Sunday, April 28, 2019

We, Too

by Abby Rosenberg (@AbbyRosenbergMD)

I didn’t want to be another “me too” story. I am becoming one, now, because I believe in the power of a collective voice.

You see, there is something terribly lonely about experiencing sexual harassment. And, there is something incredibly powerful about the quiet moment when you finally, bravely, share your story. There is something bittersweet about knowing you are not alone.

Sexual harassment in medicine is common. Over 50% of women medical students experience it before they graduate.(1) Disparities in women’s salaries, grant-funding, academic rank, and leadership opportunities are well-documented. (2-9) While sexual harassment (inappropriate and overtly sexual behavior) is often publicized only after an egregious action and corresponding court or media coverage, “gender harassment” (the broad-range of verbal and non-verbal behaviors conveying insulting, hostile, objectifying, exclusive, belittling, and/or degrading attitudes about one gender) is far more common and insidious. (1) Tolerance of both sexual and gender harassment has been the accepted “price that women pay for a career in medicine.” (10,11)

I was willing to pay this price until I experienced it within our communities of palliative care, bioethics, and humanities. When it came from the people who were supposed to model the highest standards of respect and support, it was all the more stunning, all the more painful, and all the more debilitating. Worse, as I described my own stories of sexual and gender harassment to other women across the country (both within and outside of palliative care and ethics communities), they reciprocated. Our experiences were common. Professionals in palliative care, ethics, and humanities are just as capable of gender harassment as the rest of our medical colleagues.

I and/or my peers in palliative care, ethics, and humanities have experienced all of the following. The references emphasize their commonality within our larger medical community. The reason to share these experiences here is simple: we want our women colleagues to know they are not alone.

- If you have ever been touched inappropriately, kissed, groped, or otherwise assaulted, you are not alone. (1,2,12)

- If you have been invited to talk about or participate in sexual experiences with a male superior, you are not alone. (1,2)

- If you have been physically or emotionally threatened by a male superior, you are not alone. (1,2)

- If you have been called “tasty,” “yummy,” delicious,” “an appetizer,” or any other edible derogative, you are not alone.

- If you have been told you are too attractive, too feminine, too masculine, or too ugly to be successful, you are not alone. (2,13)

- If you have been told that being a mother, single, partnered, a wife, a divorcée, or a daughter means you will not be successful in medicine, you are not alone. (2,13)

- If you have been told “you are not ready” for promotion, despite your meeting written qualifications, you are not alone. (2,13)

- If you have had to demonstrate greater academic productivity to be promoted than your male colleagues, you are not alone. (2,13,14)

- If you have worked in an environment where all or most of the leadership positions are held by men, you are not alone. (1,2,7,13,15)

- If these male leaders have known histories of sexual harassment, you are not alone. (16)

- If you have been offered teaching leadership positions rather than your asked-for executive leadership positions, you are not alone. (1,2,15)

- If you have received less salary for an otherwise identical job to a male, you are not alone. (1,2,5,9)

- If you have received less institutional support for career development than an otherwise equivalent male counterpart, you are not alone. (1-4,17)

- If you have received critical subjective feedback rather than constructive objective or positive feedback, you are not alone. (2,18,19)

- If you have been told to be “softer,” “less assertive,” “more quiet,” or “less bossy,” you are not alone. (13,20)

- If you have been called “abrasive,” “shrill,” “strident,” “pushy,” “angry,” or “aggressive,” you are not alone. (13)

- If you have felt shame because you are a victim, you are not alone. (1,21)

- If you notice that women speak several times in meetings before being recognized, whereas men speak once and are acknowledged, you are not alone. (13)

- If you notice that women speak a fraction of the time that men do in meetings, you are not alone. (22)

- If you notice that men speak over and around women, re-explain their words, or generally seek to have the last word in discussions, you are not alone. (22)

- If you have been labeled as “difficult” for trying to make change, you are not alone. (13,18,20)

- If a male colleague has loudly suggested you curtail your advocacy efforts, while multiple women quietly thank you, you are not alone. (13,23)

- If you have been told to “be more grateful,” “keep your head down,” “practice meditation,” or otherwise improve yourself in order to handle gender harassment, you are not alone. (2)

- If you have heard, “he doesn’t mean it that way,” “he is from another generation,” “he is a leader in his field,” or some other excuse to tolerate poor behavior, you are not alone. (24)

- If a male mentor has distanced himself from you because “you might accuse [him] too,” you are not alone. (25)

- If you have witnessed perpetrators receive “executive coaching” or “leadership development” opportunities to fix their behavior, while the women victims are left to wait, hope, or suffer in silence, you are not alone. (26)

- If you have felt unsupported by your colleagues, leadership, or larger institution, you are not alone. (1,26)

- If you have observed other men (and women) bystanders look the other way rather than intervene to stop gender discrimination, you are not alone. (1)

- If you have stayed silent for fear of losing your job, you are not alone. (1,10,11,26)

- If you have spoken up and experienced retaliation compromising your physical or emotional health, or your career development, you are not alone. (1,11,26,27)

- If you have chosen continued poor physical or emotional health over speaking up, you are not alone. (1,11,21,26,27)

- If you have avoided your workplace or a colleague because you feel unsafe, you are not alone. (1,11,26)

- If you have noticed your avoidance is compromising your upward mobility and opportunities, you are not alone. (1,11,26)

- If you have experienced burnout or considered leaving medicine altogether as a result of your experiences with gender harassment, you are not alone. (1,11,21,26)

- If you have felt supported by your institution because it has transparent policies such as equity report-cards, 360-degree evaluation procedures, zero tolerance of repeat offenders, alternative reporting options, protection from retaliation, and efforts to promote women leaders, you are not alone. (1,2,10,11,28)

- If you have felt grateful to men and women colleagues who stand with you, listen to you, speak for you, and champion your cause even at personal expense, you are not alone. (1,2,10,11)

- If you have been inspired by the bravery of those who share their stories and speak for change, you are not alone.

