Wednesday, August 10, 2011

Sexual Harassment in the Workplace

I think this is an important topic to discuss, one that is all too often swept under the rug. I recently had an uncomfortable encounter with a clinician in the doctor’s lounge – I work at many hospitals so think I can say this pretty anonymously. He introduced himself, and asked me immediately if I was married. The way he did it – body language and demeanor, mostly - made me physiologically recoil, but I quickly regained my composure.

He continued the “too familiar for someone you have just met” small talk, some of it bordering on inappropriate, until I found a quick exit when another doctor walked in the lounge and said hello to him. I said, “It was nice to meet you.” I turned around, pushed the green exit button, and walked out the door.

When I checked in with my female colleague he had mentioned during the interaction a few days later, it turns out she has had some reportable incidences with him. I could handle occasional randy attendings during residency – most harmless, but some encounters are just plain creepy. My female friend did not report this clinician we both had negative encounters with, but she did at least document them in case she needed to support someone else, as well as confidentially notify the Chief of Staff. We wondered aloud that if he treated his colleagues this way, how must he treat his subordinates. She vowed to draw a tighter line if she had another strange encounter. “I wanted to maintain professionalism at the first incident, but I think I will have to be stronger with my words if it happens again.”

I was bouncing all this off of one of my friends from medical school, and she said, “I had two reportable incidences in medical school. But I didn’t report them. I’m sure I told you. Do you remember them?” I remembered one – the attending that tried to hold her hand in the hallway all the time. Once he lifted her shirt and tickled her belly. Luckily that was toward the end of her rotation, so she didn’t see him again. But I did not remember the other, she never told me.

“I didn’t? Maybe not. Probably because at the time, that fourth year medical student reported that doctor that reached up her skirt and grabbed her leg, and she was being raked over the coals. I didn’t want to be ‘that girl.’”

So tell me, I asked. Turns out, in a late night OR, she was being harassed by a surgeon. While she was placing a Foley catheter, he would say, in front of residents, “It looks like you really know how to handle a piece of meat.” Another time, he was pulling a kidney out of a patient, and referred to its erect-appearing state. “I’ll bet this is exactly the state you like your dick to be in.” She told me over the phone, “That was the point I had to step away from the table and leave the OR. It was too much. My body reacted by burning, and my eyes even got a little teary – not with sadness, but with shock and anger. “

She remembered later to me on the phone that she did bounce that encounter off of someone – her then boyfriend. He encouraged her to report it, and they argued about it. She reasoned that she would be off of the rotation in a week and it would be a non-issue. If she reported it, it would be an eternal issue – one that might affect her career trajectory. Later in the year when another female in the class sought her out about her experience on that rotation – she was having similar issues – my friend assented that it was a problem and felt a measure of guilt in being silent, which may have played a part in the continued abuse. Not your fault, I told her, which she already knew, but still. This type of stuff is a Catch-22. I will be interested to read comments about the situation. I can see both sides of the coin, and we both realize there is no easy answer. There is a right answer - to report. But not an easy one.

My current encounter with the clinician was not reportable, but disturbing. I immediately bounced it off of a lab supervisor, and another one the next day. I don’t like these things to be ignored, as they are all too often. Women (and men, fewer for sure, but I do know that it exists) who are sexually harassed often feel guilty somehow, like it was something they did, and are too embarrassed to discuss the incidence. It is especially tough when you are in a subordinate position, under someone who is grading you. So it continues. Our societal reaction to women who speak up often reinforces our silence. It makes me angry.

I wondered aloud to a male colleague – one that we let into the loop for support - about the women, I know they are out there, that encourage this behavior. This colleague is conventionally handsome, I was certain he had experience in this arena. “Does the fact that some women encourage this type of interaction, out of some sort of need or desire, make these men think they can behave this way to anyone?” He assured me that no, it was still inappropriate. “You should gauge a woman’s reaction, her comfort level, to this type of small talk. If it isn’t there – you back off immediately.” I guess some guys don’t get this. No brain to mouth filter. The charge from the inappropriate interaction is enough for them to continue without reserve. Women can overstep bounds as well. My one reportable incident in medical school, one that I did not report, was perpetrated by a woman.

