Picture source: tctmd.com
The recent headlines exposing sexual harassment in the medical fraternity elicited a gamut of reactions ranging from anger to shock and disbelief. What was alarming were the number of doctors who recounted their personal traumatic experiences in various disciplines. It is a tragic day when we realise “interpersonal mistreatment”, whether in the form of bullying or sexual harassment, has been running rampant unchecked for decades. A systematic review in 2014 reported 25% of nurses globally had experienced a form of sexual harassment in the workplace. We, who take an oath to do no harm, end up scarring the people we’re meant to mould.
So how do we move forward?
Lets’ begin by understanding what sexual harassment entails and the many spectrums of it.
Gender harassment is when an individual is exposed to crude comments and hostile behaviour/gestures simply because of their gender. Unwanted sexual attention, which appears to be the most common type, is when the perpetrator makes sexually suggestive comments that are not welcome and being touched deliberately without consent. The third is sexual coercion, where there’s a quid pro quo. The victim feels the need to submit to the demands of the perpetrator for employment reasons and advancement.
The following case vignette can aid our understanding of sexual harassment and the consequences to the victim.
Picture source: Odyssey
P is a young house officer who has been waiting a year to begin her career. She was posted to a district hospital 3 hours away from her hometown. On her first day, P’s consultant suggested that a “pretty girl” like her should be careful where she goes in the town for fear of attracting the wrong attention. He further insisted that P join him for lunch every day to “protect her as she dresses sexily”. The consultant would frequently pull her away from the ward to accompany him for meetings. This lead to her colleagues ostracising her as they had to cover her workload in the ward. P’s colleagues and nurses coined the nickname “anak emas” for her as she appeared to be this consultants favourite. P frequently developed abdominal pain during work and self-medicated for gastritis.
Picture source: Fierce Healthcare
When P approached him to sign her log book towards the end of her posting, he gave her a “goodbye kiss”. P submitted as she was afraid of the repercussions should she refuse. P started experiencing insomnia and would cry daily on the phone to her parents. She was unable to concentrate at work and was reprimanded. She felt despondent that she had waited so long to start work but it had all “become a mess”. P impulsively felt she was unable to work and immediately left for home. She refused to answer phone calls from the hospital administrator and informed her parents she wanted to resign.
In the above situation, we can clearly see the pattern of unwanted sexual attention that culminated in sexual coercion by P’s boss. What exacerbated the situation was the lack of support from colleagues, but conversely the gossip which contributed to her symptoms.
The consequences to P are multi-fold as can be seen. Firstly, the harassment triggered psychological symptoms that have affected her functioning. P may be experiencing a depressive disorder evidenced by the frequent crying, low mood, poor concentration and insomnia. Secondly, the “gastritis” may be a manifestation of her psychological state and be a form of somatisation. Finally, she now has adverse job related consequences as she has “disappeared” from work and has been labelled as a “problem doctor”.
How do we manage P’s situation effectively?
- The hospital administrator should be informed of the harassment and investigate impartially while maintaining strict confidentiality and only involving key parties.
- P should be reassured that her accusations will not lead to any retaliation and her career will be unblemished.
- P should be referred urgently to a psychiatrist to provide a thorough assessment of her symptoms to diagnose her accurately and treat accordingly. A first line medication for her depressive disorder like Mirtazepine can alleviate the mood symptoms while aiding her sleep and will have no exacerbation of her gastritis.
- P can also be referred to an occupational therapist to educate her on deep breathing techniques and progressive muscle relaxation for anxiety.
- P can be offered short-term medical leave to allow her to recuperate.
The initiative by several hospitals that state a “zero-tolerance policy” and setting up of an impartial investigative committee is applauded.
Let’s focus on the victims, and provide a helping hand rather than a gossiping tongue.
Dr Sumeet Kaur (MBBS, M.Psych. Med. (UM)) is a Clinical Psychiatrist and Medical Lecturer at University Sains Islam Malaysia and Hospital Ampang.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]