The harsh reality of sexual harassment in hospitals

Westend61 / Oneinchpunch

Hospitals and medical schools are finally coming to terms with the fact that they have a sexual harassment problem. Measures are being implemented but change will be slow. Two women tell SWI swissinfo.ch how their lives were upended whilst they were studying medicine in Switzerland.

Helena* was 21 years old when she was assigned to a small countryside hospital in Switzerland for her first clinical clerkship. The one-month placement went smoothly… until it didn’t. On her last Wednesday, she ended her shift later than usual. “I was exhausted and I just wanted to change my clothes,” she recalls. On her way to the changing rooms she was followed by a more senior colleague.

The man cornered her at the end of the corridor, put his hand on her flank, and tried to block her escaping his hold. But Helena was quick enough to break free and run away.

“As a young Swiss woman, you expect to be harassed in the pub or at parties, but this was shocking and scary because it happened in the work environment, which you think is safer,” she tells SWI swissinfo.ch.

Harassed before their career even begun

Sexual harassment is not unique to a country or a workplace. Academic institutions are concerned too, including in Switzerland. Universities have recognised the issue and are tackling it. But statistics show that both medical faculties and hospitals have a major problem.

According to a 2018 survey in the United States, 45% of female medical students have been victim of sexual harassment, almost twice the number of peers in other faculties. In the United Kingdom, 48.8% of female and 18.9% of male surgical trainees say they have experienced some form of sexual harassment.

The data is scarce in Switzerland, but the information available shows a similar scenario. A 2018 survey by the students’ association CLASH in Lausanne (Collectif de Lutte contre les Attitudes Sexistes en milieu Hospitalier) found that over half of students have experienced sexist behaviour during a clerkship. Victims are mainly female students, while the perpetrators are men in higher hierarchical positions. A follow-up survey in 2022, to be published on March 23, confirmed the findings.

The situation for young female medical students has been vividly described in a recent article in the New England Journal of MedicineExternal link: “Look at the woman to your left and then at the woman to your right. On average, one of them will be sexually harassed during the next four years, before she has even begun her career as a physician,” said the dean of a medical school.

Dangerous times

The most sensitive time for medical students is during their clerkship in the fourth, fifth and sixth years of their studies. They are usually sent to hospitals outside the university and become dependent on their supervisors.  

A recent post in the University of BernExternal link student magazine reports various sexual harassment incidents that have taken place during clerkships. They include “recurring messages via social media, unpleasant and unwanted touches, suggestive comments and unwanted invitations to eat or spend a night together in the staff room”.

Even when not directly exposed to sexual harassment, medical students and doctors have to cope with daily cases of microaggression fuelled by stereotypes and unconscious bias. Women contacted by SWI swissinfo.ch cited comments such as, “women are too fragile, not smart enough for medicine”, or “women should stay in paediatrics or in the kitchen, not in surgery.”

In a recent articleExternal link, the Swiss Junior Doctors’ Association asks how it is possible that hospitals, the places whose core purpose is to cure others, are not capable of protecting their own employees.

“We need a new culture about consent and providing a safe space, already in training. Our teachers should make sure that students of all genders feel comfortable during a medical examination for instance,” asks Bea Albermann, a medical doctor and former president of the Swiss Medical Students’ Association (SWIMSA).

“To prevent these incidents from happening in the first place, we also need to train both students and teachers against unconscious bias.”

Sexual harassment vs microaggression

The International Labour Organization (ILO) recognises three forms of sexual harassment: Verbal, nonverbal, and physical. The verbal form comprises socially and culturally inappropriate and unwelcome sexist remarks and comments, persistent proposals and unwelcome requests or persistent personal invitations to go out. The nonverbal form includes unwelcome gestures, suggestive body language, indecent exposure, repeated winks, unwelcome display of pornographic materials. Finally, the physical form ranges from intentional touching, caressing, pinching and hugging to sexual assault or rape. The prevailing cultural narrative focuses on sexual assault or rape, yet the vast majority of incidents fall into the first two forms.

Microaggressions comprise remarks linked to the person belonging to specific groups, usually minorities (women, people of colour, LGBTQ+, etc.). They are divided into microassaults (i.e., explicit derogatory comments like name-calling, finger-pointing, etc.), microinsults (i.e. subtle snubs, hidden insults like saying to a woman “I‘m surprised you drive so well” or to a gay “You don’t sound/look gay”), and microinvalidations (i.e. messages that disconfirm and nullify, like saying “women cannot be surgeons”).

The silence of the lambs

Healthcare has traditionally been a male-dominated discipline. Although women make up 61% of all students in medicine, as qualified doctors they still have difficulty climbing the ranks. Only 15.3% of chief physicians are women, according to the Swiss Foundation of Medicine (FMH) statisticsExternal link for 2021. In the UK, only 13% of surgical consultants are women.

ResearchExternal link shows that factors like a strict hierarchical structure, a male-dominated environment, and a climate that tolerates misconduct and promotes silence all provide a fertile ground for harassment. Medicine, unfortunately, ticks all the boxes.

Experienced physicians have power both because of their leadership positions and because of their monetary value to their organisations – turnover of experienced physicians results in huge costs for a hospital. This may encourageExternal link institutions to protect a physician accused of misconduct who may in turn believe that they are above the law.

And then there’s the competition, people working long and stressful hours, and practically living together.

“The working environment in the hospital is very different to other faculties,” says Britta Engelhardt, chair of the Commission for Equality, Faculty of Medicine at the University of Bern. A hospital has to provide a 24/7 service to patients, which also comprises research and teaching.

Under such conditions, omerta is still the rule. The future career of young (but also more senior) medical doctors often depends on a positive evaluation from their senior physician. As a result, sexual harassment by them often goes unmentioned or unreported.

