Massachusetts Medical Society: Is the Medical Profession Finally Standing Up to Sexual Harassment?

Is the Medical Profession Finally Standing Up to Sexual Harassment?

By Lucy Berrington, MS

In the past two years, as sexual harassment has become a national talking point and high-profile figures were held accountable for years of inappropriate behaviors, the evidence mounted that medicine is not more virtuous in this regard than other industries. Surveys and perspectives were published in medical journals and the mainstream media, #MeTooMedicine emerged as a Twitter hashtag, and physician leaders lost their jobs — adding up to the message that conventional approaches have failed to prevent or address sexual harassment in the medical workplace.

Jo Shapiro, MD
Jo Shapiro, MD

Yet that same evidence also speaks to an increased recognition of sexual harassment and its broad, negative impact on individuals and organizations within the medical profession. “In the past year, more people have come forward [to report harassment] than in previous years,” says Jo Shapiro, MD, director of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital, which handles cases of sexual harassment involving physicians.

Endemic Harassment

A report by the National Academies of Sciences, Engineering, and Medicine, released in June, placed a justifiably harsh spotlight on sexual harassment in the STEM fields and academic medicine in particular. Surveys suggest that the sexual harassment of women on medical faculties and women medical students is endemic. Research on sexual harassment broadly has found that women of color are particularly likely to be targeted.

“My intuition is that the problem is at least as bad in medicine as elsewhere,” Reshma Jagsi, MD, DPhil, a professor of radiation oncology at the University of Michigan and the lead author of a 2016 JAMA paper on sexual harassment in academic medicine, wrote in NEJM in January: “And the data show that the problem for female physicians is certainly bad enough that the profession must work together to correct it.”

Effective Prevention Goes Far beyond Policy

Existing harassment policies and procedures are often symbolic and focused on avoiding liability, the National Academies found. Hospitals are not necessarily addressing the problem more effectively than universities. “Every hospital I know of has policy against sexual harassment and people you can report to. But the question is, are people using that system?” asks Dr. Shapiro.

The answer is no, surveys show. This reluctance reflects the belief, pervasive in medicine and academia, that the people reporting harassment will suffer negative career consequences. “I take that extremely seriously,” says Dr. Shapiro. “I’m most interested in making sure people are not harmed for having come forward with concerns.”

Easier Reporting, Fair Investigation

The Center for Professionalism and Peer Support at Brigham and Women’s is designed to foster a culture of “mutual respect, trust, and teamwork,” according to the hospital website.

A key goal of the Center, which opened in 2008, has been lowering the barriers to reporting harassment. That means inviting employees to have a conversation rather than requiring them to file a formal report. It also means demonstrating fairness, both to the person reporting harassment and to the alleged perpetrator.

The success of such an approach depends on its sustained presence and visibility. “It takes a while to set up a whole program where this gets integrated into the fabric of the institution,” says Dr. Shapiro. “The fact that people are willing to come forward where they tolerated harassment for years, makes me think there is an increased sense of safety in reporting.”

Organizational Climate

Harassment is more common in hierarchical organizations, especially those that are perceived to tolerate it, research shows, which may help explain its prevalence in medicine and academia, the National Academies report pointed out. Harassment is less common in organizations that actively support inclusion, diversity, and respect.

The National Academies called for academic leaders at every level to “make the reduction and prevention of sexual harassment an explicit goal of their tenure.” The support of clinical leaders is vital, says Dr. Shapiro. “A department asked me to do a presentation on harassment. At the end, the chair stood up and said, ‘I want to make this really clear: we just will not tolerate this in our department.’ People are so relieved that the institution itself is not OK with harassment.”

Two Types of Perpetrators

Based on her own experience, perpetrators of sexual harassment divide into two types, says Dr. Shapiro. The first involves people who do not see their behaviors as intentionally malicious. “Our answer is it’s not about your intent, it’s about your impact. And it’s illegal. Anecdotally, from my experience, these are the ones who are more likely able to stop it when we make it obvious how harmful it is.”

The second type appears shrewder. “I think they know what they’re doing and use it as some sort of power thing. I think the only way they change is if they know it will harm them. The institution has to have the backbone to say, ‘If you do this again, or because you’ve done this, this and this is going to happen’ — potentially the loss of a leadership position or employment.”

The Nature and Impact of Sexual Harassment

Identifying Harassment

The most common forms of sexual harassment are gender-based, according to the National Academies — “behaviors that communicate that women do not belong or do not merit respect,” such as hostility, objectification, and exclusion. Sexual harassment also includes unwanted sexual advances and sexual coercion.

Professional and Health Harms

Sexual harassment undermines professional and educational attainment, research shows. The National Academies warned of the “costly loss of talent” resulting from sexual harassment and urged institutions to consider it as important as research misconduct in its negative effect on the integrity of research.

Sexual harassment also affects the mental and physical health of people targeted. “The long-term effects of sexual harassment in the workplace have not been well researched,” says Maria G. Michas, MD, MPH, FACOEM, medical director of Employee Health Services, Occupational Injury Care & Wellness, at UMass Memorial Health Care. “In a study of more than 500 cases, 46 percent of women said the harassment interfered with their work performance. Thirty-six percent reported nausea, vomiting, depression, headache, or drastic weight change. Sexual harassment has also been reported to result in increased sick leave, decreased productivity, increased job turnover, and litigation.”

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