Harvey Weinstein ousted. Matt Lauer fired. Al Franken resigned. The #MeToo silence breakers named Time Magazine Person of the Year. A large shift has occurred in our culture, and it should reach to the hospital wards and clinic offices. It’s time to talk about #MedicineToo.
I was called to admit a patient with a chronic suprapubic Foley, vague symptoms, and a dirty urinalysis . My medical student saw him first, and together we agreed that he more likely had colonization than a true infection. I went to see the patient to tell him he was going to be discharged.
He gave me weird vibes during the history, and when I examined his catheter site, he told me he was having testicular symptoms and asked if I could do a testicular exam. I thought it was strange my male medical student or the ED providers hadn’t mentioned this, but I performed the exam which was normal. During the exam, the patient grabbed my ID tag and gave his opinions on my current appearance (beautiful) in contrast to my ID picture (ugly). I felt uncomfortable, mumbled something, and left the room.
On leaving, I realized that this patient may have have falsified symptoms to make me examine his genitals while he talked down to me. I felt disgusted and enraged that I hadn’t figured out what happened sooner so I could stand up for myself.
The worst part was the next steps to take weren’t clear to me. I told my attending, and together we called hospital counsel. They recommended calling public safety if the patient was not being discharged and having male staff care for him in the interim (not an easy feat). In looking through his chart, we discovered this was a pattern for him. In fact, he was banned from one of the med-surg units for touching a female nurse. Should I have known this before our encounter? The EMR can notify me when patients’ vitals are concerning for sepsis, but there was nothing to say “this patient has sexually harassed others, bring a chaperone in the room with you.” Further investigation into this revealed that there was no clear answer on how to make others aware of his past behaviors. Frustrated, I put a line about the incident in his discharge summary and moved on with my day.
Sexual harassment in the workplace takes on many forms, both overt and covert. That situation was overt-- -someone else makes comments in a sexual manner meant to intimidate another person. The more difficult situations to handle happen more often—the covert comments, or microaggressions, that can make medicine a hostile environment for female physicians.
I was rushing to an educational conference, eager to get out of the bitter cold. Dressed in a bulky winter coat, neck warmer, and gloves, I fumbled as I entered the elevator. With my head down I was trying to pull my badge out of the layers of clothing to swipe my badge, hit the elevator button, and begin the ascent to the third floor. As the doors were closing, a man stepped into the elevator. “Sorry”, I mumbled as I explained away my fumbling with my badge and the elevator buttons. He reached in front of my body and pressed the elevator button, successfully lighting it. “Thanks,” I said. “Magic fingers,” he replied with a smile. I laughed, awkwardly. “You should see what else they can do” he finished, holding eye contact with me. I nervously laughed again, albeit much more quietly this time. As soon as the doors opened, I dashed out of the elevator, down the hall, and entered my department’s office space. To my surprise, he followed me. I turned left, taking my hat off as I turned the corner, and entered our conference space. I picked a seat, removed my coat, and sat as I watched my elevator companion walk into the conference room with me. Taking off his hat, he advanced to the front of the room. He was introduced as a renowned professor and began his talk.
One of the best things I have learned in medical education is the difference between observation and evaluation. Observations are safe spaces where data lies and science is born. Evaluations are muddled by assumptions, experiences, emotions, and our many mental models with which we organize the world. In reflecting on this interaction, I can’t know what he meant by his comment. I have replayed the incident in my mind, trying to come up with benign explanations. Maybe he put his foot in his mouth and it came out awkwardly. Perhaps he didn’t appreciate the connotation of his comment. Given these possibilities, I did nothing about the incident. I mentioned it to my husband and a few trusted colleagues, then dismissed it as an unfortunate uncomfortable moment. But how uncomfortable it was! I was interested in the topic he was speaking about, but felt wary to ask questions during his talk. I avoided his eye contact and felt oddly ashamed.
How should one handle such situations? I honestly don’t know. I know I don’t want to assume the worst of someone and be wrong. I also know I felt very uncomfortable and it was harder to take part in the work of learning. So I forgot about it, added it to the pile of memories where I laughed awkwardly and crossed my fingers that I won’t run into him again. Here lies the problem with covert harassments. They are obscure, difficult to unpack, and ripe for multiple interpretations allowing them to hide under a veil of confusion and discomfort. #Metoo? I’m not sure. I wonder if he would have said that to my male office mates? Maybe not.
So what can we do? In a recent exercise hosted by my institution, we practiced telling patients, or other employees, when they were being discriminatory or inappropriate. Initially another awkward role-playing exercise, it became helpful to say the words “That statement is inappropriate. You can’t say that to me.” The idea was to empower us as physicians to recognize that we too have rights against harassment. Like any other muscle memory, maybe after doing this exercise, it will be easier to tell that patient how unacceptable his behavior was, or tell that professor what his comment implied. We have to continue speaking up: to hospital administration, program leadership, our colleagues, and our patients, if we want to create a safe and respected work environment.
Dr. Elizabeth Harry
Dr. Harry is a hospitalist at Brigham and Women’s Hospital and an assistant program director of the internal medicine residency program where she is the director of wellness. She is an instructor of medicine at Harvard Medical School. She also directs the humanistic curriculum for the interns and juniors in the Brigham and Women’s Internal Medicine Residency which is a longitudinal wellness curriculum that partners with the Boston Museum of Fine Arts to discuss topics that impact well-being. She is a member of the best practices subcommittee of the collaborative for healing and renewal in medicine (CHARM) under the AAIM and the cochair of the wellness interest group of the Academy at Harvard Medical School where faculty across Harvard hospitals align initiatives to focus on wellness in education. She is on the executive wellness task force of Society of Hospital medicine.