Portal de Periódicos da CAPES

Special Report

2018; Lippincott Williams & Wilkins; Volume: 40; Issue: 3 Linguagem: Inglês

10.1097/01.eem.0000531126.85885.a9

1552-3624

Gina Shaw,

Workplace Violence and Bullying

sexual harassment: sexual harassmentWhen the New York Times published its seismic story last year detailing decades of sexual abuse allegations against movie mogul Harvey Weinstein, the floodgates burst at the seams. More than 80 women, including actresses Gwyneth Paltrow, Lena Headey, and Lupita Nyong'o, went public with their stories of sexual harassment by the film producer. Hundreds of thousands of women came forward on social media in the aftermath, using the hashtag #MeToo—originally created by activist Tarana Burke a decade ago and revived by actress Alyssa Milano—to share their own stories of sexual harassment and abuse. More powerful men were revealed to have engaged in sexually predatory behavior. More industries were exposed as #MeToo hit Silicon Valley, finance—and medicine. The hashtag #MeTooMedicine began trending in November, spotlighting female doctors' experiences with accounts such as “Was a med student in small community hospital. Orthopedic attending wondering out loud in OR whether I'm sexually experienced,” and “Internist on rounds meets my student eyes, then looks down & up my body. He says openly, ‘You should wear a dress more often.’” About a year earlier, Reshma Jagsi, MD, a professor, the deputy chair, and the residency program director in radiation oncology and the director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan, published disturbing findings from a survey about sexual harassment of women in biomedical research, the first like it since the mid-1990s. The level of harassment had declined since the previous study (which had a somewhat different design), but one in three women in her sample of 1,000 biomedical researchers reported experiencing sexual harassment. “In that earlier study, a cross-sectional sample of women on U.S. medical school faculties, 65 percent of the more than 3,000 respondents said they had experienced sexual harassment,” said Dr. Jagsi. (The survey was conducted in 1995 and later published in Annals of Internal Medicine. [2000;132(11):889.]) “I decided to do a follow-up survey, this time focusing on a specific subset of faculty—women and men who were new recipients of K awards from 2006 to 2009. Paper after paper was showing that women, even when they are the cream of the crop and highly qualified, are still less likely to get independent grants than their male peers and are still making far less. With all of the bad news about the gender gap in medicine, I was just looking for some good news.” At first blush, you might say that her findings, published in JAMA May 17, 2016, represented good news. About one in three women responding to the survey (30.4%) reported that they had personally experienced sexual harassment in their professional life, vastly more than men; only about four percent of them reported sexual harassment. But Dr. Jagsi noted that the gender composition of medicine has changed markedly in the 20 years between the original survey and her own, and sexual harassment and gender bias should have declined much more than it did. “The original survey included many women who had gone to medical school in the 1970s, when women were only a small minority in the field,” she said. “In our sample, the mean age was 43. These women had gone to medical school in the 1990s, when women were over 40 percent of the medical school class. We assumed that sexual harassment would be far less common now that women are no longer that small minority, but that's not the case. It's true that 30 percent is a lot less than 65 percent, but it's still far too many.” Unwanted Advances What do we know about sexual harassment in emergency medicine specifically? Not nearly enough. There are only two significant emergency medicine-specific papers in the literature that focus on sexual harassment, both surveys from the Society for Academic Emergency Medicine that focused on emergency medicine residents (other papers have addressed bullying and harassment in emergency medicine, but without a specific focus on sexual harassment). In the first, published in Academic Emergency Medicine in 1995, 63 percent of women vs. 32 percent of men reported receiving unwanted sexual advances, 66 percent of women vs. 27 percent of men experienced discomfort because of sexual humor, and 71 percent of women compared with 17 percent of men reported unfair treatment because of gender. (1995;2[4]:293.) Li and colleagues followed that with a 2010 survey that found that 37 percent of female residents in this survey reported that they had been sexually abused or harassed compared with only seven percent of men. (J Emerg Med 2010;38[2]:248.) The proportion of participants reporting sexual harassment in these two surveys were similar to those in Dr. Jagsi's and her earlier Annals paper, with about two in three women reporting sexual harassment in the 1990s-era survey compared with about one in three in the later survey. The data for emergency medicine are too old, said Robert McNamara, MD, a professor and the chair of emergency medicine at Temple University's Katz School of Medicine and the lead author of the original study conducted as part of the Society for Academic Emergency Medicine In-service Survey Task Force. (Acad Emerg Med 1995;2[4]:293.) “I'd like to think that we have made more progress since then, with greater awareness and new policies at many institutions. As a result of these changes, I've seen faculty let go at my institution; I've seen faculty removed