#CardiologyToo? Sexual Harassment Also Infects Hospital Corridors and the Cath Lab
Tales of workplace sexual harassment and inappropriate interview questions within cardiology hint that the halls of medicine have their own secrets.
A mounting din of sexual harassment allegations has, for months, been echoing through entertainment and politics—it was only a matter of time before the issue was raised openly within the medical field.
American College of Cardiology (ACC) president Mary Norine “Minnow” Walsh, MD (St. Vincent Heart Center, Indianapolis, IN), told TCTMD she has noticed more women “informally” reporting stories to each other in a way not previously done and an uptick of reports on social media using the hashtag #MeTooMedicine. “There’s general conversation about it among women and men and just some open discussion about appropriate behavior in the workplace,” Walsh said. “Things that were thought to be acceptable previously are no longer acceptable.”
Some soul-searching in medicine was unavoidable. “Everybody's natural next question is: is this a problem in medicine as well?” Thomas Varghese, Jr, MD, MS (University of Utah, Salt Lake City), told TCTMD. “We hope that pure souls or altruistic individuals are involved in the field of medicine, because all of us feel it’s a higher calling and we're here to help patients and to advocate for their health. But statistics are statistics, and so if in every other field, if there’s going to be a problem, you know sadly medicine wouldn’t be above that, per se.”
This week, in a perspective published in the New England Journal of Medicine, radiation oncologist Reshma Jagsi, MD, DPhil (University of Michigan Medical School, Ann Arbor), outlines some of her experiences following the publication of a study she led regarding workplace sexual harassment in medicine. For example, after detailing a harassing encounter she once had with a “luminary” of a male surgeon, Jagsi says she now keeps her distance from him and “even gave up a valuable scholarly opportunity just to avoid him.”
Her intuition, she writes, “is that the problem is at least as bad in medicine as elsewhere, especially if one adds harassment by patients to that by colleagues and superiors.”
Varghese heads the general thoracic surgery section and serves as the cardiothoracic surgery residency program director at his institution. “The biggest thing we’re struggling with in medicine is we don’t know [what] the magnitude of the problem is yet,” he said. Whatever it may be, though, “we should not wait for a huge scandal to happen” before acting, Varghese advised. “We need to do something about it.”
This “new openness” and the fact that people who have previously displayed certain types of unacceptable behavior have “been outed” is welcome, Walsh said. “In an environment like we have now . . . , women would be more apt to report [sexual harassment] either to their HR department or go public.”
Hierarchy and Power
But the field of medicine is foundationally different than, say, the entertainment industry.
“Medicine is a very hierarchical profession, especially during training,” Walsh observed. “So unlike in some professions, upsetting the apple cart in any way as a junior person is risky because of the consequences downstream, which might include lack of promotion and/or not receiving support in the job market later.”
And in cardiology specifically, where women currently account for 13% to 14% of practicing physicians, the issue of sexual harassment “may be even more prominent,” she said.
Issues related to gender disparity—like differences in opportunity, pay, or respect—have been openly discussed within cardiology for a few years now. But Kimberly Atianzar, MD (Swedish Heart & Vascular Institute, Seattle, WA), who is currently completing an advanced fellowship in structural heart disease, commented to TCTMD that sexual harassment remains a “very much a hush-hush type of situation” even though female doctors swap stories more now than they did in the past.
Jagsi too says she has received many private messages from female physicians describing “appalling” incidents since the publication of her research. However, “none of the women who’ve contacted me have reported their experiences,” she writes. “They speak of challenging institutional cultures, with workplaces dominated by men who openly engage in lewd ‘locker-room conversation’ or exclude them from all-male social events, leaving them without allies in whom to confide after suffering an indignity or a crime.”
Atianzar said she never experienced any sexual harassment until she entered general cardiology fellowship and was “completely taken aback” when it happened. There was the fact that her class of six fellows for the first time included three women; previous classes at this institution had only ever included one woman. Some senior fellows reacted to this innocuous demographic change by joking that there needed to be a “girls mafia”—ostensibly to represent or protect the women. Then there was a specific senior fellow who “would talk very abrasively about women,” because he “knew it made us uncomfortable.”
Although she did approach this man and asked him to change his behavior, Atianzar said she never reported him officially, because “our attendings would sometimes be in the rooms [when he used this language] . . . and so in our heads we'd be like, well, they know about it and they’re not really saying anything.
“From our perspective, we were just new fellows,” she continued. “I think the mindset is you don’t want to be blacklisted [or have them] think that you don't have a thick skin.”
The final straw, she said, was the attending who would “leer” at female fellows and make blatantly inappropriate sexual comments. Atianzar recalls one instance when this physician and a female fellow were reading echoes in front of the rest of the fellows, and he asked the fellow what part of the cardiac cycle she liked best. “She said, ‘Excuse me sir?’ And he said, ‘Everyone has a favorite part of the cardiac cycle.’ And she was like, ‘I really like diastole.’ And he was like, ‘Oh, so you like to receive.’”
He said, ‘Everyone has a favorite part of the cardiac cycle.’ And she was like, ‘I really like diastole.’ And he was like, ‘Oh, so you like to receive.’ Kimberly Atianzar
All 18 fellows ended up collectively reporting the incident to higher-ups but no action was taken, according to Atianzar. Indeed, it later became clear that the attending was made aware of the complaint, but the entire incident ended up being treated as “a joke” within the department, she said.
