#MeToo: Sexual Harassment and Discrimination in Medicine

#MeToo: Sexual Harassment and Discrimination in Medicine

June 9, 2018

© 2018 American Medical Association. All rights reserved.

CONFIDENTIAL AND PROPRIETARY


Objectives:

• Identify the difference between harassment and discrimination.

• Recognize how harassment and discrimination impacts patient care.

• Explore ways to reduce sexual harassment and discrimination behaviors in the workplace.

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#MeToo: Sexual Harassment and Discrimination in Medicine • SPEAKERS:

• Henry Lin, MD, Moderator, Pediatric Gastroenterologist, Children's Hospital of Philadelphia, Immediate Past Chair of AMA Young Physicians Section

• Reshma Jagsi, MD, Dphil Professor and Deputy Chair, Department of Radiation Oncology Director, Center for Bioethics and Social Sciences in Medicine University of Michigan

• Tiffani Bell, MD, AMA Resident & Fellows Section representative to the Minority Affairs Section

• David G. Gabor, Esq. , The Wagner Law Group

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Reshma Jagsi, MD, DPhil Professor and Deputy Chair, Department of Radiation Oncology

Director, Center for Bioethics and Social Sciences in Medicine University of Michigan

Sexual Harassment in Academic Medicine




Trigger Warning

• Throughout this session, we will be talking about potentially upsetting topics surrounding sexual harassment and discrimination.

• If you feel triggered by the discussion at any point please feel free to exit the room any time.

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#MeToo: Sexual Harassment and Discrimination in Medicine Defining our terms

• Sexual harassment is behavior that derogates, demeans, or humiliates an individual based on that individual’s sex (Berdahl, 2007)

• Some scholars now prefer the term “sex-based harassment”

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Decades of research in occupational psychology

• Harassment more common:

• In historically male-dominated fields

• Where big power differentials/hierarchies exist

• Where women are in the minority

• And when institutions tolerate the behavior

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#MeToo: Sexual Harassment and Discrimination in Medicine What Does that Mean for Medicine?

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#MeToo: Sexual Harassment and Discrimination in Medicine Women in Medical Leadership

Strong hierarchies in academic medicine

Low proportions of senior academic positions are held by women ◦ In 2015, 39% of all faculty were women, but only 22% of full professors 16% of department chairs 16% of medical school deans

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#MeToo: Sexual Harassment and Discrimination in Medicine • Yale Medical School Removes Doctor After Sexual Harassment Finding

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Self-Reported Experiences of Recipients of NIH K08 and K23 career development awards from 2006-2009 (survey conducted in 2014)

Women No. (%) n = 493

Men No. (%) n = 573

Respondents who perceived gender-specific bias in the academic environment 343 (69.6) 125 (21.8)

Respondents who reported they personally experienced gender bias in professional advancement

327 (66.3) 56 (9.8)

Respondents who reported they personally experienced harassment * 150 (30.4) 24 (4.2)

* “In your professional career, have you encountered unwanted sexual comments, attention, or advances by a superior or colleague (yes or no)?”




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Severity Among Women Who Reported Having Experienced Harassment (n = 150)

Experience No. (%)

Sexist remarks or behavior 138 (92.0)

Unwanted sexual advances 62 (41.3)

Subtle bribery to engage in sexual behavior 9 (6.0)

Threats to engage in sexual behavior 2 (1.3)

Coercive advances 14 (9.3)


• 59% perceived a negative effect on confidence in themselves as professionals

• 47% reported that these experiences negatively affected their career advancement

30% 4%

Dr. Jagsi,

Your paper struck a particular chord with me... I brushed what happened under the rug; and in a residency program where the chair invites the male (and not female) residents & attendings over every week for poker, these things largely go unnoticed.

Over the past 4 years, I've wondered if something was pathologically wrong with me that I invited that kind of behavior (was it because I wasn't smart enough, was it because I was soft-spoken, was it because there was something so wrong with me that I couldn't even recognize it) and whether it would keep me from achieving anything of merit.

