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Scope and Prevalence of Sexual Harassment
What Triggers Harassment?

Why do people engage in sexual harassment? In many cases, sexual attraction is not the motive, and the offender is instead seeking power in the form of hostile, bullying behavior.

The Likelihood to Sexually Harass scale, developed in 1987, identifies factors distinctive in harassers, such as lack of empathy, a belief in traditional gender roles, and a tendency toward dominance or authoritarianism.

Some attitudes that can lead to sexual harassment are developed through socialization, particularly in past years. Janet Shibley Hyde, PhD, a psychologist at the University of Wisconsin, says that some boys are raised to think that men should be the initiators of sexual relationships, and are also socialized to be more aggressive. Those factors can create problems when combined.

Sexual harassment doesn't only take place against women. Men can also sexually harass other men. Often, it's a form of gender-based bullying and may demean the person's sexual orientation. The behavior can also be overtly sexual, but usually there is no sexual attraction involved. In the 1998 Supreme Court decision that established man-to-man sexual harassment as illegal, oil rig workers bullied and sodomized a fellow worker, and the employer did not take action against the workers.

Women have also been cited as bullying or intimidating other women in the workplace, although this is typically not sexual harassment.

How Environmental Factors in Healthcare May Contribute to Harassment

Sexual harassment may present itself somewhat differently in healthcare than in other sectors. But certain factors specific to medical organizations may contribute to the environment where sexual harassment can take place.

High-stress environment. Physicians and staff constantly deal with life-and-death issues. Some people respond inappropriately to stress by bullying and harassing others.

Hierarchical organization. In many healthcare organizations, victims face large differences in power and influence. First-year residents or nurses may work directly with a renowned physician, and they may feel too intimidated to correct offensive behavior. Or, a popular and busy doctor generates a lot of income for a hospital, and the hospital may be loath to fire or discipline him for bad behavior.

Higher proportion of men in leadership positions. In 2017, for the first time, women comprised a majority of the entering class in US medical schools. But among physicians overall, men still outnumber female physicians 2 to 1, and men still make up the majority of division chiefs, department chairs, and CEOs in hospitals.

Patients are in the mix. Unlike other industries, the healthcare workplace contains more than just fellow employees. Patients, their families, and a variety of contracted workers are part of the picture, and they can engage in sexual harassment as well as be the targets of it. Harassment by patients can stem from feeling intimate toward the caregiver, their state of undress, and medications or medical conditions that can make them aggressive.

Opportunities in isolated areas. Within a large medical center and even in a doctor's office, there may be areas where harassers can be alone with their victims. The most common places sexual harassment occurred as cited by physicians in a Medscape survey were an administrative area not accessible to patients, a hallway, a patient care unit, an operating room, the perpetrator's office, and a patient exam room. Other areas included parking lots or garages and on-call rooms.

Attitudes That Lead to Sexual Harassment

Lax attitudes toward eliminating sexual harassment are a major impetus for the behavior to continue. Studies have shown that a perceived absence of sanctions is the best predictor of the risk for continued sexual harassment.

Ultimately, the leadership of an organization decides whether sanctions against sexual harassment will be taken seriously.

Ultimately, the leadership of an organization decides whether sanctions against sexual harassment will be taken seriously. Leadership decides what conduct won't be tolerated, what measures will be taken against offenders, and whether all offenders will be treated equally. High-ranking executives also have a role in promoting the policy through personal comments, speeches, and training for all employers.

In reality, however, rather than being committed to ending sexual harassment, some leaders' main concern is to not violate the law. They may set up a policy and produce training videos for employees, yet their investigations may let harassers off the hook. It's very important for leadership to be personally committed to stopping sexual harassment.

In addition to the C-suite executives, other potential role models in the organization, such as a senior physician or a department head, can influence whether or not others commit sexual harassment. In one study, college men who had professed a willingness to sexually coerce were found to be more likely to do so when they were paired with an authority figure who acted in a sexually exploitive way.

Who's Doing the Harassing?

The majority of sexual harassment instances are perpetrated by men, although most men are not sexual harassers. Their victims are usually women, but they can also be other men.

In a 2017 study, fully one quarter of men said they were involved in behavior that constituted minor sexual harassment. Among that group, 16%-19% cited telling sexual stories or making remarks that might be considered offensive; 7% cited displaying suggestive pictures; and 4% cited continuing to ask for a date after the person said no.

Sexual Harassment Among Physicians 

In medicine, physicians often harass other physicians. In Medscape's survey, 47% of the physicians who reported being harassed identified colleagues as harassers, whereas 16% identified nurses and 4% identified hospital or organization administration.

The harasser could be a subordinate, a peer, or a supervisor in the work hierarchy. In the Medscape survey, 37% of harassers were subordinates, whereas 26% were equals and 37% were superiors. In another report, a female surgeon said she was harassed by hospital employees who refused to follow her instructions. She said that when she expressed concern to her supervisor, she was asked to leave.

Physicians who engage in gender harassment may also engage in simple bullying. The most common types of bullying by physicians are showing disrespect, berating, using abusive language, being condescending, yelling, and making insults.