The harassment continued once Atianzar began applying for interventional cardiology fellowships. At five out of the seven programs where she interviewed, the men questioning her, including associate program directors, asked about her “biological clock” and her marital status. “One asked me what I’d do if I got pregnant,” she said.
“[I] was very uncomfortable,” Atianzar explained, “because I had this mindset that if I answered [their questions] truthfully, that it would really skew whether or not they would actually consider me for the fellowship.”
It wasn’t until a while later that an attending at her home institution told her that these sorts of questions cannot legally be asked by interviewers. In fact, Atianzar said, “I was asked [them] so many times that I didn’t think that [this was wrong].”
Patients Lose in the End
Kusum Lata, MD (Sutter Health, Stockton, CA), who graduated from interventional cardiology fellowship in 2016, had a different experience. She told TCTMD that she felt “really protected” from sexual harassment during her fellowship. “But in the outside world it’s brutal,” Lata said. “Every day you are thinking about how to avoid a confrontation.”
Every day you are thinking about how to avoid a confrontation. Kusum Lata
Just this week, Lata was rattled by a blog post penned by anesthesiologist Karen Sullivan Sibert, MD (University of California Los Angeles), who wrote that a victim of harassment or assault should “never be made to feel that it is her fault,” but advised women to do their part to avoid these kind of encounters. For instance, Sibert said they should wear long hair in a ponytail and avoid wearing contact lenses.
“Yes, it’s unfair that women have to think in self-protective ways while men don’t,” Sibert wrote. “It would be lovely if the world were a perfect place, but it isn’t and won’t be. It makes more sense to be smart and in control than to have the unreasonable expectation that life will change immediately just because Harvey Weinstein has been disgraced.”
None of this advice sits well with Lata. “We shouldn’t need someone to tell us how to dress ourselves and how to talk,” she said. “I understand mannerisms and professionalism, that's good and we all have to learn. [But] when I read that, I was like, ‘Wow.’” It is this kind of guidance, she added, that leads some women who have trained for years to become, say, interventional cardiologists to wind up leaving the field altogether.
Atianzar agreed that the current way women are treated in some medical specialties, including cardiology, is turning away smart, capable future leaders. “It really is so disheartening to know that people actually do [try] to prevent someone talented, prevent someone with potential, prevent someone that has this great ability to have a fantastic career on the mere fact that they are a woman,” she said.
Who loses in the end? “Patients and society as a whole,” according to Varghese, “because there are brilliant individuals whose careers may have been thwarted or people who decided that this is not worth it and decided to do something else as a result.”
‘You Are Not Alone’
Reading personal stories like those of Jagsi “gives you confidence that you are not alone,” Lata said. “Most of the time when [sexual harassment] happens, the perpetrator will try to segregate you and make you think that you are the only one who is causing this problem. At the personal level, it helps a lot.”
The “most important service” Jagsi did with her perspective was to tell a personal story in a public forum, Walsh added. “It’s a similar story to what many women may tell. The fact that she was willing to be so public about it I think allows other women and some men to reflect on what their own experience has been, and what is and is not appropriate now.”
What is needed most today is “more transparency, because obviously there's a problem,” Varghese said. “We need to shed light on . . . all the cases: sexual assault, sexual harassment, preying on vulnerable populations. All that needs to come to light [so that we can] then put in place policies, culture change, procedures, so that we eliminate the problem and prevent it from ever happening again in the field.
That said, “there may be people who want to come forward and say things but they still want to maintain anonymity, and that's fine,” he continued. “We should never judge a victim's desire of going public or not. We should just be in a position to help them.”
We should never judge a victim's desire going public or not. We should just be in a position to help them Thomas Varghese, Jr
Culture change in general “is always going to be difficult,” Varghese said. “When you’re talking about changing a culture, theoretically there’s somebody or some group that’s benefiting from maintaining the status quo. So there's always going to be resistance.” The “only way to do it” is by increasing awareness in a multipronged manner through education and leadership training “and being very transparent about the right reasons for why the culture has to change,” he continued. “It’s going to take time.”
Several of those interviewed by TCTMD for this story said that new policies and procedures need to be put in place on a national level to ensure victims of sexual assault or harassment feel comfortable telling their stories without fear of retaliation. “The counterbalance of course is that we want to make sure there’s due process, so that people aren’t unfairly accused,” Varghese noted.
“My gut instinct is that maybe people are still fearful of saying something,” he said. “This is kind of a call to action for all organizations, all institutions, [and] all specialties. . . . I’m hoping that one of the takeaways from a movement like this is that every organization across the country and maybe across the world will look at their own policies and procedures and reporting mechanisms, and look at their own culture and say, ‘What can we do to improve this?’.”
Atianzar also said she thinks sexual harassment training should be implemented in the medical school curriculum. “The more that we talk about it, the more we address it, I think that over time it will be something that is hopefully eradicated and a thing of the past—that we really all can treat each other with respect,” she said.
Reflecting on the last several years of her career, Atianzar said she “had this almost like naivete of how the world is. You think that everything is positive. . . . Then you realize that not everyone is really for you. I think that it’s changed me.”
Jagsi R. Sexual harassment in medicine—#MeToo. New Engl J Med. 2018;378:209-211.