Both my female colleagues (current and med school friend) and I have pretty wide personal space boundaries around men. I do have a sibling relationship with a man at work I trained with – we have known each other as residents and now partners for over ten years. We can share silly sex stories we read – you know, not personal but Anthony Weiner type stuff that I might not talk about with most men – there is just an incredible comfort level. I am friends with his wife. I am finally starting, with my other male partners, to forge sibling relationships after knowing them for over three years. It takes a lot of time for me.

So I am posting this because I hope that some readers out there that may be in a situation they are uncomfortable with can know that they are not alone. It is OK to speak up. Or walk away. We do not have to tolerate this behavior, in the workplace. My friend and I have discussed our current inappropriate interactions with many male and female colleagues, with details, and have found lots of support. To quote Hillary, it takes a village. We can drive this behavior out of it, together.

I have sought and received the permission of both of my friends mentioned in this article to write this post. They have read it and are comfortable with what I have said. The older incident – ten years past now – contains more details, as it is in the past. The current situation is still too fresh to flesh out online.


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  2. Speak up! Each and every time. Somewhere out there is a student/intern/resident who may wind up with behavior even more inappropriate if the person in a position of power thinks that he/she can get away with it.
    I had no incidents in school, but after graduating and hitting private practice, there was a senior practitioner who thought it was OK to hug me, rub my back, and ask me out to dinner...he knew my husband from office functions and he still thought this was OK. I wound up leaving the practice. There was nobody to report to so I had to let it go, but believe me, if I had been able to go over his head, I certainly would have.

  3. I had to interact with some one on a daily basis at work who was becoming increasingly inappropriate. I decided to confront this behavior. I told the person how I felt about it and that it had to stop. It never happened again, and work did not suffer. I think it works better when you are afraid how reporting will affect YOU. Its the first time I spoke up. Its better than not doing anything. I just have a history of ignoring inappropriate comments, and now I will not.

  4. I've never heard of any good coming from a trainee reporting an attending sexually harassing them. But I have heard of women getting "raked through the coals" for it, as you said. Personally, I wouldn't report something like that unless it got to the point where it was totally intolerable.

  5. Personally, I wouldn't report something like that because, a) even if the person seemed like a total jerk and I didn't like them, I'd be afraid of ruining his/her life, b) I'd question whether they really meant the gesture inappropriately or if they are just clueless as to how they come across, and c) *I* don't want to be put under the microscope, like what happened to your friend, which is more or less guaranteed if you file a formal complaint.

    If it really bothers you, just tell them that what they did makes you feel uncomfortable or that you don't like it. Preferably do this with another person around and document the conversation. Then, if they start acting abusive, report them at that time with the supporting documentation. I think most of the time the behavior will stop. In the rare instances that it doesn't you will have a much stronger case.

  6. I think that, as an attending, if the other person is at the same level as you (has no power over you), it is best to confront them personally. They may indeed be unaware of how they are being perceived. Or, they may not realize that other people notice it ;). I've recently had this discussion with one guy I'm working with on a project. His comments to me were getting way out of line. He didn't mean badly, I don't think -- he just didn't realize that he was saying things that made me uncomfortable. Once I pointed it out, he stopped. I'm lucky there, but .... I do feel it's our job as "superiors" to delineate the lines, so that our trainees don't have to experience this.

    As a trainee, it's tougher. As you say, there are all kinds of politicial and career-related issues to take into consideration. Hopefully med school & residency administrations will eventually become more supportive, and will act without any public discussion.

    Any which way, I hate the fact that this is part of life. I find it really frustrating that men often interpret "friendship" as meaning "sexual interest." Gizabeth, hold on tight to those sibling-like guy friends!!!

  7. My favorite career blogger, Penelope Trunk, has a great post about why you shouldn't report sexual harassment (in most cases).

    I'm inclined to agree, especially in cases when you're a trainee.

