Welcome to "The Hypocritical Oath," my MedPage Today series where I explore ethical failures in medicine, from shortcomings in medical culture to abuses of power and patient harm. I try to give a voice to those that have been dismissed in an effort to inspire better doctors, committed to upholding our stated values.
The following is a fictionalized account of a situation that may arise in a healthcare workplace.
The Scene
It's an uncharacteristically beautiful day, but the anesthesiology attending is trapped in the operating room, behind the curtain at the mercy of a beleaguered attending surgeon. He doesn't mind, preferring it on this side anyway.
He has a medical student with him, a third-year, aspiring to become an anesthesiologist himself. The attending is monitoring too many things at once, but he can hear the conversation behind him between the student and a nurse who has stepped over to their end of the operating table.
"I just had to do that once to see how juicy you were," says the nurse.
There is uncomfortable muttering from the medical student.
The nurse laughs. "We've been talking about you; you're famous."
The student mutters something in response.
The nurse continues. "Bet it's hard for you to get a seat belt on."
The interaction sounds strange, but the attending is trying to keep the sedated patient stable. Vital signs look good. Should I say something? A palpable tension fills the air, and he turns his attention to variables within his control, choosing comfort in reliable numbers and physiology over the turbulent Pandora's box that he doesn't dare to open.
He continues to watch the numbers as the nurse leaves. The student lowers his eyes to the ground.
The Student's Perspective
My first clinical rotation of the year was an anesthesiology elective. On my second-to-last day, a nurse came over to me and the attending with some equipment. The attending didn't see what happened, but it's a small space, you know? There's no way he couldn't hear what was going on.
She walked up to me, put both her hands on my chest, and squeezed my pec muscles. And then she said, "I just had to do that once to see how juicy you were." Apparently, the staff was talking about my...my physique a lot. She made some comments about how I look. Not exactly...sexual...but, like, how it's probably hard for me to get a seat-belt on, because I'm muscular. Stuff like that.
I wish the attending had said something then or later. Literally anything to address the issue. I was assigned to the electroconvulsive therapy service the next day, which was a huge relief because I knew I wouldn't have to see her.
And I had my neuro rotation after that, which was also a relief because I knew it would be more structured than an elective, so I'd always be supervised and there would always be people around me.
I told a few friends. Some didn't believe me or said I was exaggerating. And I get it; at first, I was so shocked it happened that I almost didn't believe it myself. Then those classmates didn't believe me, and it was disheartening.
I didn't report it because I didn't feel comfortable. I was afraid of how people would perceive me. And it was my first rotation -- if I reported it, I didn't know how that would play out professionally. I didn't know what repercussions there might be. What if no one believed me? How would that affect me going forward? What about my grade?
What if I were a woman? Perhaps it would be even worse for a woman? Many of my female classmates have experiences like this. I never realized how easily it can happen.
Do I think it's assault? No, I'd call it harassment. Why isn't it assault for me? I guess I never thought about it.
I'm really self-conscious of what my body looks like in scrubs now. I always wear an undershirt. Maybe I should take it as a compliment. Guys take pride in having a muscular physique. In fact, some guys wouldn't take offense to it; they'd find it validating.
But my surgery rotation is coming up, and I'm pretty anxious about it. It means I have to go back to the OR. She'll probably be there. I'm on edge even thinking about it.
We always get these scenarios in medical school lectures, but they're real. It's eye-opening when it happens to you. We're always told to speak up, but when it actually happens, no one speaks up. If this happens again, I think I'll feel responsible for not saying anything. But I don't know how it could affect me professionally if I do say something. I wish the attending had said something. I don't understand, if you're the attending and this literally happens in front of you, how could you not say anything?
Afterword
It can be easy to forget the male victims of sexual misconduct and harassment. But the fear and anxiety that come with harassment cross all boundaries.
Just as women face gender bias, men too are hurt by: gendered expectations of casual stoicism over emotional vulnerability and genuine connection; the belief that female attention should be flattering or that women cannot be perpetrators; and a narrow definition of masculinity. This includes men in medicine, shaming them into silence.
Assumptions that men are unaffected by harassment are damaging; although women are disproportionately affected by sexual harassment and violence, "disproportionately affected" does not at all translate to, "This can't happen to men."
Sexual misconduct is fundamentally about power and control and there are many ways, other than gender, in which to be on the lower end of a power differential. You may be an actor subject to the whims of a Hollywood producer. You could be the patient of a predatory physician who wields the resources of an institutional giant. Or you could be a medical student in an operating room, where hierarchy is a well-established fact of medical culture and you have no leverage.
The pattern never varies. The events you never solicited. The shock, the disbelief. The desire to forget. The paralyzing fear that insidiously consumes you from the inside. The inability to concentrate. The struggle to move forward from one day to the next. The isolation.
No one deserves to endure humiliation and harassment in the clinical environment, silently and in isolation, without even the faintest hope of a lifeline.
Supervising attendings have an ethical responsibility to protect their trainees. At the very least, the attending physician in this case could have gently spoken to the student later to offer support.
What would you have done in the same position?
Chloe Nazra Lee, MD, MPH, is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York.