Is sexism in surgery linked to bullying in hospitals?
It started with a book launch. Dr Gabrielle McMullin was introducing the book Pathways to Gender Equality. The Australian Centre for Leadership in Women could not have anticipated her comments.
“What I tell my trainees is that if you are approached for sex, probably the safest thing to do for your career is to comply with the request, unpleasant as it may be.”
Her comments were widely reported. Some condemned her for making ‘sexist’ commentary. However, they sparked some female surgeon’s to contact the media, with their stories of sexual abuse and cover-ups by hospital officials. The issue of sexism in surgery subsequently exploded into the public arena, like a burst boil.
Dr Mullin on the barriers for women wanting to become surgeons in Australia
Stories of abuse towards female surgeons in Australian hospitals included:
- Being sexually harassed then told “you should be flattered.”
- Being called a “dumb bitch’ and ‘f***ing useless.”
- Told to “get some knee pads and learn to suck c**k.”
Female surgeons stated that sexual harassment was occurring within a culture of cover-ups and fear. “The worst thing you could do,” they said, “is to complain to a supervising body”.
They referred to the case of Caroline Tan, a bright women in her third year of neurosurgical training at a public hospital. Dr Tan’s complaints about sexual harassment from a senior surgeon resulted in her being given poor marks and facing threats of failure in her surgical program. Hospital management failed to resolve the issue, and the case ended up in the Victorian Civil and Administrative Tribunal in 2008.
Dr Tan alleged the senior doctor befriended her; then one day took her into his office. She alleged he ‘grasped her unexpectedly from behind, spun her around, embraced her, kissed her on the lips, put his hand on her breast, pinned her against the desk, pulled his erect penis out of his fly then said to her “do you want to go down on this?”
Dr Tan won the case, and the senior doctor was ordered to pay $100,000 in damages. This failed to cover her costs of fighting the case. The senior surgeon she complained about has kept his job. Dr Tan has been unable to secure a position in a public hospital after in the case. Dr Tan says she has no regrets. She believes there is a culture of fearful silence in Australian hospitals, and calls for an enquiry into the mistreatment of whistleblowers.
There are high rates of drop out of medical programs among female doctors. According to Dr Ruth Mitchell, a neurosurgeon registrar at the Royal Melbourne Hospital, women are at least twice as likely to drop out of surgical training programs as men. While 52% of medical graduates were women in 2013, only 9% of fully qualified surgeons are women. Dr Mitchell’s presentation The Case of the Missing Trainees showed that female doctors are least likely to qualify in surgical specialities. Despite one in four medical specialists being female in 2012, only 8.8 percent of surgeons were female.
Guidelines published by the Royal Australasian College of Surgeons in early 2014 declare “bullying and harassment are endemic in the health sector, between all types of staff at all levels of seniority”. There is concern among some Australian medical bodies that surgeons are ‘eating their young’. This issue is not limited to surgeons, however.
Studies show that medical students are being bullied in Australian hospitals but are afraid to report the culprits for fear it will jeopardise their careers. In 2013, a Beyondblue survey of 1800 medical students showed that over half were emotionally exhausted, close to 10% showed high levels of psychological distress and about one in five had considered committing suicide in the previous year. This issue came to the public attentions after the sudden, unexpected deaths of three trainee psychiatrists and an intern working in Victorian hospitals.
4 Corners has just produced an excellent episode titled ‘At their Mercy’, in which Dr Tan talks about her experiences of sexual harassment and medical students speak out about serious bullying.
Horizontal violence has long been documented in nursing. In my time nursing in large public hospitals, I have witnessed the following behaviour from nurses.
- Deliberately kicking of bedpans full of urine across public wards, spilling the contents
- Grabbing patients by the hair and yanking their heads backwards and forwards, to prove the absence of neurological symptoms
- Screaming verbal abuse at junior doctors in public wards, belittling them for not knowing how to use catheters and other hospital equipment
- Jamming large suction catheters down dying patients throats, to prove they are not being managed properly
- Deliberately withholding educational material on how to perform essential clinical procedures from graduate nurses, and then publicly ridiculing them as being incompetent
I could go on…
Personally, I believe the key issue relates to the failure of hospital management to deal with staffing issues openly and effectively. Medical and nursing unions hold enormous power over the health industry. Hospital management positions are often filled by doctors and nurses themselves, creating a conflict of interest. Many of the nursing administrators I have come across, lack management skills. Many are the peers of staff being complained about and prefer to cover up issues, rather than damage long-term friendships. The result is that dysfunctional doctors and nurses can remain for years, damaging ward culture and causing unnecessary distress to each wave of new training doctors and nurses.
I believe the answer is to change the very nature of hospitals. Move healthcare out of patriarchal, hierarchal institutions, and into the general community. Allow patients to publicly rating hospitals and staff in a Trip Advisor style. Provide high-quality aged and end of life care services, so patients have other options, besides ending up in a screaming match between dysfunctional bullies and terrified junior staff. Make lodging complaints, placing limitations on practice and de-registrating doctors and nurses far easier. And provide ongoing legal and emotional support for new doctors and nurses. People who have made the sacrifice of study and years of grueling shift work deserve support and respect.
If we can’t care for each other, why are we in the health industry in the first place?
©Wikihospitals May 2015