We can do better than this in palliative care. We are a community trained to see our patients and colleagues as human beings with equal value. We are the ones who listen. We are the ones who speak for the vulnerable.

I know there are myriad more experiences. To all of you who are suffering in silence, you are not alone. We are listening. We are speaking. “We, too,” are with you.

Abby R. Rosenberg, MD, MS, MA, is a pediatric oncologist, bioethicist, and palliative care physician and researcher. Her hobbies include narrative writing and, when needed, change-making.

REFERENCES
1. Sexual Harassment of Women: climate, culture, and consequences in academic sciences, engineering, and medicine. Washington, DC: National Academies of Sciences, Engineering, and Medicine; 2018.
2. Kang SK, Kaplan S. Working toward gender diversity and inclusion in medicine: myths and solutions. Lancet. 2019;393(10171):579-586.
3. Witteman HO. Gender bias in academia. Lancet. 2019;393(10173):743-744.
4. Witteman HO, Hendricks M, Straus S, Tannenbaum C. Are gender gaps due to evaluations of the applicant or the science? A natural experiment at a national funding agency. Lancet. 2019;393(10171):531-540.
5. Jena AB, Olenski AR, Blumenthal DM. Sex Differences in Physician Salary in US Public Medical Schools. JAMA Intern Med. 2016;176(9):1294-1304.
6. Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex Differences in Academic Rank in US Medical Schools in 2014. JAMA. 2015;314(11):1149-1158.
7. Wehner MR, Nead KT, Linos K, Linos E. Plenty of moustaches but not enough women: cross sectional study of medical leaders. BMJ. 2015;351:h6311.
8. The Lancet. Feminism is for everybody. Lancet. 2019;393(10171):493.
9. Glauser W. Why are women still earning less than men in medicine? CMAJ. 2018;190(21):E664-E665. 10. Choo EK, van Dis J, Kass D. Time's Up for Medicine? Only Time Will Tell. N Engl J Med. 2018;379(17):1592-1593.
11. The Lancet. Time's up for sexual harassment in medicine. Lancet. 2018;391(10140):2576. 12. Clancy KB, Nelson RG, Rutherford JN, Hinde K. Survey of academic field experiences (SAFE): trainees report harassment and assault. PLoS One. 2014;9(7):e102172.
13. Williams JC, Phillips KW, Hall EV. Double Jeopardy? Gender Bias Against Women of Color in Science. worklifelaw.org 2015.
14. Raymond JL, Goodman MB. Funders should evaluate projects, not people. Lancet. 2019;393(10171):494-495.
15. Chisholm-Burns MA, Spivey CA, Hagemann T, Josephson MA. Women in leadership and the bewildering glass ceiling. Am J Health Syst Pharm. 2017;74(5):312-324.
16. Johnson CY, Guarino B. After outcry, Yale removes prestigious honor from professor who sezually harassed a colleague. Washington Post 2018.
17. Sege R, Nykiel-Bub L, Selk S. Sex Differences in Institutional Support for Junior Biomedical Researchers. JAMA. 2015;314(11):1175-1177.
18. Cecchi-Dimeglio P. How Gender Bias Corrupts Performance Reviews, and What to Do About It. Harvard Business Review 2017.
19. Evans J, Slaugher J, Ellis A, Rivin J. Making Jokes During a Presentation Helps Men but Hurts Women. Harvard Business Review 2019.
20. Dzau VJ, Johnson PA. Ending Sexual Harassment in Academic Medicine. N Engl J Med. 2018;379(17):1589-1591.
21. O'Neil A, Sojo V, Fileborn B, Scovelle AJ, Milner A. The #MeToo movement: an opportunity in public health? Lancet. 2018;391(10140):2587-2589.
22. Powell K. How female scientists can confront gender bias in the workplace. Nature. 2018;561(7723):421-423.
23. Berg S. 4 qualities women leaders need in medicine to succeed. AMA Wire. 2018. https: wire.ama-assn.irg/life-career/4-qualities-women-leaders-medicine-need-succeed? Accessed 10/26/2018.
24. Jagsi R. Sexual Harassment in Medicine - #MeToo. N Engl J Med. 2018;378(3):209-211.
25. Soklaridis S, Zahn C, Kuper A, Gillis D, Taylor VH, Whitehead C. Men's Fear of Mentoring in the #MeToo Era - What's at Stake for Academic Medicine? N Engl J Med. 2018;379(23):2270-2274.
26. Fnais N, Soobiah C, Chen MH, et al. Harassment and discrimination in medical training: a systematic review and meta-analysis. Acad Med. 2014;89(5):817-827.
27. Abbasi J. Sexual Harassment and Assault Associated With Poorer Midlife Health in Women. JAMA. 2019;321(3):234-236.
28. Westring AF, Speck RM, Sammel MD, et al. A culture conducive to women's academic success: development of a measure. Acad Med. 2012;87(11):1622-1631.

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