We must stamp out sexual harassment in surgeryBMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2812 (Published 29 November 2023) Cite this as: BMJ 2023;383:p2812
- Clara Munro, general surgery registrar1,
- Rebecca Cox, specialist GP in women’s health, cofounder2,
- Chelcie Jewitt, emergency medicine registrar, cofounder2
A recent report titled Breaking the Silence,1 written by the Working Party on Sexual Misconduct in Surgery, details the stark reality of sexual harassment, assault, and rape among surgical staff in the UK. Of more than 1400 UK surgeons surveyed by the reports’ authors, 30% of female respondents had been sexually assaulted.
Almost 90% of female surgeons said that they had witnessed sexual misconduct at work in the past five years—and over 80% of male surgeons gave the same answer. Among the responses were 11 reports of rape. This is one of many reports quantifying the extent of the problem facing the profession. But these reports must galvanise action to create safer environments for women to work as surgeons and in healthcare.
This is just one of the most recent reports in the #MeToo moment experienced in UK surgery in recent years. The Surviving Healthcare report, published this week by Surviving in Scrubs, details more than 170 incidents of sexism and sexual violence between colleagues in the healthcare workforce.2 In 2021 the Royal College of Surgeons published Sexual Assault in Surgery: A Painful Truth,3 collating research and experiences of sexual violence in surgery—followed soon after by Philippa Jackson, a consultant plastic surgeon, responding publicly with an account of her own experience of sexual assault as a trainee.4
In 2022 the Surviving in Scrubs campaign was launched, with a website publishing anonymous testimonies from healthcare workers.5 Multiple stories detailed the lived experiences of women in surgery and the impact of sexist behaviours on their mental wellbeing, physical health, and careers. In 2023 a joint investigation by The BMJ and the Guardian found that 212 NHS trusts in England had recorded more than 22 000 reports of staff experiencing sexual assault from 2017 to 2022.6 Increasing data to help quantify this previously disregarded issue show that these are not isolated incidents. We must be clear: working in healthcare is still not safe for women. So, what are we doing about it?
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.
Competing interests: None to declare.
Provenance: commissioned, not externally peer reviewed.