  8. Christie Critters - how awful. I think speaking up is important, but am clearly a bit baffled about to whom to speak. In your instance, I guess confronting the offender is the most reasonable, if you feel comfortable with that.

    anon@11:35 - I think this is the most rational approach and very reasonable if you are a colleague, but not so much if you are a subordinate.

    Fizzy - I agree, did not report myself as student, but refuse to tolerate as equal. If I had a reportable encounter, would consider anon@11:35 approach.

  9. Ha ha. Just figured out how to increase my comments. Post replies in batches. Watch out, Fizzy, here I come! Actually, it is out of fear - have lost long responses before.

    Rock Star MD Girl - glad I made you laugh this morning - I agree strongly with creating witnesses to help support your case. All too often the offender can blow the encounter off as over-reaction - not so easy if you have someone else there - sincerely, promiscuous pom squad girl (ha ha).

    MLR - nice comments. Agree 100%. Me and female colleague were just talking about how some guys just can't be "friends" with girls, and some can. Training programs should support confidentiality of students, I think. The disgruntled part of me thinks they know - just turn a blind eye to keep the talent around. I have seen it get so bad they "transfer" the person to another institution. And so it continues.

    Maren - nice reality check, thanks for sharing. Helps support my friend who allowed me to share her experiences anon online. Still frustrating, however.

  10. Dear Gizabeth,

    It’s a great pleasure to read your blog. I find your post so interesting. Your post is so empowering, this simply lightens up the mind of every woman on what and how to handle harassment. As you said it…It’s OK to speak up!

    As a reader, I consider your writing to be a great example of a quality and globally competitive output. It would be a great thrill and honor if you could share your genuine ideas and knowledge to our community, Physician Nexus. With this you can gain 1000 physician readers from over 62 countries on Nexus.

    We would love for you to visit our community. It's free, takes seconds, and is designed for physicians only - completely free of industry bias and commercial interests.

    Ruby Abarcas
    On behalf of the Physician Nexus Team

  11. This comment has been removed by the author.

  12. Work environments should be safe places. I think health care settings need to offer sexual harassment training so that folks have boundaries and there are expectations. Don't be naƮve, you do have to prepare yourself for uncomfortable and inappropriate situations, which may be addressed one on one, but if there's continual, escalating inappropriate behavior particularly by superiors then you have to find a way to address them professionally.

    While the fear of ridicule or damage to you professionally is real there can be reward seeking justice that outweigh the risks. If we continue to let these things slide, how will they get better. If not you then who? These concerns are institutional, you should get to know the policies, position of leadership and practices of your institution so that you know what you are up against. I hope for better days ahead and lots of women in medicine have shared that the profession has improved since their days in training. Know that progress and change come at a cost. Only you know the price you can pay.

    Final note, many of my colleagues are experts in martial arts. I'm all for self-defense.

  13. Thanks so much for this post. Women are often silent and feel guilty when things like this happen. Additionally, women who do report incidences are indeed often crucified for doing so. In my former career I had an incident where a coworker patted my inner thigh and told me to “be a good girl” and prepare some file or something for him. Usually overly outspoken, I froze, then went to the bathroom and cried. I told no one aside from my best friend for years. I didn’t tell my husband, then boyfriend, until probably two years later. However, what did happen is that I became hypervigilant about my person space. I have only had two borderline incidences since being a resident - both with the same attending who has a reputation for being sexist. Both times he just said totally ridiculous and inappropriate things. And although I didn’t report him, I spoke up for myself - LOUDLY!

    I don’t know the right answer. I unfortunately feel that reporting people ends up hurting the victim more, although it allows people to continue bad behavior. Right now I feel like SPEAKING UP each and every time is the best option for me, even as a trainee. Hopefully, if people continue to speak up when the event happens, then things will change.

  14. Cutter --

    I admire your balls. So often when something like this happens, I'm taken aback and am unable to react in the moment, like what happened to you in your former career. What you suggest is probably the most pragmatic, but so hard to do!

