A conference dedicated to women in medicine, WIMIN, came hard on the heels of a much-publicised report on sexism in surgery. One in three female surgeons in the UK reported experiencing sexual harassment. If ever you wanted to find pockets of where the patriarchy is alive and well, where sexism is routine and where misogyny seems baked into systems relied on for ‘health care,’ look within the halls of English hospitals. A couple of hundred doctors, surgeons, anaesthetists and nurses came to WIMIN to share their experiences of the medical front line – both for women professionals and for patients. It ain’t pretty.
Women have been trained as doctors in the UK for 100 years. Since 1995, every year more women than men have entered UK medical schools. In 2022, a large majority (62 percent) of entrants were women. In 2023, 35 percent of Surgical Speciality Trainees and 15 percent of Consultant Surgeons are women. But they aren’t staying. The Working Party on Sexual Misconduct in Surgery (WPSMS) was formed in 2022 to try and understand why – and stem the tide.
That will take some full-blown culture and leadership change. A survey published in September in the British Journal of Surgery was titled Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities. Its incendiary findings reveal that almost 30 percent of women had been sexually assaulted – by a colleague. Fully 90 percent of women surveyed (and 80 percent of men) admitted witnessing some form of sexual misconduct by colleagues. Sexual coercion was common, with 11 percent of women saying forced physical contact was linked to career opportunities. A number of participants had been raped at work, as well as in other work-related contexts including teaching spaces, conferences, and after-work events with colleagues. Even if the 80% of men who witnessed sexual misconduct did not approve, they did not call it out; they were complicit.
The organisations that manage the health system don’t seem to be listening. The study notes a widespread “lack of faith” in accountable organisations’ dealing with sexual misconduct and points the finger at … basically everyone: the British Medical Association (BMA), the General Medical Council (GMC), Health Education England (HEE), NHS Trusts, and the Academy of Royal Colleges.
A letter to The Times from Dr Peter Hilton, a retired doctor, commenting on the report, both reflected the culture and exacerbated it. He confidently and condescendingly reminds young women to get over themselves: “Sexually inappropriate comments and actions do occur. It is stressful. All I can say is that if they want to make a success of this rewarding career than they should toughen up.” It perfectly illustrates the problem of the power-wielding, transactional power system between male-dominated senior doctors and female-dominated trainees. A group of 50 doctors and former colleagues of Dr. Hilton got together to write a rebuttal.
None of this should be much of a surprise. An earlier report suggests not much has changed since 2019 when yet another review found “the majority of those who had experienced sexual harassment at work were targeted by a colleague and 71 percent did not report it, fearing retaliation, career damage, not being believed and fearing nothing would be done.”
As an aside, the medical profession in other countries should not feel superior. In the USA a 2019 ‘National Survey of Sexual Harassment Among Surgeons’, reported that 58% of female surgeons experienced some form of sexual harassment in the previous 12 months. An earlier report in Australia in 2015 found a culture in the surgical profession of bullying, discrimination and sexual harassment.
A #MedicineToo Moment?
The women are starting to organise. Conferences and new websites are following on from data gathering exercises and reports.
Women in Medicine Conference Conference (WIMIN)
In its third year, WIMIN was started by two doctors, Drs. Helen Burdett and Dr Kate Stannard. Tired of the highly siloed and male dominated medical conferences on offer, they wanted, says Stannard, “to address the difficult issues – and explain the high attrition of women in medicine.” In this, the conference delivered. It brought together some of the leading voices surfacing the challenges women face in medicine.
At the sold-out WIMIN conference in September, a couple of hundred doctors shared stories of the daily misogyny and poor behaviour in hospitals – especially in surgeries. Why is it worst in this most elite part of the profession? One senior doctor suggested it was the entitlement and culture of some of the most powerful people in the room, still dominated by posh, public-school educated boys who’d grown up in male-only schools. As another surgeon said, once you were scrubbed and sterilised and about to operate, you can’t repel inappropriate physical sexual advances. Your hands are – almost literally – tied.
