In another recent study involving a survey of 137 residents at a children’s hospital in Mexico, 32% reported bullying and 82% reported harassing behaviors.3 Being female and younger than 29 years of age were reported as factors significantly associated with workplace bullying.3
If current methods and policies to prevent harassment and bias in health care are not working, what can leaders and others do to address this, especially if staff members do not feel there is someone they can talk with openly? Some organizations have set up an independent intermediary or outside organization with a hotline to report inappropriate actions or conversations and to manage the matter through to resolution. Other health care systems require staff to take real-time or virtual training to learn how to address being bullied or what to do when they see someone else being disrespected.4
Policies and training are well meaning and necessary, but gender bias and harassment must be eliminated. It is an issue that affects all of society. In the enormous public response to publicity around harassment and gender bias—across multiple industries and organizations over the last several months—society has decided: This is wrong.
Medical training teaches physicians to step up and say something. Physicians learn to say “I have a concern” when they need to stop before a surgical procedure for the safety of the patient. Today, surgeons see this play out every day, but in previous years, that was not the case. No one spoke in the operating room, except the surgeon. Now, anyone can speak up, and should do so, when necessary.
Physicians need to take this process, built upon safety, and encourage those in medicine to be brave and to speak out when they are, or witness someone else who is, being harassed or disrespected. Every physician, female or male, should feel empowered and encouraged to speak up, without fear, if she or he ever experiences or observes behavior that betrays the values central to a person’s identity. Every physician, female or male, should be brave enough to say, “This behavior makes me feel uncomfortable” or “I feel disrespected” to anyone who is inappropriate or disrespectful.
When it comes to respect, everyone must speak the same language and understand the same definitions. How physicians treat each other and other members of the health care organization creates the workplace culture and affects the health care environment, regardless of the person and his or her academic rank or clinical role; regardless of the clinical, administrative, or supporting duties and responsibilities; and regardless of the location, from operating rooms to board rooms. More importantly, leaders must ensure that issues brought to their attention involving disrespect of others, sexual harassment, or other unprofessional behaviors are immediately recognized, addressed, and resolved.
The medical and research communities are taking notice. Many recent publications,5,6 journal articles, and commentaries have addressed the issue of gender bias and harassment in medicine, including one that suggested 2018 would be the “year of reckoning for gender equality,” as well as the “year of reckoning for women in science.”7 Similarly, a committee of the National Academies of Science, Engineering, and Medicine will deliver a consensus report in 2018 on sexual harassment of women in science, engineering, and medicine and its effect on career advancement.
Medicine is at a tipping point. For the first time, in 2017, the number of women entering medical schools outnumbered men.8 With these students come different perspectives and active voices. This millennial generation knows that discrimination and harassment are not right. But for the young people of this generation, as well as people of the generations that preceded them and who work in academic medical centers, health care institutions, and other settings, now is the time for mutual respect, for utmost civility, and for women (and men) to be brave in putting an end to sexual harassment and abuse.