  15. Ruby - thank you so much for your compliments! I have never heard of that site, but will check it out.

    World House Medicine - your response is encouraging, whereas others were disheartening. I agree that institutions should have policies that make the workers feel protected - especially subordinates. While I don't know martial arts - I am a tall, strong woman, and have taken self defense classes. This would only be necessary in an extreme circumstance - one that has not been demonstrated here, but still. Every bit helps.

    Cutter - wow. Thanks so much for sharing that, here. It just goes to show that we are all in the same boat, and reinforces the guilt and shame that doesn't need to be there. I, like Rock Star MD Girl, admire the hell out of you for learning to speak up, especially as a trainee. I am sure you have inspired many with your words.

  16. It's definitely challenging when there is a power difference (medical student and attending). I only recently graduated from medical school and there was an anonymous process to report things. It was a committee for "Inappropriate Treatment of Medical Students." Theoretically you remain anonymous and reporting won't affect your grade. I don't know if it really ends up this way for people.

  17. Dr. Army Wife - that does sound like a nice way to handle things, in theory. Might make med students feel a little safer to know they can anonymously report uncomfortable interactions, and it would be a good way for the administration to document consistency in the attending's behavior.

    I have seen, in my career, two attendings ultimately let go for continued sexual harassment/abuse. It got pretty bad before it finally ended, in both cases.

  18. Gizabeth, I've seen two people demoted (taken out of positions of power) but have never seen anyone fired at my institution. That said, I know of someone who was recently fired from a significant position (with huge impact on trainees) at another institution. It does happen.

    I love the idea of anonymous reporting. Or, at the very least, it should be anonymous to the person getting disciplined (it may be impossible for the discipliner -- the dean, or the chair -- to not know who said it?)

  19. OMDG and Gizabeth:

    Thanks for you comments. Although its probably less that I have balls and more that I was so hurt and disappointed in myself the first time that I decided I had to make an agreement with myself in order to feel empowered again. Its really amazing how pervasive this problem is!

  20. Anonymous surveys are double edge swords. If it is truly anonymous, you wonder if tranees will start blaming attendings they do not like otherwise. In such cases person who is blamed has no defence and cannot prove it wrong.

  21. Anon@11:54 - I agree with that, but if it is a pervasive problem, and not just a personal vendetta, time, and repeat offenders, will tell the truth. People talk. Everyone knows who the offenders are. There needs to be an official record. People don't just get demoted or let go at the drop of a hat. It either takes years of continued reporting (one of the attendings I know who was let go) or a serious offense (the other). There are sensitive people in place that can handle these matters. Just like out of court divorce settlements, there should be closed door sexual harassment reporting designed to protect both parties involved.

    MLR - I was also thinking, with an anonymous system in place that was clearly advertised to protect trainees, it might somewhat inhibit the behavior of the offenders as well. In knowing they can't get away with it, because the system/workplace will not turn a blind eye.

  22. So what's the best way for me to tell a woman that she has a nice caboose?

  23. During my anesthesiology rotation, one of the CRNAs that I worked with was reviewing some concepts with me and just reached out and started touching my neck, face and the chest where the lung cuppolas are located. I was so stunned that I just froze and, as a freshly minted MS III, am completely unsure of myself and what the right way to handle it.

    He seemed aware that he had crossed into my personal space and that it was making me uncomfortable. I'm still processing this but I think part of my not reacting was a way of being, or at least appearing, defiant. As in, you don't have the power to make me feel uncomfortable. Not sure if that makes sense to read but that is kind of how it feels.

    There was another component that impacted how I reacted. An entire surgical team was in the room prepping for the surgery so people were present when it happened and it just happened to be a team with the specialty to which I am interested in applying. I stood there wondering what they thought about the scene and how my reaction would appear. It was a small OR and there was no way that a) nobody noticed and b) my response would go unnoticed. If I did nothing, did it look like I was soliciting this weird touching? If I addressed it, would it look like I am a problem student that should be avoided?

    I ended up trying to focus raptly on the content of what was being said and completely ignore that he was touching my body. And then avoided any OR where he was listed for the duration of the rotation.

