Re: Systematic sexism and sexual violence harm doctors’ pay and career chances, report finds
Dear Editor,
The insightful report from Surviving in Scrubs was recently covered in the BMJ news section (21 November 2023) (1). This report adds to the now vast amount of evidence demonstrating that sexism and sexual harassment/assault are critical issues within the NHS, requiring robust and timely solutions (2-4).
We have facilitated several active bystander, women in healthcare and sexual harassment workshops at healthcare conferences. Across these, the views of women of differing seniority in a range of healthcare professions are that an organizational rethink is required regarding the response to these incidents.
The report’s recommendation of separate sexism and sexual misconduct policies should undoubtedly be a factor in this, but also a scaled approach is an emergent theme in numerous discussions we have facilitated. Many colleagues acknowledge a reluctance to report for fear of then losing control of the situation. This is due to investigations being often conducted without consultation with the victim on a preferred course of action. For what our workshop participants have deemed ‘lower level’ incidents (e.g., a one off inappropriate comment) the opportunity to resolve matters informally such as the ‘cup of coffee’ conversation (5) would be preferred, but is often not facilitated by current more punitive systems. The evidence suggests these ‘lower level’ behaviours, if they go unresolved, often progress as perpetrators realise they can get away with more and more (6). Having a less persecutory system with a more varied response to issues may enable more women to report incidents at an earlier stage.
The response of men is also important in this epidemic of sexism and sexual misconduct. In the report it is noted that female healthcare workers were undermined, and not given as many opportunities as their male colleagues. When hosting sessions on women’s healthcare/ sexism/ sexual misconduct, with an equal split in the gender identities of session facilitators, we found very small numbers of men chose to attend the sessions and participate in discussion of the issues. Men have an important role to play in recognizing the system unfairly benefits many of them, but also that the privilege they hold is vital to allyship and active bystanding in situations. Half the incidents in this report happened in patient facing environments. The evidence suggests therefore men see these behaviours and often choose not to act or challenge them. If we are thinking of how to move forward with action on sexual harassment and assault in the NHS it is critical we get men to see this as their problem on which they need to act (7).
This report is important and timely to further evidence the current state of the problem, particularly alongside the other reports building around this epidemic. What we now need to think even more about is the practical aspects of action; the who, when, where and how of actually making tangible change for half (or more) of our medical workforce.
1. Iacobucci G. Systematic sexism and sexual violence harm doctors' pay and career chances, report finds. Bmj. 2023;383:2744.
2. Cox B, Jewitt C, MacIver E. Surviving healthcare report: sexism and sexual violence within the healthcare workforce. [updated Nov 2023. Available from: https://www.survivinginscrubs.co.uk/surviving-healthcare-report/.
3. Begeny CT, Arshad H, Cuming T, Dhariwal DK, Fisher RA, Franklin MD, et al. Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights. Br J Surg. 2023;110(11):1518-26.
4. British Medical Association. Sexism in Medicine. BMA; 2021 2021.
5. Dubree M, Pichert JW, Cooper WO, Hickson GB. Promoting professionalism by sharing a cup of coffee [Available from: https://www.myamericannurse.com/promoting-professionalism-by-sharing-a-c....
6. Pina A, Gannon TA, Saunders B. An overview of the literature on sexual harassment: Perpetrator, theory, and treatment issues. Aggression and Violent Behavior. 2009;14:126-38.
7. Launer J. Sexual harassment of women in medicine: a problem for men to address. Postgrad Med J. 2018;94(1108):129-30.
Competing interests:
No competing interests
31 December 2023
Nicholas J Miller
FY1 Doctor
Dr John Frain (Clinical Associate Professor at the University of Nottingham & General Practitioner)
Rapid Response:
Re: Systematic sexism and sexual violence harm doctors’ pay and career chances, report finds
Dear Editor,
The insightful report from Surviving in Scrubs was recently covered in the BMJ news section (21 November 2023) (1). This report adds to the now vast amount of evidence demonstrating that sexism and sexual harassment/assault are critical issues within the NHS, requiring robust and timely solutions (2-4).
We have facilitated several active bystander, women in healthcare and sexual harassment workshops at healthcare conferences. Across these, the views of women of differing seniority in a range of healthcare professions are that an organizational rethink is required regarding the response to these incidents.
The report’s recommendation of separate sexism and sexual misconduct policies should undoubtedly be a factor in this, but also a scaled approach is an emergent theme in numerous discussions we have facilitated. Many colleagues acknowledge a reluctance to report for fear of then losing control of the situation. This is due to investigations being often conducted without consultation with the victim on a preferred course of action. For what our workshop participants have deemed ‘lower level’ incidents (e.g., a one off inappropriate comment) the opportunity to resolve matters informally such as the ‘cup of coffee’ conversation (5) would be preferred, but is often not facilitated by current more punitive systems. The evidence suggests these ‘lower level’ behaviours, if they go unresolved, often progress as perpetrators realise they can get away with more and more (6). Having a less persecutory system with a more varied response to issues may enable more women to report incidents at an earlier stage.
The response of men is also important in this epidemic of sexism and sexual misconduct. In the report it is noted that female healthcare workers were undermined, and not given as many opportunities as their male colleagues. When hosting sessions on women’s healthcare/ sexism/ sexual misconduct, with an equal split in the gender identities of session facilitators, we found very small numbers of men chose to attend the sessions and participate in discussion of the issues. Men have an important role to play in recognizing the system unfairly benefits many of them, but also that the privilege they hold is vital to allyship and active bystanding in situations. Half the incidents in this report happened in patient facing environments. The evidence suggests therefore men see these behaviours and often choose not to act or challenge them. If we are thinking of how to move forward with action on sexual harassment and assault in the NHS it is critical we get men to see this as their problem on which they need to act (7).
This report is important and timely to further evidence the current state of the problem, particularly alongside the other reports building around this epidemic. What we now need to think even more about is the practical aspects of action; the who, when, where and how of actually making tangible change for half (or more) of our medical workforce.
1. Iacobucci G. Systematic sexism and sexual violence harm doctors' pay and career chances, report finds. Bmj. 2023;383:2744.
2. Cox B, Jewitt C, MacIver E. Surviving healthcare report: sexism and sexual violence within the healthcare workforce. [updated Nov 2023. Available from: https://www.survivinginscrubs.co.uk/surviving-healthcare-report/.
3. Begeny CT, Arshad H, Cuming T, Dhariwal DK, Fisher RA, Franklin MD, et al. Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights. Br J Surg. 2023;110(11):1518-26.
4. British Medical Association. Sexism in Medicine. BMA; 2021 2021.
5. Dubree M, Pichert JW, Cooper WO, Hickson GB. Promoting professionalism by sharing a cup of coffee [Available from: https://www.myamericannurse.com/promoting-professionalism-by-sharing-a-c....
6. Pina A, Gannon TA, Saunders B. An overview of the literature on sexual harassment: Perpetrator, theory, and treatment issues. Aggression and Violent Behavior. 2009;14:126-38.
7. Launer J. Sexual harassment of women in medicine: a problem for men to address. Postgrad Med J. 2018;94(1108):129-30.
Competing interests: No competing interests