Helena*, who is now 26, is an assistant doctor in a Swiss hospital; she also studied at the University of Bern. Her aggressor was a resident higher up in the hierarchy. “We both took part at morning briefings and we maybe talked a couple of times, nothing more,” she says. Even if she recognises that the encounter could have ended badly, she points out that the aftermath was far worse than the experience itself.

At the time, she felt guilty and powerless. She was angry her university had sent her to a place with low safety standards – a hospital where changing rooms for men and women are not entirely separated. Most importantly, she was very confused about what to do: “I didn’t want to sneak on him, or ruin his career, but I didn’t want this to happen to somebody else either. This was the hardest part, having no person to talk to.”

At that time, the hospital had no official contact point for cases like hers and she didn’t want to go to the surgical department heads because “they were all men and you don’t think they are on your team: would they ever believe or trust my story?”. 

Helena* reported the incident to a senior female doctor in the hospital, but she decided not to proceed further as her clerkship was ending two days after the event.

Baby steps

Once back in Bern, Helena* confided with a friend who was collecting anonymous testimonies on sexual harassment to present to the medical faculty.

The resulting internal survey tackled some of the issues raised. “We are aware of the issues and we have implemented specific actions,” says Engelhard. Since 2020, at the beginning of the fourth year Bern medical students have to attend a lecture on sexual harassment and what they can do in case they are victims. The university has also provided a list of contact points in the respective teaching hospitals so that students know where to go and what procedure to follow in case of sexual harassment. Similar initiatives have been implemented in other Swiss universities.

The students in Bern welcomed the new approach. But the lack of trust is so great that some of them still doubt whether their testimony will remain anonymous or receive a proper response.  

Some questions remain unanswered: how much power can a university exert on an external hospital in a case involving a student? Can they exclude the hospital from the list of accepting students? And at what price?

Higher ranks, bigger problems

The threat of harassment doesn’t end with medical school. A recent surveyExternal link by the British Medical Association found that 91% of female doctors had experienced sexism at work. In Germany, 70% of physicians at the Charité hospital in Berlin reported having experienced some form of harassment during their careers.

A 2019 surveyExternal link among 1,071 people in French-speaking Switzerland showed how sexual harassment increases as a career progresses, with senior physicians being the most affected. In 2022, the Tages-Anzeiger Swiss daily newspaper conducted a survey and received more than 250 answers from victims of sexual harassment. In the main article, explicitly titled “I’m going to intubate you in all holes”, the authors report how sexual harassment in Swiss hospitals takes place mainly through comments, indecent exposure, and touching by male doctors and even patients.

Surgery seems to be the place where things get worse. Doctors contacted by SWI confirmed this. “The amount of comments and stereotypes there is incredible,” said one doctor.  

Impact

Sexual harassment has a significant impact on victims’ mental health, ranging from increased anxiety, depression, post-traumatic stress disorder (PTSD) and burnout to excessive drug and alcohol use. Evidently, it has also an impact on medical students and doctors’ performances at work and their ability to take care of patients.

The case of Rachel, who was victim all through her residency, just shows how far sexual harassment, also in its milder forms, and microaggressions can go in damaging a person’s career and life. “I expected sexism, but my years in Switzerland were the worst of my life,” she says.

Rachel* was a medical resident in surgery in a Swiss university hospital. Medical residents undertake speciality training that lasts four to seven years. During that time, they are supervised by certified doctors and have to pass a Swiss federal exam to become licensed doctors.

On her first day as a resident, Rachel was singled out. “You are the blonde girl that the chief was talking about”, she recalls male colleagues telling her. “They started calling me Marilyn for my looks. Every morning they commented on my makeup, my dress, my breasts. After one month I changed the way I dressed completely, questioning my appearance.”

Pictures of her were shared in a WhatsApp group. “It was a huge humiliation. And then of course there were the sexual proposals: do you want to come back home with me? Are you interested in cheating on your boyfriend?”. 

Rachel at first accepted the jokes and refused the solicitations, but the constant commenting and microaggressions began to take a toll. “I lost myself. I was depersonalised. I accepted too many things,” she says. In the meantime, she also realised what was happening at winter retreats and parties: drinking and sex were necessary to be part of the group.

Gradually, she started to change her behaviour. “I stopped laughing at their jokes and asked them to stop. Things started to change,” she says – for the worse. “I was put on night shift after night shift, given only three days off in a month. I was on call almost every Sunday.”

When she sought help and spoke out the hospital director suggested she talk directly with her boss or leave the training. Five years later, she left the hospital and the country, leaving behind her family, which she’d built in the meantime, in Switzerland. She now continues her medical career elsewhere in Europe.

Rachel is still paying the price for speaking out. “I’m away from my family. I feel guilty because I couldn’t change things. And I don’t know what will be of my career. My community is small. My former boss can still damage me.”

At the time of publication her former boss still occupies a leadership position in a Swiss hospital.

Drastic solutions

Researchers do have proposals, which include continuous surveys to measure the problem, following through on policies and punishing the perpetrators.

But the scarcity of resources is a big problem for implementation. “Universities lack funds for prevention. Besides, around 80% of those who allocate the budget are white men, who are statistically the least likely to experience sexual harassment,” says Albermann. SWIMSA, in its position paper, calls for more initiatives and engagement at the national and cantonal level.

Experts contacted by SWI agree that if there is some progress, it lies with the younger generations. Students, including men, “are more engaged, savvier, and have more strategic thinking than previous generations”, they say.

Helena is not discouraged. “Things are changing, we are not a minority in medicine anymore. We are experiencing the same as other women before us, but we have been educated to stand up for our rights. And we are not going to stay silent,” she says.

*Not their real names. 

Edited by Virginie Mangin