#MedicineToo

Aparna Alankar.

Judge Brett M. Kavanaugh was recently sworn in to the Supreme Court. In the coming weeks, it is worth taking the time to reevaluate the institutions we are each a part of and how they address sexual misconduct—especially those institutions which we had once thought sacrosanct. For premeds, medicine is a good place to start.

One of the first studies of sexual harassment and discrimination in the medical workplace was led by Dr. Reshma Jagsi in 2016. Dr. Jagsi surveyed 1066 academic medical faculty members and found 30% of women reporting experiences of sexual harassment compared with 4% of men. The experiences of these women were categorized as one of the following: sexist remarks or behavior, unwanted sexual advances, subtle bribery to engage in sexual behavior, threats to engage in sexual behavior, and coercive advances. Since the culmination of her study, Dr. Jagsi was asked by the New England Journal of Medicine for her comments in light of the #MeToo movement. In a letter to NEJM, Dr. Jagsi begins by describing her urgency to correct her secretary’s assumption that she had been sought out by the journal because she herself was a victim of sexual harassment. She then wonders why this clarification had seemed so imperative to make. “Victims,” Dr. Jagsi writes, “do not fare well in our society.”

Dr. Jagsi’s words remain devastatingly poignant to this day. Women who report sexual harassment continue to experience retaliation, stigmatization, and even criminalization. Dr. Christine Blasey Ford is testament to this fact. Although the #MeToo movement has recently given many survivors the strength to share their experiences—and in the process, bring down 201 powerful men—stigma and its consequences remain formidable obstacles to overcome. In terms of medicine, Dr. Jagsi says that since the publishing of her study, many physicians have contacted her to share their own experiences of harassment—incidences occurring during training, conferences, operating room hours, and student-faculty dinners, both between peers and between superiors and subordinates. Each time, these physicians said, they had remained silent. They shared the challenges involved in speaking out amidst the “pervasive, machismo” culture of medicine, which so often failed to evolve from “lewd locker-room conversations” belittling sexual consent or alcohol’s connection to rape. They spoke of questioning their own self-worth after their experiences, and of wondering whether their experiences had been self-inflicted. One woman did, however, decide to bring in a lawyer, who then promptly told her that bringing details of her assault to HR would hurt her own career, since “HR is about protecting the institution, not [her].”

Medicine is ultimately no different from other fields in regards to prevalence of sexual harassment. Since Dr. Jagsi’s study, more research has come out documenting the sexual harassment of women in academic science, and going further to say that medicine is one of the worst fields for sexual harassment. Why then, does medicine so often fall under the radar of sexual misconduct? Perhaps we like to harbor beliefs that compassionate and benevolent dispositions push people towards becoming physicians, while forgetting that medicine has a history of male domination and hierarchical power structures, making it an institution long due for change.

One of these changes is coming about through trauma-informed healthcare, which seeks to educate physicians on the lasting effects of sexual assault and related traumas and on proper guidelines for response. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines a trauma-informed organization or practice as “acknowledging the widespread impact of trauma in both patients and staff,” and works with institutions to integrate knowledge about trauma into their policies, procedures, and practices to resist the retraumatization of survivors. SAMHSA defines six principles of trauma-informed care: safety, trustworthiness and transparency, peer support and mutual self-help, collaboration and mutuality, empowerment and voice, and the consideration of cultural, historical, and gender issues. Practical integration of these principles is simple. The patient examination room—a space where patients may need to undergo physical touch, the removal of clothing, and personal questions in the presence of an inherent power differential between themselves and their physician—represents a prime opportunity for physicians to practice trauma-informed care to improve their patient’s outlook and engagement with healthcare. A simple “would you like the door open or closed” is a gesture towards alleviating potential stress for a patient, as is taking the time before each action to thoroughly explain what will be done, how it will be done, and why it is necessary. Dr. Rittenberg, a primary care internist practicing in a women’s health group, feels that those who work in healthcare (and especially in primary healthcare) have a special responsibility to provide trauma-informed care. As a primary physician, Dr. Rittenberg says, he has a uniquely longitudinal relationship with his patients and therefore has the opportunity to offer a consistent and honest relationship from which healing from trauma can take place.

Trauma-informed healthcare is far from a solution to sexual assault in the medical workplace, but it does take steps in the right direction to push medicine back towards its ideals: a practice seeking to treat all forms of illness, physical and psychological, in a space providing security and comfort from the outside world, acting as a countering force and survival mechanism until the world finally stops placing sexual assaulters on the pedestals it still does.