    I know I shouldn't feel the need to say this, but I'm not overly conservative. I have no problem brushing or laughing off the coarse humor of so many ORs and am quite comfortable and adept at diffusing awkward moments. I just don't get offended easily. But this is the first time that anyone has ever physically violated my personal space and it was just something I hadn't prepared in advance to handle.

  24. anon@10:17 - innocently, I'm not sure that there is a good way. If you want to start a relationship with her, build up to it slowly. I am sure she will appreciate it eventually.

  25. anon@11:20 - it is 10:20 here in AR. Thanks for sharing. I have had a handful of friends from residency and medical school call me and share their experiences over the last few days after reading my blog. This type of behavior is ubiquitous. No one is prepared to or should have to "handle" physical space violation. I too can appreciate coarse humor to a certain extent - it goes with the territory, in medicine, but it doesn't mean you are overreacting to clear boundary invasion. You did well to avoid that CRNA for the rest of the rotation. I hope that by reading above comments you will be empowered to verbally confront anyone who tries to do this to you in the future. Seems that is the most effective first step. I can appreciate your mind-set/conflict at the time - seems like another good reason there should be an anonymous system set in place so subordinates can document negative interactions with staff members, which as you have delineated, are not always attendings.

  26. Thanks for posting this...I reported a sexual assault (fellow surgical resident). It was hard. I was very junior. I had to report it twice. The first time it went nowhere and in some ways I was glad...tried to forget the whole thing. I decided to report the incident a second time (to more senior consultants) because I had heard through the grapevine that this guy had tried to "proposition" a nurse during a night shift. It made me sick when I heard this as what happened to me could have happened to another person. I was numb and decided I needed to make another report. It was a long process and there were many challenges along the way. He was eventually was asked to leave the hospital but stayed on the training scheme. Someone said to me at the time that I must have friends in high was so rude...I felt so good to be able to reply that I just told the truth and went through the appropriate channels. He is a surgeon now in another state. I may not have changed his pathological behaviour but draw comfort that if he thinks about the investigation it may stop him doing it to others again. PS I am now a MiM with 4 children and on track to train in ophthalmology. PPS I am happy, don't hate men but have learned to develop internal alarm bells AND listen to them. Please, if you feel uncomfortable follow your instincts.

  27. I am very glad you started this discussion. This is the hardest topic to broach or to know what to do with!
    I think my past experiences have left an indelible mark on how I communicate with men at work. I agree, that the "older" encounters are easier to talk about than those fresh in ones mind, but I thought I'd talk about a more recent one because it has not been resolved yet, and I honestly don't know what to do about it. I am a resident and started talking with a new to the area attending when he asked about hobbies and things to do around town. It was so easy to talk to him about that, and we had enough things in common that I offered to show him some of my favorite places to go. Over the course of a month, he started asking me about my personal relationships and boyfriend. It didn't seem so out of place at the time because I had felt so comfortable talking with him about most things. I actually jokingly turned the table and asked him about his significant other or fiancee (since he didn't have a ring, I had to assume he was attached). He denied her existence. As our friendship grew, I found myself attracted to him, but did not cross those boundaries because this is a work relationship. It took a long time for me to feel comfortable talking about relationshipy type stuff with him. Somehow it felt wrong, and the more time went on, the less I wanted to be his "gym buddy", or to meet him after work. Finally, I set an ultimatum, that i felt he wasn't being honest with me, and when he denied again that he is married, I stopped talking with him.
    Long story short, a couple of months later his wife called me at work, wanting to know "what on earth I was doing with someone who is married!?!?!?!" You can imagine my relief of finding out that my suspicions were correct and the fact that I broke off all ties with him 3 months prior to that! So I am clear with his wife, but this whole experience made me feel ashamed to be associated with someone who would be so dishonest, and I still have to work with him, so can't avoid him forever.
    So here is the point where I wish someone would tell me what to do/not to do..... my program director noticed that I have been depressed/not my usual self lately. I am on great terms with him, so after being asked a couple of times if "I am ok?" I decided to share with him what had happened to me in the preceding months. Now I find myself regretting having done that, because nothing can be done, and I still have to work with the strange attending.

