We must stamp out sexual harassment in surgery

Bystanders and allies

Healthcare culture, but particularly the culture of the surgical theatre environment, is a toxic mix of hierarchical and social power imbalance, with close proximity working of a junior trainee (who may be female) with one senior trainer (more commonly male) who they rely on to teach them the technical skills required to become surgeons. Add in the normalisation of sexist “banter” that objectifies and sexualises women, perpetuating harmful gender norms, and you create a workplace culture that’s hostile to women.

The term “rape culture”7 has been used to describe a culture that tolerates or dismisses inappropriate behaviours and abuse, which establishes an environment permitting other behaviours including sexual assault and even rape. Environments may not be the same in every surgical specialty, hospital, or surgical theatre, but what they have in common is promoting a culture of male dominance. This is perpetuated not only by perpetrators but also by bystanders who witness behaviours but don’t act. Expressing dissent is challenging, but it’s where we must start if we’re to make progress towards changing the culture.

All women in surgery should feel safe at work, but this isn’t a problem for them to confront and solve alone. Dissent and culture change are the collective responsibility of everyone working in surgery and more widely in healthcare. Men must take on the role of allies to listen, educate themselves, challenge the culture, educate their peers, and reflect on their own behaviour.

Furthermore, we need to see engagement from all healthcare institutions, including trusts, integrated care bodies, universities, royal colleges, and healthcare regulators. They have a responsibility, along with employers, to take action to prevent sexism and sexual violence in the workforce. Shocked reactions and promises of change are not enough: we need action now. This means changes in education, policy, transparent reporting systems, regulation, and specialist support services. And accountability of perpetrators, with a zero tolerance policy of any behaviour or language that cultivates rape culture, is required immediately.

Despite some pushback on the Breaking the Silence report—including a letter published in the Times by a retired anaesthetist arguing that sexual misconduct has always occurred and that women should “toughen up”8—most people working in healthcare want to make it a safer place for women. While this demonstrates the different realities that women and men encounter in the surgical workplace, this doesn’t define the profession. We can move forward. Women have been tough since they started entering the profession, and they’ve stayed silent in environments that pose a risk to their own personal safety in order to provide care to patients.

Women in surgery, as well as in wider healthcare and society, are systematically undermined, undervalued, and discriminated against. Recent outpourings of evidence have documented numerous reports of sexualised comments directed at the clothing and bodies of female surgeons, their clinical judgment being ignored or valued less than their male colleagues, and their career potential being undermined because they’re pregnant. More often than not they’re unable to reach parity with male colleagues, in pay or leadership opportunities, because of factors related to their gender.

Although the onus is on organisational change, better reporting, and accountability, we all have the power to create a safer working environment by challenging the status quo and calling out poor behaviour. Start today by challenging yourself and those around you—the standard you walk past is the standard you accept.