#Metoomedicine

I have been thinking about this post for a while. It seems like a topical subject to discuss, and yet I have felt reluctant to do so. I have been extremely lucky not to have experienced sexual assault. Statistics Canada reported that there were 22 incidents of sexual assault for every 1000 Canadians aged 15 and older in 2014. However, only 1 in 20 incidents of sexual assault were actually reported to police. In years past, the image of sexual assault that I had in my head was one of a lone woman, perhaps walking home late at night, being attacked by a stranger. The truth is much more disturbing. These same statistics show that 87% of women know their attacker. It is their friend, acquaintance, coworker, neighbour, or even a family member. Sadly, sexual assault is the only violent crime in Canada that is not declining.

While I haven't experienced sexual assault, I have experienced sexual harassment. The Candian Women's Foundation states sexual harassment can encompass discriminatory comments, behaviour, as well as touching. It may take the form of jokes, threats, comments about sex or discriminatory remarks about someone's gender. I don't think I am going out on a limb by saying that most, if not all, women I know have experienced this at one time or another. I have been catcalled. I've had my bum pinched by strangers, and one “friend” tried to put his hands up my shirt. (He learned quickly not to do that....) I've even had a man at the bar run his fingers through my hair and tell me how “pretty” it was (that was a weird one!) I remember going for a run one evening as a teenager and being followed by a car. I initially tried to convince myself that it was just a coincidence that the same car kept passing me, but when it followed me down a back alley that I had turned down trying to “shake it”, I became terrified. I sprinted to the nearest public place I could find, a gas station, and tearfully asked the attendant to call my mom to come pick me up. ( This was in the day before cell phones. Yes, I'm that old!)

In 2014, the Angus Reid Institute did a poll that found 43% of women have been sexually harassed in the workplace, and women were more than twice as likely as men to say they had experienced unwanted sexual contact while at work (20% compared to 9%). Again, this is where I have been lucky. I have not experienced sexual harassment during my medical career. I am not sure why I have escaped this fate. I have worked with many decent, honourable men who have become not only my colleagues, but also my friends. Did this somehow protect me? Perhaps it is because I am tall for a woman, at least as tall if not taller than many of my male colleagues. Maybe it is harder to harass someone you have to look up to? But, I also wonder if perhaps there are other reasons. I have always played sports, both female and coed. I have been in many locker rooms, sat on many benches and celebrated in many beer gardens. While I have never been exposed to threatening comments about women, I have heard many jokes, the odd discriminatory comment and sexual innuendo. I can “give it as good as I get”. I have a thick skin, so to speak, about that sort of comment. I am ashamed to admit that maybe this has made me complicit in some respects. Perhaps if I had spoken up more, I may have spared some poor girl, who's skin wasn't as thick as mine, some heartache and shame. This is something that I need to address about myself and I will need to do some self-reflection.

Despite my own experiences, I have heard enough stories over the years from my female colleagues to know that sexual harassment in medicine does occur. When I first started my anesthesia residency in the late '90s, I often heard stories about a staff anesthetist who routinely harassed the female residents and nurses. It got so bad that the residents would not only try to avoid working with him, they would avoid the hallway outside his assigned operating room, since he often would lurk by the door, waiting to pounce on whatever poor girl wandered by. I assumed that no one had reported him, but sadly, I was informed that he had been reported. Nothing was done about it. Over the years, I have heard many, many stories and whispers about harassment that has occurred. Worse than this, I cannot think of one instance where there was a “public-shaming” of the harasser. If any punishment ever occurred, it was done quietly and behind closed doors.

I decided to look into sexual harassment in medicine and what I found has been alarming. Logging into Twitter and searching #Metoomedicine brings up post after post about the experiences that female trainees and physicians have endured. This past December, the New England Journal of Medicine published an essay by Reshma Jagsi, a physician at the University of Michigan. In 2016, she published a paper in JAMA that found 30% of high-achieving female physician-scientists reported experiencing sexual harassment. Since that paper was published, she has heard from countless female physicians, who wanted to share their stories of discrimination and harassment. Yet none of the women who reached out to her reported their experiences, she noted. In her recent essay, she recounts her own story of harassment, and how despite her research, she has only recently come to recognize her own experience as harassment. Why is this? Why are these women, who are obviously smart, tough and talented, not standing up to this harassment? While it is impossible for me to know exactly why, I suspect most women in medicine understand this reluctance. Statistics Canada states that the three top reasons why sexual assault/harassment isn't reported are that the victim perceived the crime as minor, the incident was considered a private or personal matter and that no one was harmed during the incident, so reporting was unnecessary. Added to this is the fact that medicine has a long history of male domination that has only recently began changing. For a long time, medicine was an “Old Boys Club” and it was necessary for female physicians to play along if they wanted to be accepted into it. The fear was that your career could be threatened otherwise. In addition, there is a distinct hierarchical structure in medicine, from the lowly medical students, through to internship, residency, fellowship and finally, attending physician. The Canadian Women's Foundation notes that sexual assault is rooted in gender inequality.Those who commit sexual assault perceive the victim as unequal. The strong power differential that happens in medicine can amplify this feeling. Dr. Maria Yang, a psychiatrist, recounts her #Metoo moment in an article for the Seattle Times entitled, “Who would believe a trainee?” As I read these stories, it seems to be that female medical students and residents seem to be most at risk for this treatment. Dr. Jagsi states, “My intuition is that the problem is at least as bad in medicine as elsewhere, especially if one adds harassment by patients to that by colleagues and superiors.”

So what now? I wish I had an answer. It would be wonderful if we could just implement a new policy in our hospitals and in our residency programs, and sexual harassment in the workplace would stop completely. I am not naive enough to think this is true. But I am hopeful. I am hopeful because women who have previously been silent are stepping out of the shadows. They are saying this happened to me and it's not okay. More and more, it seems this behaviour is no longer acceptable. And as staff physicians, we need to create a safe space for our trainees, so they know that we will listen and we will support them. As Dr. Jagsi says, “ We must call it out and make clear to potential future transgressors that they will not go unpunished.” Perhaps then future generations of female doctors will not experience their own personal #metoomedicine moment.