I read your article with a mixture of simultaneous dismay and relief - dismay because how could such successful women be subject to that kind of discrimination - relief because despite what they endured, they were successful...and if they have gone through similar things, then maybe I'm not defective.

I don't think I can ever talk about my experiences partially because of fear, partially because it seems ungrateful to do so...

I hope institutions pay attention. I hope people care. Your article helped me gain the closure that I didn't realize I needed.






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Conclusions

• Growing attention regarding sexual harassment in the workplace creates an opportunity to address this challenge so many women continue to face

• Many women, even those trained since relative gender equality in the medical student body, have experienced sexual harassment

• These experiences are not rare and can have lasting impact

• Women who have these experiences may be reluctant to disclose them for fear of being further victimized, stigmatized, marginalized, or worse

• Institutions and our profession must not only gather data and ensure communication about resources available for support and reporting but also support proactive interventions to transform the workplace

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Tiffani L. Bell MD Adult/General Psychiatrist and Child Psychiatry Fellow

Psychological Effects of Sexual Harassment and Discrimination #Metoo


What is Sexual Harassment?

1. Sexual Harassment is defined as “unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when the conduct is made as a term or condition of an individual's employment, education, or living environment.

2. unwelcome verbal, visual or physical conduct of a sexual nature that is severe or pervasive and affects working conditions.”.

1. Some behaviors are considered minor and thus can be brushed off unless it is recurring : ex. Frequent comments about a person’s body.

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Sexual Harassment… continued

3. Another definition of Sexual Harassment is a range of behaviors that include a range of behaviors, from daily microaggressions (subtle derogatory messages) to direct acts of physical sexual assault.

• Microaggressions are defined as an action, statement, or incident which is generally indirect, subtle or sometimes unintentional discrimination against a marginalized group.

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© 2018 American Medical Association. All rights reserved. 23

Sexual Harassment in the medical profession: legal and ethical responsibilities B. Matthews and M. Bismark 2015

• A senior surgeon warned trainees who complained about sexual harassment that these incidents were usually not well supported.

• The trainees were advised to comply with unwanted requests due to fear of jeopardizing one’s career.

• Important to remember that women have legal rights to gender equality and freedom from sexual harassment in the work place.

If it happened to me… I would report right away!


Sexual Harassment in the medical profession: legal and ethical responsibilities B. Matthews and M. Bismark 2015

Important to note that sexual harassment can happen in any field and to any gender. It is especially difficult in medicine, however, due to a known hierarchy and often feeling that one must not step out of line or one’s career may be ruined. Incidents are often not reported due to fear of not being believed, or possible retaliation after the fact.


Experiencing sexual discrimination and harassment can lead to: - A desire to leave work early, use PTO, or take more sick days. - Skipping group meetings. - Difficulty staying focused at work - Ultimately, quitting your job or changing careers.

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Physical and Psychological Effects

• Anxiety

• Depression (symptoms of depression or adjustment disorders) or sleep issues

• Headaches

• PTSD symptoms (avoidance, hypervigilence, nightmares, re-experiencing the event)

• Weight loss or gain (changes in appetite)

• Poor self-esteem or self-worth.

• Self Doubt

• Hypertension

• Many other symptoms

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If someone is a victim of sexual harassment or discrimination and it is affecting their performance, it is important to seek help (EVEN if she does not

report the abuse.)

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Thank You For Your Attention!

• We will discuss more during the scenarios.

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David G. Gabor, Esq. The Wagner Law Group




A Horrific Problem Persists

• The percentage of women who experience sexual harassment in the workplace ranges from 25% to 54% and even higher

• 75% who spoke up experienced retaliation

• Most workplace harassment is unreported for many reasons including fear

• 25,000+ sex discrimination cases filed at EEOC

• The EEOC recovered $140 Million in 2015

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A Revolution

We are in the midst of a revolution

• The United States Gymnastics Team

• Entertainment industry

• Politics

• Executives

How this affects employers

• People are more likely to speak up

• New legislation is pending

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Understanding Sexual Harassment

• Definition

• Quid pro quo

• Gender neutral

• Intent does not matter

• Sexual orientation/gender identity/transgender

• Harasser can be…..

