Changing dressings on diabetic ulcers is not particularly pleasant. The oozing, the meticulousness of laying down protective layers, and the smell make the task less than ideal for even the strongest stomach. There I was as a 3rd year medical student, working with the resident team for well over an hour assembling the dressings on the patient’s legs to apply a wound vac. To make matters even worse and more uncomfortable, the patient continued to make sexual remarks about me. I kept quiet and finished the job with the rest of the team. In fact, even when we were done, no one mentioned the inappropriateness of the patient. It just went unsaid that this is something that is encountered frequently, and I continued to see the same patient on daily rounds.
In medical school and beyond, female practitioners are common recipients of unwanted sexual harassment. In a recent study by Medscape, about 50% of female physicians said that they had experienced sexual harassment by patients, which was more frequent than their male counterparts. And in an older study published in the New England Journal of Medicine, 73% of women respondents reported having been sexually harassed. With sexual harassment and the #MeToo movement in the spotlight, it is important to have the conversation about harassment in the medical setting as well.
Medical students often find themselves in difficult predicaments; they are the learners in an environment where there are senior students, residents, and attendings above them. And to add to this hierarchy, they are constantly being evaluated by their superiors. It has been repeatedly shown that this can create an environment where harassment frequently occurs and is underreported. How do we bring the movement against sexual harassment into medicine and decrease its occurrence in this environment?
1. Report it
As we have seen through the media, underreporting is a major issue when it comes to sexual harassment, and this occurs in medicine as well. The American Medical Association and medical schools have made it clear that sexual harassment is not to be tolerated. Some students fear repercussions from evaluators so they may hesitate to to make others aware of an inappropriate situation. But if you experience sexual harassment, it is important to tell someone. Start with a peer, an academic advisor, a resident, or attending physician. The point is to make your voice heard and to make others aware of an inappropriate situation in order to remove yourself from the situation and prevent further occurrence.
If the harassment is from a patient, tell your supervising resident or attending physician and ask to be reassigned to another patient right away. It’s important to state explicitly that you wish to be removed from the situation, or you may just receive empathetic comments while nothing is done to change the situation.
2. If you see it happen to someone else, report it too
If you see a peer experience sexual harassment then you should report it as well. Your peer may be nervous about telling someone else, but it is important that the unacceptable behavior is recognized and dealt with by the appropriate administrators.
3. Keep work relationships professional
Remember to keep your relationships with your peers and co-workers professional. This especially includes when treating patients. It can be easy to become comfortable with a patient as you develop a caring relationship, but this should never be on the verge of unprofessional. Any romantic gestures on behalf of the patient should not occur, and if they do, it should be reported immediately.
Looking back, I should have asked my senior resident to not work with this specific patient anymore. At the time, I just didn’t know that this was an appropriate request to make. In order to prevent further sexual harassment, there needs to be an environment where anyone is free to share when they are uncomfortable, without fear of repercussions. Bringing the movement against sexual harassment into medical training will empower medical students and physicians to voice their concerns when they are being treated inappropriately. And in this environment, we can enhance the ability for physicians to form effective partnerships with their patients and provide the best care possible.