THE Harvey Weinstein/Don Burke/Matt Lauer furore has once again shone a light on behaviour that I was vilified for criticising almost 3 years ago now.
I had been agitating for several years about the harassment of women in surgical training and came to the attention of Diann Rodgers Healey, a remarkable woman and the director of an organisation called the Australian Centre for Leadership for Women. She was putting together an ebook entitled Pathways to gender equality in Australia: the role of merit and quotas and she asked me to write the chapter on medicine. There are chapters on other professions and it is striking how similar the issues are in all of them. Sexual harassment is a depressingly common theme.
The book launch was held at NSW Parliament House in March 2015 on the day before International Women’s Day and I was asked to give the final speech. I was then interviewed by a junior reporter from ABC Radio who asked, incredulously, if there really was sexual harassment in surgery.
I recounted the plight of a neurosurgical trainee who had been sexually assaulted by a supervising surgeon. Although he was subsequently found guilty of the assault and she was awarded damages, far from receiving any sympathy from the Royal Australasian College of Surgeons (RACS), she was shunned and has never managed to obtain a job in a public hospital. I stated in the interview that her career would have been far more successful if she had given the surgeon a blow job on that night. That sound bite was media gold and started a storm of television and radio coverage both locally and internationally.
The RACS condemned my remarks in no uncertain terms but were forced to back down when numerous other women contacted the media in a manner not dissimilar to the stream of actors who have recounted experiences with Harvey Weinstein. No one is surprised because the behaviour is endemic in every profession.
The RACS appointed an expert advisory group to examine not only the extent of sexual harassment but also that of bullying and discrimination in surgical training.
The results were damning, with 50% of trainees reporting bullying and 10% of women reporting sexual harassment. The president of the RACS gave an apology to all surgeons and trainees – albeit to no one specifically. An apparently robust complaints process was set up and a campaign entitled Operating with respect was introduced. Every surgeon in Australia is now required to complete a 45-minute online module about bullying as part of the yearly process of continuous professional development for renewal of Fellowship.
To date only 56% of surgeons in NSW have complied. There are undoubtedly those who feel that it is beneath them and it is quite likely that those who most need to examine their own behaviour are among these. Many of those who have complied are very critical of the module and consider it a waste of time – just another of the “tick box” pro formas that we are bombarded with. It is unclear what will happen to those who refuse to comply, and it seems highly unlikely that Fellowships will be withdrawn. It is a futile exercise.
Every operating theatre in Australia now boasts an Operating with respect poster proclaiming that bullying will not be tolerated and yet I continue to receive letters, emails and phone calls on a regular basis with complaints, not only from surgical trainees but trainees in all medical specialties, and also from nursing staff. When I suggest the complaints process I am met with fear of reprisal. There has, after all, been no feedback from the RACS regarding the outcome of complaints.
I was recently asked to give the keynote address at a hospital in Sydney for their inaugural “Women in medicine” meeting. It was well attended by junior staff, both male and female, and there was an impressive panel of senior women. I had advised that women should now take a zero-tolerance approach to harassment but when a young woman asked the panel what she should do if targeted they all advised against a formal complaint and suggested that she seek out a senior woman for help.
Real action therefore remains elusive, particularly from hospital administrations.
A nurse who complained that a surgeon had shouted and physically barged her during an operation told me that she had received little support and indeed had been criticised for her own behaviour (victim blaming).
Similarly, a female surgical trainee was referred to me for help by a male colleague. She recounted how a more senior trainee was trying to sabotage her career by blaming her for his mistakes in the operating theatre. As a result, she was gaining the reputation for being incompetent, something that often happens to women, and was being required to undergo a review process. He then compounded the issue by “nudging” her arm during an operation, causing her to lacerate the liver. This appalling behaviour and the implications for the patient have never been addressed by the hospital despite her report on the event.
Realistically, the only effective means of resolving this “he said, she said” situation would be for CCTV monitoring of behaviour in the operating theatre – the “black box”.
It is already available and was created in 2013 by Dr Teodor Grantcharov in Toronto, Canada. It consists of two cameras recording the operating team and their interactions and, in addition, the vital signs of the patient are recorded. When a camera is being used inside the body, as with laparoscopic procedures, this footage is also recorded. The aim is to improve safety for the patient by showing where mistakes are made and how a surgeon can improve technically, but it has also shown how communication between the operating team affects outcomes.
This would not, of course, help the many interactions that occur outside the operating theatre. It would not help the trainee who was drugged and sexually assaulted by the revered oncologist, John Kearsley, who invited her to his home to discuss her career. As with Weinstein, this was not an isolated incident but part of a pattern of behaviour. He was a predator taking advantage of his power in a hierarchical profession. I am still astounded by the number of men who express support for him and blame the victim for being stupid. It is also clear that there is willing blindness by those around these men that allows the behaviour to persist, presumably afraid for their own positions if they were to tell.
The last 3 years have taught me that the world is uglier than I had thought. I have been astounded by the stories I have heard and dismayed by the impossibility of redress for the victims or consequences for the perpetrators. I have learnt a great deal more about unconscious bias and how insidious a problem it is for women. I have learnt that there is little transparency and a great deal of secrecy. My “invisibility cloak” is useful in making people feel safer to approach me for help and I continue to do this to the best of my ability.
My advice to young women is to always have their recording device (phone) at the ready. The Channel 7 cadet who complained about sexual harassment and was subsequently fired after being falsely accused of bullying was only vindicated because she recorded the termination interview. She received a monetary payout but the career that she had worked so hard for was taken away from her and we have to conclude that she probably would have been more successful if she had complied with the sexual advances.
It has been almost 3 years since I made my infamous “blow job” comment. Nothing much has changed, it seems.
Dr Gabrielle McMullin is a consultant vascular surgeon at St George and Sutherland Hospitals, Sydney.
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