• Retaliation

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Improve Training

The Supreme Court created the Faragher Defense.

Employers have shifted to web-based training:

• Canned programs

• Attendees are distracted – they can multitask

• Minimalized message

• Unclear as to expectations

• The employer is interested in liability and not a safe and proper workplace

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Benefits Of Live Programs

• Material must be tailored to the audience

• Interactive – top down support

• Clearly set forth expectations

• Be collaborative – talk through scenarios

• Shift the focus – you are part of the solution

• Teach people how to use their voices

• Teach people the importance of respect

• Leave properly prepared

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Modify Culture

• People know right from wrong

• It is the same as traffic or criminal infractions

• We don’t need to train on that

• The challenge is that current culture fosters this sort of inappropriate behavior

• Those who report bad behavior are subjected to retaliation

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Ready To Respond

Responding to a complaint:

Bad Good

Boys will be boys. Thank you for bringing this to my attention.

Oh my, that is the worst…. We take these matters very seriously.

HR will call you in 10 minutes. I will be reaching out to HR immediately.

I don’t think that is harassment. You can also reach out to HR directly.

I know Billy. He would never do that. We don’t tolerate retaliation.

Protect your job. Don’t complain. Please reach out to me if you need to.

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The Power Dynamic

• People failed to complain due to fear and a lack of trust in HR and senior management.

• Shift towards giving employees a voice.

• By promoting top-down buy-in changes the power dynamic.

• Part of the message is that the employer wants its employees to have a voice.

• HR needs to have the power to act if there is harassment. Examine your reporting structure.

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Top Ten List

1. Audience must relate to training.

2. If you can’t do live training, work on its introduction, have senior level people introduce the program, and hold forums or town hall style meetings.

3. People skills matter.

4. Get top-down support. Use training as an opportunity to reinforce a new culture, vision, and brand.

5. Make decisions for the right reasons.

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Top Ten List: Part 2

6. Make sure managers are ready in advance.

7. Follow up with the person who reported harassment- builds trust and avoids retaliation.

8. Define “relationship” because dating happens and when one person is subordinate….

9. Consider early resolution programs such as mediation.

10. Assess existing culture.

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Scenario 1:I There must be a better way

Peter is an Attending and is working with a Fellow named Lynn in the operating room performing an endoscopy. A CRNA and OR nurse are also in the room. Lynn completes a difficult maneuver and Peter slaps her bottom,

exclaiming: “Atta girl!” Lynn momentarily freezes before completing the rest of the procedure. This action is witnessed by the CRNA and the OR nurse.

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Continued Scenario: Jessica, a medical student, is on her surgical rotation and when placing a Foley catheter, Peter, still the attending physicians says (in front of residents on the medical team), “It looks like you really know how to handle a piece of meat.”

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Scenario 2: II Not the best idea

John and Carol are physicians in the break room talking about

plans for the upcoming weekend. You walk in and overhear the two of them apparently having a pleasant conversation. John says

that he has plans to go to the beach for the weekend and says to Carol: “You should join me this weekend honey!”

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Continued Scenario: John and Carol are in the break room talking about a challenging medical case that Carol recently diagnosed. After commenting on Carol’s astute management, John says: “You did such a great job. Let's go out for a drink and talk about promotion.”

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Continued Scenario: Carol accepts John’s invitation to go out for drinks. John leans over and puts his hand on her leg and says that he will get her that promotion. He then winks.

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Continued Scenario: Carol complains to Edward, the Department Head about what happened the night before over drinks.

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Thank you

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Documents

#MeToo: Sexual Harassment and Discrimination in Medicine