Sexual harassment has become a common theme in news headlines, between the #MeToo movement bringing the prevalence of harassment to light and the #TimesUp movement’s call for action to combat harassment. The field of medicine is facing its own #TimesUp moment. Emergency physicians Esther Choo, MD, MPH, associate professor at the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University in Portland, and Dara Kass, MD, assistant professor of emergency medicine at Columbia University Medical Center in New York City, weighed in on the prevalence of sexual harassment in the medical field and the damage it is doing to the house of medicine in a recently published article in the New England Journal of Medicine. The article focused on a recent report about sexual harassment, stating:

“The National Academies of Sciences, Engineering, and Medicine (NASEM) recently released a report on sexual harassment of women working in academic sciences, engineering, and medicine.¹ Its findings are deeply disturbing: sexual harassment is common across scientific fields, has not abated, and remains a particular problem in medicine, where potential sources of harassment include not just colleagues and supervisors, but also patients and their families.”²

AECP Now Medical Editor-in-Chief, Kevin Klauer, DO, EJD, FACEP, posed some questions to Dr. Choo and Dr. Kass about their article and the NASEM report. Here are their responses.

KK: What was the recent NASEM report about, and who was involved?

EC and DK: The report was a review of the literature on sexual harassment in academic settings of science, engineering, and medicine. It was compiled by a team of senior scholars and leaders in these fields. It found that sexual harassment is highly prevalent across these fields, particularly in medicine, and does not appear to be improving. Institutions’ approaches to sexual harassment are largely focused on avoiding litigation rather than actually improving the problem, the report states.

KK: What is the impact of these findings? In other words, how should this help health care delivery and the specialty of emergency medicine?

EC and DK: The report made clear that while sexual harassment has a profound negative effect on the targets of harassment, it also has a harmful effect on entire organizations in terms of workforce engagement and productivity. This should help us realize that in order to deliver the best health care to our patients, we need to address this issue.

“The same forces that create a gender salary gap and limit opportunities for women also foster sexual harassment. You can’t peel these issues apart and address them in isolation; they are absolutely connected.”
—Esther Choo, MD, MPH and Dara Kass, MD

KK: Are all of the issues surrounding gender equity isolated or are they intertwined? 

EC and DK: The report makes clear that organizations with less gender diversity in the workforce, and particularly in the leadership team, are at greater risk for tolerance of sexual harassment. The same forces that create a gender salary gap and limit opportunities for women also foster sexual harassment. You can’t peel these issues apart and address them in isolation; they are absolutely connected.

KK: What were the most important take­away points from the study?

EC and DK: We need better measurement of the problem and more ownership by health care leaders. We need to do much more beyond trying not to get sued. We need the gatekeepers and sources of funding, like accreditation organizations and major scientific funding institutions, to provide strong incentives for health care institutions to create safe environments for their scientists. In addition, we need to change the steep hierarchies that reinforce a culture where no one can speak up about harassment. Ultimately, health care needs to make a serious investment in improving this problem, but it is one that will pay back with huge dividends.

KK: Are there actions or steps that should be taken from the study to move the needle in the right direction, or will this serve only to raise awareness?

EC and DK: The report has many levels of recommendations. There are global recommendations and immediately-actionable ones. Long-term culture change is an important goal, but that will take time. What can we do now? We can measure the occurrence of sexual harassment using standardized instruments and improve the transparency and accountability of existing policies and practices for responding to sexual harassment. It is difficult to read this report and simply feel satisfied with more awareness. This report paints a grim picture of the culture of permissiveness in medicine with regard to harassment. Our hope is that this information and this conversation will lead to meaningful action.

References

1. National Academies of Sciences, Engineering, and Medicine. Sexual harassment of women: climate, culture, and consequences in academic sciences, engineering, and medicine. Washington, DC: National Academies Press, August 2018.
2. Choo EK, van Dis J, Kass D. Time’s up for medicine? only time will tell. N Engl J Med. 2018;379(17):1592-1593.