Predators seek out positions of power and medicine is not immune. There are pathways to redress, but they are not well defined.
Understanding the options available to victims-survivors of sexual assault in medicine will be a small but vital step, according to attendees of the first Australasian Summit on Sexual Harassment in Medicine in Canberra last week.
The summit brought together 140 participants, ranging from medical students to university deans, and was the brainchild of Canberra GP Associate Professor Louise Stone.
Speaking at the WONCA conference in Sydney later in the week, Professor Stone said one of the big issues discussed was how the way medicine is structured, and how its strict hierarchies, requirements to work insane hours and huge power imbalances make it difficult for survivors to come forward.
“It’s always difficult to imagine sexual harassment happening in the cold hard light of day of hospitals,” she told delegates.
“I think [some people] do this slight sidestep into thinking that the prevalence of sexual harassment in medicine is low, or worse still, that it’s a myth.”
Truth be told, Professor Stone said, the quantitative data on sexual assault of doctors by doctors is not great.
While there are multiple surveys that do collect the data – e.g. the annual medical training survey, surveys from the Australian Salaried Medical Officers Federation, etc. – results can be hard to compare for various reasons.
“We really don’t know the true prevalence of sexual harassment because, quite frankly, the surveys are all flawed, the response rates are low, and they all measure different things,” Professor Stone said.
“But it is more than zero, so it’s a problem.”
As part of her research, Professor Stone has interviewed doctors who have not spoken up about assault at work for a variety of reasons.
One woman had, as a junior doctor, been assaulted by a colleague on a rural placement.
She told Professor Stone that she felt like she was at fault for smiling too much and not being “more professional”.
“And that means sometimes we bury our own trauma. When it’s buried, we may not recognise it or have access to it.
“We’re not going to fix that with policy change.”
Another doctor told Professor Stone about being asked by a superior if she wanted to learn how to suture a patient on the ward.
As she sutured, her male superior inappropriately touched her from behind.
She felt unable to say anything because a patient was present.
“There’s a whole lot of subconscious behaviours – even before the thought of ‘I’m going to ruin my career’ and ‘why would I report?’ Registers – which may be why altering policies, or educating staff rarely works,’” said Professor Stone.
The summit addressed the different avenues that a doctor who has been assaulted by a colleague might take.
“They’ve got the Medical Board, the colleges, the universities, the medical defence organisations, doctors health advisory services, individual therapists, the police and the Industrial Relations Commission,” Professor Stone told The Medical Republic.
“I was very surprised the first time I tried to map that out for a survivor and I realised how opaque that was.”
The first goal of the summit was untangling the outcomes that lay on the other side of each pathway, acknowledging that different survivors want different things.
“One of the big things we discussed was that some people want healing, some people want justice and some people want change,” she said.
“Those are three different things with three different pathways.”
A wellbeing counsellor, for instance, might provide the help that someone needs to heal in an emotional sense, but won’t necessarily give them their options for reporting the offender.
Going to the police, on the other hand, might help bring that person to justice but it is unlikely to affect change at the college training level.
Sometimes, going through one door can close off the others.
One of the goals for Professor Stone and colleagues over the next few months will be creating a website that maps out what each route can lead to.
It’ll be a small step, but a step nonetheless.
“Medicine is in the best position [to fix this],” she said.
“We manage trauma all the time. We manage complex systems all the time, we manage healing all the time.
“If we can’t sort it out, then who can?”