Sexual harassment is particularly present in surgery. In a recent study, 58% of female surgeons had experienced sexual harassment in the previous year alone.

Some physicians who are high earners for an organization may engage in harassment with little risk for sanctions. They are often less likely than others to see that their behavior is ethically problematic.

Some victims of sexual harassment claim that organizations are often willing to cover up for high-powered harassers. For example, a woman who was a sales representative for a medical device company accused a neurosurgeon of groping her on several occasions. She said she complained to her company, but the company did not act because the neurosurgeon generated a large volume of sales per month.

The cost of doing nothing, however, can be much higher than that of losing income from the harasser. In 2012, a former physician assistant in cardiac surgery won nearly $167 million against a Sacramento hospital because she was terminated for filing complaints of being sexually harassed by surgeons.

Patients or Their Family Can Become Harassers

Patients or their visitors can also harass physicians and other clinicians. In the Medscape survey, 32% of female physicians and 23% of male physicians said they had been harassed by patients.

Some patients may mistake a physician's empathy for romantic interest. These patients may not fully understand that their behavior is inappropriate. Other patients may be cognitively impaired—either permanently or through medications—which leads to their inappropriate behavior.

Employers have an obligation to protect healthcare workers from sexual harassment by patients and their visitors. Several years ago, the Equal Employment Opportunity Commission filed a lawsuit against a Virginia health system for allowing one of its receptionists to be sexually harassed by a male patient. The receptionist complained to her supervisor, but the organization did nothing to protect her from future harm. The system agreed to pay $30,000 in penalties.

Victims of Sexual Harassment 

How many people are victims of sexual harassment? Reports vary widely, even in controlled studies. The problem is that many people don't know exactly what sexual harassment is, and they are often likely to shrug off verbal harassment, which is very common.

In a 2018 survey, 59% of women and 27% of men said they had personally received unwanted sexual advances or verbal or physical harassment of a sexual nature. In a study of women surgery residents, 70% of them said they experienced sexual harassment in their training. The most common types of harassment were sexist remarks, sexually explicit comments or jokes, and discussion of the resident's body in an inappropriate manner.

In a recent survey, 10% of men reported being victims of sexual harassment or sexual misconduct at work.

A number of victims are men. In a recent survey, 10% of men reported being victims of sexual harassment or sexual misconduct at work. Their harassers are very rarely women, but rather men who bully them in a gender-specific way.

In medicine, residents are a common target of harassment because they have a low status, and they don't want to rock the boat for fear of ruining their career. A female surgeon recalled that when she was a resident performing surgery in the operating room, she was almost finished spreading apart a patient's surgical staples when the attending remarked, "You know how to spread good. That will teach you how to spread."

Nurses are more likely than even female doctors to be victims of sexual harassment. In a February 2018 Medscape poll, 71% of nurses said they had been sexually harassed, compared with 58% of women physicians. Other caregivers are also frequent victims. Medscape also polled dieticians, physical therapists, chiropractors and paramedics and found that, overall, 58% said they had been sexually harassed.

The Impact of Sexual Harassment

Victims often try to deal with their harassers on their own. Most often they simply try to avoid them. Most of them don't try to confront their harasser. In Medscape's sexual harassment survey, 29% told their harassers to stop, and 20% told them how the harassment made them feel, but 55% did nothing.

Victims often try to ignore the incident, tell themselves that it's part of the job, and say they're not affected by it. But even low-level sexual harassment can take a psychological toll on victims. It can result in negative mood, self-blame, reduced self-esteem, emotional exhaustion, and lowered satisfaction with work and with one's life.

The organization suffers, too. When victims have to avoid their harassers in a team, it can impair communication among caregivers, and this reduces the quality of patient care. Some victims even change jobs to get away from their harassers. In one study, 8 in 10 female victims of sexual harassment began a new job within 2 years.

False Accusations 

It does happen that a person could be falsely accused of sexual harassment. The accuser's motives could be personal or strategic. A spurned lover may produce old intimate emails and pawn them off as unwanted solicitations. An employee on probation may file a harassment claim as a way to try to stop her employer from firing her. Hopefully, a good investigator can expose these ruses. However, there are physicians who say their job and career have been harmed by false accusations.

In a 2018 survey, 52% of women said not being believed about sexual harassment was a major problem.

The majority of sexual harassment claims are typically considered real. Rather than false reports, a key issue is that many victims are not believed when they make a complaint. In a 2018 survey, 52% of women said not being believed about sexual harassment was a major problem. Interestingly, only 39% of men thought this was a major problem.

The split opinion between the sexes in the 2018 survey reveals a difference in attitudes between the sexes. Women tend to be worried about not being believed, and men more often worry about being falsely accused.

The victim may be denigrated for what she endured, labeled as a false accuser, and be targeted for retaliation. Furthermore, it allows perpetrators to continue harassing.

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Susan Strauss, RN, EdD

| Disclosures | January 01, 2020

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Susan Strauss, RN, EdD

Strauss Consulting, Burnsville, Minnesota

Disclosure: Susan Strauss, RN, EdD, has disclosed no relevant financial relationships.