Next year’s conference, September 13-14th, will be hosted by the University of Cambridge.
Sexism in Surgery Report
Professor Carrie Newlands, a longtime surgeon and now faculty at the University of Surrey, presented her headline-grabbing report on sexism in surgery entitled Breaking the Silence: Addressing Sexual Misconduct in Surgery. It’s published by the Working Party on Sexual Misconduct in Surgery (WPSMS) formed in 2022 to address the issue head on with data and proposals for change. They are also behind the report referred to above.
The ask? A pretty standard list of what most would have imagined already existed:
- implementation and investigation of the report findings
- policies and codes of conduct around sexual safety and misconduct
- education on sexual safety/ misconduct at all career stages
- tracking of culture and performance of accountable organisations
- continuous data collection
Surviving in Scrubs
Drs. Becky Cox and Chelcie Jewitt presented the website they co-founded called Surviving in Scrubs, aimed at calling out sexism and harassment in health care and shifting what they consider to be a routinely misogynistic culture. Women doctors, they report, are less likely to be appointed to leadership positions, and women patients are less likely to receive standard treatments.
On the website, they are collecting the experiences and stories of women across the country. They show that harassment and assault are common and that the impact on staff and morale is huge and largely ignored. Women have difficulty reporting, the systems in place aren’t independent, and most say they fear repercussions. The result? “Guilt, shame, not being believed, loss of professional identity, and humiliation.”
A Broader Problem – A System Under Strain
Dr Bill Kirkup CBE has been the head of multiple independent reviews into public service failures, including several into maternal health issues. “Why do we keep having to do this?” he asks. There have been multiple major investigations into unusual baby deaths since the year 2000. Five between 2015 and 2022 alone. The latest, in 2022, was called Reading the Signals, because, he says, every case shares remarkably similar – and repeating – characteristics. Where all the issues were revealed by families who knew there was a problem before the system recognised it.
Kirkup points to multiple failings and areas for improvement: a maternity signalling system that has lots of data but doesn’t use it to improve outcomes. A professional culture that is under strain, characterised by aggression, hostility and rudeness to both staff and patients. This even led to a conference focused on managing the problem, called Doctors in Difficulty & Difficult Behaviour. Problems of teamwork within and between professional groups without a common purpose. Leading to accounts of “bullying, intimidation and disregard, with staff left to work outside their competence areas.” And, finally, organisations that resist course correction, preferring “denial, deflection, dishonesty and aggression” and citing reputation management as the excuse for endless cover ups.
Gender Balance is Key to Healthy Healthcare
As so often, women are the canaries in the coalmine. They are the first victims of a cracking ecosystem. A system that’s been under constant review, political pressure and cost constraints for decades. People strained to breaking point during a pandemic. And a culture locked in yesterday’s hierarchies and behaviours.
But women are the change agents that these systems usually need. They are the majority of the newly arriving talent, the majority of the patients and carers of patients requiring services. Ignore, misunderstand and abuse them at your peril. It’s the system that will fail if they give up on it.
Comment from the Joint Royal Surgical Colleges
“The findings of the working party’s survey on sexual misconduct in surgery are shocking. As leaders of the four surgical royal colleges, we want to send a strong message: these utterly unacceptable behaviours have no place in surgery. We would like to thank the working party for having the courage to speak out on this very serious problem. We will work with the group and colleagues across healthcare to ensure that surgery is the safe and welcoming profession it should be.”
- Professor Rowan Parks President of the Royal College of Surgeons of Edinburgh (RCS Edinburgh)
- Mr Tim Mitchell President of the Royal College of Surgeons of England (RCS England)
- Mr Mike McKirdy President of the Royal College of Physicians and Surgeons of Glasgow (RCPSG)
- Professor Laura Viani President of the Royal College of Surgeons in Ireland (RCS Ireland)
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