from resident contact. It might be worthwhile at this juncture to repeat the SAEM survey.” Carol Bates, MD, the associate dean of faculty affairs at Harvard Medical School and a past chair of the steering committee of the Group on Women in Medicine and Science (GWIMS) for the Association of American Medical Colleges, cautioned that it would be naïve to assume that times have changed for emergency medicine. “Sexual harassment is not a thing only committed by past generations; we have, unfortunately, young people who have not necessarily respected sex and gender in their approach to their professional work. And people are very afraid of retaliation, which is a hard thing to get at. Most institutions may have very clear policies on sexual harassment, policies that prohibit retaliation. But in our world, if a senior person in the field is at a national meeting and says informally, ‘Don't hire Sarah,’—not saying anything about sex and gender, but just maligning the person's qualifications—that's not likely to ever get back to the institution. The person just doesn't get hired and doesn't know why.” Dr. Jagsi noted that the harassment has had a significant effect on the careers of many women in medicine. “What jumped out at me in our survey, and in conversations I have had with women since then, is the sheer frequency of the harassment and the perceived impact on women's careers. Many of the women were describing more serious forms of harassment, and were saying that this did have an impact on their confidence in themselves as professionals. And we asked only about workplace sexual harassment from superiors or colleagues, not even about harassment from patients, which we know is very prevalent. Something serious is going on for many women.” Dr. Jagsi described the flood of contacts she received from women in medicine since the publication of her paper (New Engl J Med 2018;378[3]:209) and particularly as the #MeToo movement grew. “The brave physicians who contacted me say they remained silent and questioned their self-worth after their experiences, wondering whether they brought it on themselves,” she wrote. (See sidebars.) “The details of their experiences are appalling. One told of having a senior male leader in her field unzip the front zipper of her dress at a conference social event. Many report unwanted touching of breasts and buttocks,” she wrote. “One described having a ‘tormentor’ during training, and others noted remarkably consistent experiences in the operating room that ironically they thought were unique. One even described a rape by a superior during her training that she had never reported. In fact, none of the women who contacted me have reported their experiences. They speak of challenging institutional cultures, with workplaces dominated by men who openly engage in lewd ‘locker-room conversation’ or exclude them from all-male social events, leaving them without allies in whom to confide after suffering an indignity or a crime.” A Shift to Zero Tolerance A new, comprehensive report on sexual harassment in science—this one more broadly focused on academia in general and sponsored by the National Academies of Science, Engineering and Medicine's Committee on Women in Science, Engineering, and Medicine (CWSEM)—is now in the works, with three goals: Reviewing the research on the extent to which women in the fields of science, engineering, and medicine are victimized by sexual harassment; Examining the extent to which sexual harassment in academia negatively affects the recruitment, retention, and advancement of women pursuing scientific, engineering, technical, and medical careers, and comparing these careers to other sectors; Identifying successful policies, strategies, and practices for preventing and addressing sexual harassment in these settings. The panel has had seven meetings over the past years, five open to the public and two closed, and ultimately plans to issue a consensus report. Dr. Jagsi said the kinds of calls and speaking invitations she is receiving these days do suggest a shift in the national consciousness. “After studying gender issues in medicine for quite some time, I have typically gotten lots of invitations to speak on unconscious bias, work-life balance, negotiation, mentorship—those kinds of things,” she said. “This year, however, I am getting lots of invitations both from individual institutions and from professional societies to speak about sexual harassment and how we promote culture change in institutions to support women. That is heartening.” What is she going to tell those institutions and societies when she speaks to them? That's the challenge. “I don't have one great, brilliant solution,” she said. “The best that I can do is share the good ideas I hear from other sources.” As an example, she cites Astronomy Allies, a group of young astronomers who provide support at professional conferences and elsewhere. Created by Heather Flewelling, PhD, an astronomer at the University of Hawaii's Institute for Astronomy in Honolulu, after she was stalked by another scientist at the annual meeting of the American Astronomical Society (AAS) in 2014, the volunteer organization provides vetted allies by phone, text, and email to any conference participant who feels she is being bothered. The Allies mirror Flewelling's own experience, as friends rallied to escort her between sessions and keep her safe. “That was a really nice, concrete example that could be replicated from within medicine,” said Dr. Jagsi. “Those kinds of initiatives are grassroots, concrete, and they actually do have the power to change culture.” Dr. Bates, Dr. Jagsi, and other members of the GWIMS