    So what would you do if faced with the prospect of having to work one on one with someone who clearly has ulterior motives? My conscience is clear, with the exception of feeling led on, and a near miss situation if I hadn't put my foot down. I don't really know how to approach this person the next time we have to meet.... Can't confront him now, can't really discuss it.

  28. anon/MiM of 4 (wow!!) @ 1:11 - sexual assault is much different that sexual harassment - not so much grey areas in terms of reporting. You did the right thing for yourself and for your conscience - not that I need to tell you something you already know - I am impressed you took it through twice in order to get the issue resolved. Yes, I hope getting administration, and I am guessing possibly the law as well, involved helped to curb a future assault.

    I am so proud of you! I will never forget your story. Good luck in ophthalmology - my best friend from med school is in that field and I love hearing stories from her private practice.

  29. anon@9:35 - I don't think you should regret talking to your program director. You did do something - the fact that this attending did this to you is important information for the department to know, so they can watch out for future trainees. You are right - an adult's bad behavior is not reportable, but if sexual harassment or anything worse ensues then the foundation has at least been laid.

    If you have to confront him in the future - that's tough. I might follow his lead. If he ignores, I would. If he tries to continue what he did in the past, I would confront him and lay down clear boundaries. If he ignores them, you can talk to your program director again.

    In the meantime, this encounter has obviously left you feeling depressed, as it would many women. You need to take care of yourself. Most residency trainees have access to free counseling - I might look for this and work out your issues there - I have friends that took advantage of it during residency for burnout and relationship issues. I also went through counseling for a year around my divorce and it was invaluable. I think you will find that time, and work, will heal you. Good luck.

  30. I've never experienced anything of this nature, but I think it is a very important topic. If I ever do encounter it, I'll be better equipped to handle it after reading these experiences.

  31. This is a difficult issue and it's like a fine-art in communication. Like dealing with a female that's threatened by you, sometimes it's better to catch bees with honey than vinegar. You wouldn't report a female that was "being mean to you". You'd look like an idiot.

    After spending time in the army I learnt a few methods. I personally find a reaction something like a semi-joke but peppered with a dash of "I'm going to stand up to you so back-off" seems to work well, in fact much better than reporting the incident. If you're not fun to tease and annoy, they are likely to stop playing with you.

    An example would be to react in some way to show you are alert, but not get mad straight away and DO NOT flirt back. That is the worst thing you can do. It's difficult to give an exact example because it depends a lot on the total dynamics of the relaitonship.

    A lot of guys are threatened by women coming into their "man-cave". I feel an understanding of this is the best way forward in then finding the suitable reaction.

    Of course any actually assualt should be reported, such as a hand up the skirt. That's just ridiculous.

    Just my opinion in the hope of helping somebody.

  32. Kyla - I hope you never do experience it.

    CJ - good points. It is a fine art. Unfortunately, many subordinates don't feel like they are in a position to joke/threat someone away, but it might work, if they felt empowered to do so.

    One of my mom's favorite sayings to try to quell my kid's fighting is "use honey, not venom." I love that.

    Thanks for the good opinion.

  33. Dear Dr. Gizabeth,
    It’s a great pleasure to read your blog. I find your post very informative. Thank you for sharing.
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    Janmar Delicana
    On behalf of the Physician Nexus Team

  34. I am sorry it took me so long to respond to this.

    I was just talking about this with some classmates. I also have noticed that many attendings find it perfectly appropriate to comment, extensively, on a medical student's appearance. Many of my classmates, including me, have gotten a detailed critique on our weight, our breasts, etc. Sometimes this is couched as mentoring somehow, and not an advance.

    I really think it is unlikely that our male colleagues get the same educational guidance.

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  36. If this kind of sexual harassment case cannot be resolved at work, you can immediately file this complaint to the police. This kind of behavior should not be tolerated in any workplace.


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