Not OK: When Patients Sexually Harass Physicians

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The #MeToo movement has led the medical community to an open discussion about sexual harassment. MedPage Today explored discrimination and gender harassment amongst staff in a recent series, and earlier in the year we explored the systems that enable sexual assault committed by physicians on patients.

But an issue that doesn't get much media attention is also one of the most common forms of abuse faced by women in the medical profession: physicians being mistreated by patients.

And while there are still not many available solutions for a physician who is being sexually harassed by a patient, many institutions are increasingly coming to their aid in a number of ways.

We learn more about this emerging issue and the mechanisms being put in place at their institutions:

Sharonne N. Hayes, MD, cardiologist and professor of cardiovascular medicine at the Mayo Clinic in Minnesota

Elizabeth M. Viglianti, MD, internist at the University of Michigan Health System

Kali Cyrus, MD, MPH, health policy fellow at the American Psychiatric Association and assistant professor of psychiatry at Johns Hopkins School of Medicine

Seun Ross, RN, director of nursing practice and work environment at the American Nurses Association

The following is a transcript of their remarks:

Hayes: The MeToo movement has led us to talk a whole lot more about sexual harassment and gender harassment in medicine. And the particular focus has been on a staff to staff, or staff to learner, but we know that patients can also be harassed or discriminated against.

Cyrus: There's not a ton of research out about verbal harassment by patients, whether it's for sexual harassment or other identities, but it does show that it's overwhelmingly happening and physicians, specifically, aren't really sure how to handle it.

Viglianti: Our commentary that was recently published in The Lancet was on patient-initiated sexual harassment. The big thing with our article was that it highlighted something that had been ongoing in medicine for years, and it finally brought it to light. It came under the attention, of course, [from] the National Academies of Sciences, Engineering, and Medicine report that brought attention to medicine having a huge proportion of female trainees that had sexual harassment or experiencing sexual harassment.


Cyrus: As psychiatrists, we do have patients who are sort of always maybe yelling things at us or saying things that may not be the nicest, but it really had become a more widespread issue where people didn't know what to do.

Viglianti: The pivotal question is, "Do I feel safe?" If you're not feeling safe, then that behavior is not okay.

Sexual harassment in the workplace, whether it's by patients, by a peer, is scientific misconduct which may impair the science that we produce.

Ross: Sexual harassment negatively affects the attention and focus of a nurse, and this shift of focus can potentially cause patient harm and that is deeply troubling. Harassment of any form is not just part of the job.

Hayes: I heard from leaders who said, well, is this really prevalent? And it was kind of a catch-22 since we had no reporting mechanism.

Ross: At the heart of this issue, our existing toxic workplace cultures that discouraged nurses from reporting for fear of retribution.

Hayes: It might be, I feel ashamed. I feel like if I report this, I will be blamed for [it] even if I didn't. There's often a deflection or a minimizing of the behavior. And then you add to the fact that there really isn't, at most organizations, a reporting mechanism.

Cyrus: When this happens in the psychiatry world, we usually excuse it because we say, "Oh, the patient doesn't really mean to be doing this to me. They're acting out." We usually sort of brush it off in psychiatry, but I think we're moving towards the fact that the harassment still happens. Just because the person doesn't mean to step on your toe doesn't mean that it doesn't hurt when the toe is stepped on.

Ross: To truly prevent harassment of all forms, nurses must feel empowered to speak up and report.

Hayes: The National Academy of Science and Medicines report that kind of highlighted this has got us to talk about patient behavior, and in particular patient's sexual and gender harassment. But what we have found is that there was a whole lot more of that going on, whether it was comments felt to be innocent, too overt sexual assault by patients of our staff, and that is worthy of its own study addressing and policy.

Viglianti: What we highlight in our article is that, yes, there's a patient-provider relationship, but the provider needs to be paid attention to. And if a provider begins to feel unsafe, that there's an algorithm for them to follow. Certainly, I will give a patient the benefit of the doubt by asking them to stop and allowing them to redirect their behavior. Maybe they weren't conscious that they were making me feel uncomfortable, but if they don't stop and I still continue to have this feeling of uncomfort, not feeling safe, that I [will] then go and find a situation out of the room where I can hand off that patient care and still keep myself safe, and finding the appropriate support.

Hayes: Whether it's an appointment coordinator who has a patient, say, I only want to see a man or a woman provider, or it's an inpatient or an outpatient who, calls somebody a name, is sexually aggressive. Any of those things. We have a mechanism and it's a really easy mechanism. It's a button on webpages for all of the practices that they can report that behavior. It's not mandatory reporting and it can be done anonymously, and we are not in just encouraging that, but we are socializing and training those who are at most risk -- our learners, nurses, frontline staff, emergency department staff. It's really telling them our expectation is that you seek help and you report it. That's a cultural shift.

Cyrus: A few years ago, a colleague of mine approached me. She works at the VA. Her name is Dr. Kirsten Wilkins. I was a resident at the time. We'd been having some informal conversations across our department of psychiatry about what to do when patients said inappropriate things to us. One talk at a conference turned into another talk at a conference and then a Grand Rounds, actually, in our department, which was really successful. Once another member of the team, his name is Dr. Matthew Goldenberg, joined, we actually started to put more words to it and came up with a really sort of catchy acronym that essentially describes I think a really good way to remember steps to just start wrapping your head around responding to this issue. It was really a solution that came from a problem that had presented itself at our institution. As psychiatrists, we do have patients who are sort of always maybe yelling things at us or saying things that may not be the nicest, but it really had become a more widespread issue where people didn't know what to do.

So the acronym ERASE, E-R-A-S-E. The E stands for expecting that incidence of harassment may happen. R is recognizing when these incidences of mistreatment or harassment are actually happening. The A is addressing the situation in real time preferably, but at some point just addressing it. The S is supporting the learner or whoever the victim is on the team. E is establishing a positive culture. So I think the first step is just establishing a culture where people can bring these issues up and openly discuss them.

Viglianti: The advice I would give an untrained professional, which I think is most of us, is that they're not alone, and the first thing that they have the right to do is to let the patient know that they're not being made [to] feel comfortable. That's okay. It's okay to say that. And to recall that it's a contract, the patient and the provider. You go into this both with expectations, and if the patient is violating that, you have every right to tell them to stop, and if they don't stop, for you to go seek help and find appropriate care for that patient, but also taking appropriate care for yourself and your well-being.

Hayes: One other effect of having a policy that's robust and follow to protect our staff is to avoid the lasting effects of the shame and blame that particularly women have experienced and have felt and often have kept secret. Some of these incidents.

I met with a young individual, a learner who had been advised to speak to me in my role about an egregious patient interaction where it actually was not a sexual harassment, it was more of a patient aggression. After that she said, well, there's this one other time and I've only told my mother. This will be the second time I've told this story. And this story was of a gender harassment. It was a patient who kind of was coming onto her every morning in pre-rounds. And then she actually called the patient out one day. She said, this just doesn't make me feel comfortable. And when she rounded with the team, the patient asked that she not care for him anymore. She was never asked is there a source for that? So she felt, well I must have brought it on, I'm to blame for this. And she was never taken care of, to the point that literally two years later she had only told her mother.

That story sticks with me because if we just take this at our word, we leave lasting damage to the victims of sexual harassment. And so we have to take it seriously as healthcare organizations and individuals, and particularly where we have learners in our midst, who are really responsible for their learning and their well-being.

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