Female doctors who have experienced sexual assault have spoken of work conditions they felt made them more vulnerable to harm from senior colleagues, an Australian researcher says.
“[They described] the enforced closeness that can occur in long sessions in operating theatres,” said Dr Louise Stone, an associate professor at the Australian National University.
“[The] emotionally intense experiences in traumatic situations, and relocation to rural hospital environments where they had little support and lived in hospital accommodation.”
Stone, who has researched sexual harassment in medicine, said women had also spoken about “the boys’ club culture” that reduced their confidence and sense of self”.
One junior doctor told Stone that while she was on a surgical rotation and suturing the wound of a patient, a male specialist registrar came up behind her and started thrusting against her from behind. She silently continued suturing the wound of the oblivious patient, who was awake but lying down and facing away from her.
“You are taught in medicine to protect the patient no matter what, even if you are struggling,” Stone said. “It put her in an untenable position, but she still asks herself what she could have done differently. What was she supposed to do, turn around and belt him in front of the patient?”
The young doctor told Stone that at the time of the assault she “had difficulty believing that his behaviour was actually real” and that afterwards she sometimes felt she was “going mad and this made me feel even more unconfident and uncertain about myself”.
On Sunday radiation oncologist Dr Dominique Lee identified herself as the doctor whose complaint led to the jailing of Dr John Kearsley, the director of radiation oncology at St George Hospital in Sydney, after he drugged and then indecently assaulted her while she was completing her specialist training.
A decade on from the assault, Lee remains the only junior doctor to have successfully prosecuted a senior doctor through the criminal justice system.
Stone, who is also general practitioner, will in October host the first Australasian Summit on Sexual Harassment in Medicine, bringing together representatives from peak medical bodies, medical colleges and health experts to discuss how Australian healthcare culture can be changed and assaults prevented.
Stone decided the invite-only summit was needed after researching sexual assault in medicine, leading to a book she co-authored on the findings, which will be published in the new year.
Stone said sexual harassment was common in medical school, with 14.5% of medical students reporting sexual harassment since starting at university. Women and students from the LGBTQI+ community reported higher risks.
Junior doctors mostly experienced sexual harassment from their senior colleagues, she said, and at least 45% of the perpetrators of bullying, harassment or discrimination were supervisors.
“The survivors fear losing their reputations, their training positions and their careers if they report the abuse,” Stone said.
“The personal benefit of reporting is usually negligible. Survivors fear gaining a reputation as a difficult person who is ‘unprofessional’ or a ‘troublemaker’.”
Another junior doctor told Stone that a senior registrar she was working under held her against a wall and sexually assaulted her. She decided to leave the hospital system altogether. She told Stone she still blamed herself at times. “Maybe I should have been more professional and not smiled as much,” she said.
Stone hopes that through hosting a summit on the issue, medical leaders will commit to doing more to prevent it.
“We need to work on prevention, to improve detection, to manage misconduct but also to support survivors,” Stone said.
“Medicine is a profession that deals with trauma and abuse every day. We should be leading the eradication of sexual harm by healing our own culture.”
‘Power is concentrated’
Tish Sivagnanan, president of the Australian Medical Students’ Association (Amsa), called on hospitals to urgently overhaul their harassment policies.
Sivagnanan said each hospital had its own specific human resource mechanisms for reporting abuse and inappropriate behaviour.
“But a range of significant barriers exist that often prevent reporting, including the fact medicine is an environment with an innately hierarchical structure, where power is concentrated to senior medical staff who attract significant influence and control within the hospital system,” she said.
“This combined with the meritocratic nature of medical training, where career advancement is often dependent on recommendations from supervisors, leaves those who are the targets of harassment fearful of educational and career repercussions if they were to report superiors.”
Sivagnanan cited a 2019 inquiry conducted by the Australian Salaried Medical Officers’ Federation (Asmof) into sexual harassment, which found more than 30% of all doctors had experienced sexual harassment at least once in their careers.
Female doctors were consistently more likely to experience sexual harassment, with 50% of female doctors saying they had experienced at least one incident, compared with 6% of male doctors. Up to 90% of perpetrators were reported to be male, and 70% of perpetrators were reported to be fellow doctors.
Dr Antony Sara, Asmof’s federal president, said such statistics were the result of “survey bias” and that overall incidents of sexual assault were “not high”. But he said the culture of medicine needed to change.
“The number of these [assaults] that would be actionable, rather than just a micro-aggression, would be fairly unclear,” he said.
“I am not downplaying the event. The issue is how many are nasty enough that a doctor in training is going to lodge a complaint and ask us, Asmof, to support them in that complaint when it can easily be a career-limiting move if it is not a major event.
“It needs to be more than just a micro-aggression to get any traction. The number of truly actionable cases may not be high. Many cases are ‘he said/she said’ and are very hard to prove on the balance of probabilities, let alone beyond reasonable doubt.”
Sivagnanan said Amsa wanted hospitals and the networks they were part of to develop more clear reporting processes that were underpinned by procedural fairness, confidentiality and privacy, and to adopt a zero-tolerance approach to reports of abuse.
“As each year passes, medical students and junior doctors continue to face harassment, bullying and abuse that that too often flies under the radar,” Sivagnanan said.
Independent and impartial investigators should handle reports of harassment, she said, and hospitals must “ensure that staff who submit reports are fully protected from potential personal and career-based reprisals”.
Do you know more? Email melissa.davey@theguardian.com
Information and support for anyone affected by rape or sexual abuse issues is available in Australia at 1800Respect (1800 737 732). In the UK, Rape Crisis offers support on 0808 500 2222. In the US, Rainn offers support on 800-656-4673. Other international helplines can be found at ibiblio.org/rcip/internl.html