steering committee recently authored an opinion piece, “It's Time for Zero Tolerance for Sexual Harassment in Academic Medicine.” (Acad Med 2017 Nov 7. doi: 10.1097/ACM.0000000000002050.) They proposed several key first steps—most of which could just as easily be undertaken specifically within departments of emergency medicine or by leadership in the field. Among them: Institutions must develop mechanisms that encourage victims to come forward without fear of retaliation from their harassers. Training for all, with the inclusion of information on reporting or intervention by bystanders and dissemination of best practice approaches to reach those resistant to training, must be mandatory at all institutions. Those who are found to have committed sexual harassment must be sanctioned and monitored; in the most severe behaviors this would include dismissal. “We urge those hiring faculty who seem to have been inexplicably dismissed to engage in due diligence to explore the reason for departure and thus avoid hiring faculty who may engage in this serial behavior,” they noted. “Locker room talk” should not be tolerated. Professional societies should break silence and address this issue in leadership councils and in annual meetings. Policies banning retaliation should be promulgated and enforced. Additional research on the prevalence and severity of sexual harassment is necessary, along with research on successful interventions. “I think—I hope—that we are at a place where institutions are looking very carefully at their policies, disseminating information about reporting, and making it as safe as possible for people to report,” Dr. Bates said. “There's hope in the national conversation that we're going to get to a place in medicine and all professional domains where this is no longer tolerated and people feel comfortable speaking out. But my optimism on this topic is tempered by the fact that we have a president who has been accused of sexual harassment and a pedophile who was almost elected to the United States Senate. So we still have a long way to go.” #MeTooEM BY LOICE SWISHER, MD This has always been an odd topic for me. I had an incident a long time ago when I was a young attending, and we went to bed at night. I usually left the light on so I didn't stumble out into the hallway if my name was called urgently. A longtime nurse brought me a pillow and then turned out the light. I thanked him, and thought he was leaving. The next thing I knew he was on top of me. I said, “We are not doing this,” and he got up and left. He and I worked together for years after that. He never talked about it. I never talked about it. I sort of chalked it up to his getting a wrong signal. It has been more than 20 years. I still think about it and whether I should have handled it differently. Was I wrong? Dr. Swishergraduated from the Medical College of Pennsylvania emergency residency program after an educational fellowship in the early 1990s. She has been the nocturnist in the ED at Mercy Philadelphia Hospital since 1997. She writes the blog, Lions and Tigers and Bears, for EMN, which can be found athttp://bit.ly/LionsTigersBears. Follow her on Twitter@L_Swish. #MeTooEM Too BY CHRISTINE BUTTS, MD I've been working since I was a teenager. I've had many jobs, from “sandwich artist” and theme park worker to various temp jobs and my ultimate role as a physician. There has been something in every job. Some of them were really easy to think of, like my 30-year-old married boss who constantly made suggestions about dating me. I was 15. Others were tougher to think of, like being stuck in the backseat of a car with two male coworkers having a detailed discussion about their sex lives. When I started thinking about my career in medicine, at first I couldn't think of anything. But I realized there were many small things that added up to years of harassment. When you see the stories of the horrible abuse that so many women have endured, there isn't much of a gray area. The reality of sexual harassment for me, and I would guess for most women, is much more subtle. It's the colleague that sidles up against you a few times and brushes his hand by your breast. Some might argue it was an accident and you might agree, at least until three of your female colleagues say he did the same thing to them. It's the faculty member widely known for rubbing up against female residents. It's seen as a joke within the department instead of being seen as unacceptable. It's the co-worker who tells you that you look nice while looking you up and down. How could someone complain about a nice compliment? It's the awkwardness and surprise I felt as a student when an attending put his arms around my waist to guide me through a procedure. Maybe he was just trying to make sure I got it right. We're told to suck it up in medicine when we feel tired or stressed. We're encouraged to be tough, especially in emergency medicine, where so many clinical situations involve life-and-death decisions, hostile consultants, and violent patients. The same expectation exists in dealing with harassment. I don't want to be seen as hysterical. I bet many of my female colleagues feel the same pressure. We are already outsiders in many ways, struggling to be seen as just as tough and capable. We don't want to rock the boat. Dr. Buttsis the director of the division of emergency ultrasound and a clinical assistant professor of emergency medicine at Louisiana State University at New Orleans. She writes The Speed of Sound column for EMN, which can be found athttp://bit.ly/EMN-SpeedofSound. Follow her on Twitter@EMNSpeedofSound. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].