Editor's Choice

No room for sexism

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4720 (Published 01 September 2016) Cite this as: BMJ 2016;354:i4720
  1. Fiona Godlee, editor in chief
  1. The BMJ
  1. fgodlee{at}bmj.com

It is perhaps no great surprise that two traditionally macho cultures—Australia and surgery—combine to harbour sexist attitudes. But the extent of the harassment of Australia’s female surgeons, and the impunity with which senior surgeons meted out the abuse, has only recently been fully acknowledged. That it has is thanks to the courage of one woman in speaking out. Vascular surgeon Gabrielle McMullin’s description of an entrenched culture of sexual harassment caused a media storm last year, followed by a flood of corroborative stories from female surgeons who had experienced persistent sexual advances and innuendo, gender slights, and comments on their appearance, with predictable effects on their careers and emotional health.

Luckily, as Amy Coopes reports (doi:10.1136/bmj.i4210), it also brought about a concerted response from the Royal Australasian College of Surgeons, including an unreserved apology from its president. A college inquiry unearthed a toxic culture of fear and reprisal. Too many surgeons had been silent bystanders as well as perpetrators, he said. The college’s new education and awareness campaign—“Let’s operate with respect”—includes mandatory training on discrimination, bullying, and sexual harassment. McMullin wants further action, including black boxes to record what is said and done in operating theatres.

What of the UK? GMC data indicate that bullying happens but is less prevalent than in Australia, a fact that Scarlett McNally attributes (doi:10.1136/bmj.i4682) to longstanding training programmes and a willingness to challenge inappropriate behaviour. Still, there is room for improvement. McNally highlights the challenge of avoiding “unconscious bias”—the natural tendency to form assumptions about another person, which can lead to sexism, racism, and even “heightism.” And she reminds us that bullying and abuse put patients as well as staff at risk. Studies repeatedly show that rigidly enforced hierarchies and poor interpersonal relations impair patients’ safety and deliver poorer experiences of care. And organisations with women in leadership positions have been found to perform better (https://www.theguardian.com/business/2015/sep/29/companies-with-women-on-the-board-perform-better-report-finds).

Any talk of sexism in UK medicine may seem odd while we bask in an unprecedented era of female leadership. At least six of the medical royal colleges (including physicians, surgeons, and general practitioners) have women at the helm, and we currently have women in the roles of chief medical officer and (ahem) editor in chief of The BMJ. But women are still vastly under-represented in senior academic positions and NHS trust boards. In a BMJ Blog Miriam Fine-Goulden says that if we are to correct this we need to hold men and women to the same standards in their personal and professional lives (http://blogs.bmj.com/bmj/2016/08/15/miriam-fine-goulden-how-we-talk-about-women-leaders). She asks us to reflect on how we talk about our colleagues: “Would I say this if that person was a member of the opposite sex?”

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