When a patient sexually harasses a physician, what recourse does that physician actually have? While the majority of physicians are white (56%) and male (64%), the physician workforce is diversifying to the point where women now outnumber men among physicians 34 years or younger in most racial and ethnic groups. This changing composition may create increased targets for sexual harassment, which is unfortunately often directed toward gender and ethnic minorities.
The dawning of the #MeToo movement brought national attention to sexual harassment in a variety of fields — medicine among them. The remarkable 2018 report of the National Academies of Sciences, Engineering, and Medicine (NASEM) contextualized the extent of the problem with compelling data. Among other staggering statistics, the report found that more than 50% of women faculty and staff experience sexual harassment in academia. Furthermore, it highlighted the incidence of sexual harassment by patients and patients’ families as a unique aspect of the experience of physicians and other healthcare providers. Timely studies of sexual harassment at individual institutions also demonstrated this, such as a survey at the University of Michigan Medical School showing that 64% of women and 44% of men had been harassed by patients and their families. Even more significantly, in the study, sexual harassment was associated with lower mental health.
Over the past several years, numerous studies have highlighted the importance of addressing biased patient behavior — sexual harassment and otherwise — in the clinical environment. This work began with a foundation of first understanding the problem, as shown by increasing recognition of the microaggressions and sexual harassment that many women physicians experience from patients. Moving beyond mere recognition, steps have been taken to establish a framework for addressing patient-instigated microaggressions and sexual harassment in real time in clinical care settings. For example, a recent piece in JAMA Internal Medicine from Sheffield et al. provided concrete examples of how an individual — or an ally — can address these challenging patient encounters.
Recently, we worked with a group of women physicians at the University of California, San Francisco, to shift the focus from individual responses during the clinical encounter to an examination of the institutional approach to addressing harassment. During the latter half of 2020, we surveyed the top 50 U.S. hospitals for sexual harassment policies and found that few institutional policies specifically addressed sexual harassment from patients toward physicians. Prior studies that examined whether publicly available patient rights and responsibilities policies addressed sexual harassment found the answer was, regrettably, rarely. Our study demonstrated the dearth of internal, employee-facing policies. Rather than looking toward what is lacking, however, we were inspired by exemplar policies like that of the Mayo Clinic. This policy clearly defines sexual harassment and outlines a concrete plan for institutional response — its format is a paragon for other institutions seeking to improve.
Standardization of policies to specifically address the range of biased patient behaviors toward clinicians would serve to 1) create awareness, 2) allow a policy-based foundation for reporting and addressing such behavior, and 3) allow tracking of events to inform policy updates and effective institutional responses. A two-pronged approach to addressing biased patient behavior that focuses on both individual bystander responses and the institutional policies will most effectively protect physicians and promote environments of zero tolerance for sexual harassment.
We hope our work serves as a compelling argument for broader institutional-level policies to address biased patient behavior, which would in turn ensure the safety and well-being of physicians and physicians in training. With the diversification of the physician workforce, particularly along gender and racial lines, it is even more imperative that we examine how hospital policies can catalyze change to protect physicians from this caustic form of workplace harm.
Gabriela Reed, MD, is an internal medicine resident at the University of California, San Francisco. Sarah Ahmad, MD, is an Assistant Professor of Neurology in the Division of Headache Medicine at the University of California, San Francisco. Christina Mangurian, MD, MAS, is a Professor and Vice Chair for Diversity and Health Equity in the Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco.