Speaking Up: Sexual Harassment in the Medical Setting

Public awareness about the topic has increased since the 1990s when Attorney Anita Hill made allegations of sexual harassment about Supreme Court Justice Clarence Thomas. The authors became interested in this topic after a third-year medical student approached her Clerkship Coordinator to report she was confused about what to do because a male patient had brushed his hand on her backside on the inpatient psychiatric unit. When she reported the incident to her female supervisor, she was told, “Don’t make a big deal about it, it happens.” Definition For purposes of this article, we use the Equal Employment Opportunity Commission (EEOC) definition of sexual harassment. In 1980, the EEOC defined sexual harassment as unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature.1 Prevalence of sexual harassment The US Merit Systems Protection Board conducted surveys in 1980, 1987, and 1994, and each of the surveys yielded similar results.2 In the first survey, 42% of women and 15% of men reported sexual harassment on the job; in the second survey, the same percentage of women and 14% of men reported sexual harassment; and in the third survey, 44% of women and 19% of men reported sexual harassment. Sexual harassment appears to be common during medical training. A meta-analysis of data on the topic reported that 59.4% of medical trainees, including medical students, interns, and residents in all specialties, had experienced some form of harassment.3 Another study of emergency medicine residents found that 68.9% of women and 41.9% of men responders reported sexual harassment.4 A 1994 survey of interns and residents in an internal medicine residency program showed that a total of 83 episodes of sexual harassment had occurred.5 Of these, 41 occurred during medical school and 42 during residency. About 77% of women did not report the harassment because they were not confident it would help, and 82% of men felt they could deal with the problem with no outside help. Women also reported fear of retaliation and feelings of shame and guilt. Other reasons were fear of not being believed, embarrassment, lack of trust in authority figures, and lack of familiarity with available resources. A New Zealand study in 2001 that included trainees from all specialties showed that 20% of them had been sexually harassed: women were more likely to report the harassment than men were.6 Most harassers of women in hospitals tend to be male—whether attending physicians or others—and most episodes are likely to happen during medical school. Harassers of men were reported to be mostly nurses; these incidents tended to occur during residency and were found to be mostly non-physical in nature.5 A British survey of 100 male and female psychiatric trainees showed that 86% reported unwanted sexual contacts such as deliberate touching, leaning over or cornering, letters, telephone calls, and exposure to sexual material. Most of the offenses were perpetrated by patients.7 Findings indicate that female doctors are mostly harassed in their offices by their patients, but also in high-risk areas such as inpatient wards or walk-in clinics.6 Harassment also occurs in emergency departments, where there is a large proportion of previously unknown patients, as well as patients under the influence of alcohol or drugs. In the New Zealand study, more than half of all trainees reported some form of threat by patients, and one-fifth had been sexually harassed. Psychiatric trainees were identified as being more at risk