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AUSTRALIA echoed last week with calls for an end to violence against women and dismantling of the power structures that enable it.
The stories coming out of Canberra in recent weeks have revealed a toxic culture, where bullying is rife and young women are seen as disposable commodities, quickly discarded once they have outlived their usefulness in favour of the next fresh-faced recruit.
It’s not just the national capital, of course, and nor is it new. “I was protesting about this in the 1970s,” I heard a woman say at one of the marches last week.
This is a time of reckoning for workplaces and organisations around the country.
At least I hope it is. It would be hard to accept the return to business as usual we have seen so many times before.
The health system is certainly not immune to these kinds of allegations. No system is. A number of senior doctors have been accused in recent years of offences ranging from sending their junior colleagues unsolicited sexual messages to outright assault.
Those cases create headlines, but the reality is they are probably the tip of the iceberg. Those subjected to these behaviours rarely make a complaint.
Most women I know have been sexually harassed at work, but I can’t think of any who have taken action against the perpetrator. I certainly haven’t.
The reasons for that are complex, but high on the list has to be the knowledge that we are likely to suffer more than the perpetrator if we try to do anything about it.
“There is little doubt of the perception among medical students and trainees that complaining [about sexual harassment] can damage a career,” two (male) surgeons wrote in the MJA in 2015.
The hierarchy was seen as too powerful, they went on, noting the “perceived disconnection between organisations’ stated values and their responses in individual cases of alleged abuse”.
Perhaps things have improved since then, although a 2018 paper, also in the MJA, stated unprofessional behaviour in general was sufficiently widespread in the Australian health system it could be considered endemic.
The researchers cited numerous studies showing high levels of bullying and harassment across the sector. An Australasian College for Emergency Medicine member survey, for example, found 34% of respondents had experienced bullying and 6% sexual harassment.
The range of behaviours studied in the 2018 MJA article was broad, from incivility to assault, and not necessarily sexual in nature, but it does raise broader questions about the culture of the health system.
A 2020 survey conducted by the same researchers found more than 90% of hospital staff had experienced unprofessional behaviour at work, 39% on a daily basis.
Just under 15% reported experiencing extreme behaviours such as assault.
“Tolerance for low level poor behaviour may be an enabler for more serious misbehaviour that endangers staff wellbeing and patient safety,” the researchers wrote.
If we are really going to do something about violence against women across all sectors of our society, addressing cultures where bullying is tolerated will need to be part of it.
Not all men assault or harass women. This is true.
But the statement is also a deflection, an evasion of responsibility. The onus is absolutely on all men to help build a new kind of society where women don’t live in fear.
That means calling out bad behaviour when you see it. It means raising boys who truly understand what consent means. And sometimes it means having the courage to speak up against your colleagues.
Jane McCredie is a science, health and medicine writer based in Sydney.
National sexual assault support
1800 RESPECT: National sexual assault, domestic family violence counselling service. Operates 24 hours/7 days a week.
Phone: 1800 737 732
Blue Knot Foundation: For adults with experiences of childhood trauma including child sexual abuse. Operates 9am-5pm Monday-Sunday.
Phone: 1300 657 380
Bravehearts: For those wanting information or support relating to child sexual assault and exploitation. Operates 8:30am to 4:30pm Monday to Friday.
Phone: 1800 272 831
IF YOU ARE IN IMMEDIATE DANGER, PLEASE CALL 000
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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Anonymous (March 29, 2021 at 2:50 pm) imagines that a simple re-statement of the laws wins the day, over ‘objectivity’, with regard to whether colleagues are supportive of an accuser (March 29, 2021 at 9:54 am).
But several of these laws at their pointy ends, even down to their definitions, are regarded by many people as contentious and unreasonable, S 18.C being the most prominent example.
It is in totalitarian systems that the population can be made to clap in unison for laws that oppress them. But even in those systems, the populace will subvert unfair laws where they can.
The aim of this article, which is laudable, is to highlight lapses in the medical system and to support those who have suffered abuse within that system. It has become customary to attribute blame to ‘the system’ or ‘the (toxic) culture’ whilst forgetting that at the point of infringement there remains the interaction between two sentient individuals with agency.
The law needs to imagine that these are black and white; current commentary resolves them into Good and Evil, and assumes that merely to make the allegation is to be legally vindicated. One would not know it from the portrayal of recent events in the Australian press, but there are two sides to every story.
It may well be that instances are very much in the minority, but where observers can see a perversion of natural justice, they will, while being compelled to observe the letter of the law, make their own decisions about whether and how much to support the protagonist.
There is objectivity and there is the rule of law – only it isn’t enforced in the Australian medical workplace – or Parliament.
Here’s what the Law Council of Australia has to say about bullying and harassment:
‘Under anti-discrimination law, it is unlawful to treat a person less favourably on the basis of particular protected attributes such as a person’s gender, sexual orientation, race, disability or age. Examples of unlawful actions can include harassing or bullying a person. Workplace anti-discrimination law is set out in federal and state statutes. There are specific legal provisions for sexual harassment, racial hatred and disability harassment.
Bullying is defined under section 789FD of the Fair Work Amendment Act 2013 (Cth) as when an individual or group of individuals repeatedly behave unreasonably towards a worker and that behaviour creates a risk to health and safety.
Bullying includes a range of behaviours such as:
yelling, screaming or offensive language;
excluding or isolating employees;
psychological harassment;
intimidation;
assigning meaningless tasks unrelated to the job;
giving employees impossible jobs;
deliberately changing work rosters to inconvenience particular employees;
undermining work performance by deliberately withholding information vital for effective work performance;
constant unconstructive criticism and/or nitpicking;
suppression of ideas; and
overloading a person with work or allowing insufficient time for completion and criticising the employees work in relation to this.
Harassment provisions are included across a range of legislation, including the following:
section 28A of the Sex Discrimination Act 1984 defines sexual harassment as when a person makes an unwelcome sexual advance, an unwelcome request for sexual favours, or engages in other unwelcome conduct of a sexual nature in relation to a person. This occurs in circumstances where it is possible that the person harassed would be offended, humiliated or intimidated. Sexual harassment can be subtle and implicit rather than explicit;
section 18C of the Racial Discrimination Act 1975 prohibits offensive behaviour based on racial hatred. Offensive behaviour includes an act that is likely to offend, insult, humiliate or intimidate another because of their race, colour or national or ethnic origin; and
section 25 of the Disability Discrimination Act 1992 prohibits harassment in relation to an employee’s disability.
https://www.lawcouncil.asn.au/policy-agenda/advancing-the-profession/equal-opportunities-in-the-law/bullying-and-harassment-in-the-workplace
Regarding (March 29, 2021 at 10:44 am) it is precisely why an independent third party (non-medical) should be employed. Because of precisely what you have stated “the possibility that colleagues may simply not agree with the perception or interpretation of the action”.
Think, “birds of a feather flock together” – the lack of diversity and inherent bias of having a group of people who think just like you.
Perhaps not cultural backwardness, or nepotism (March 29, 2021 at 9:54 am).
Be open to the possibility that colleagues may simply not agree with the perception or interpretation of the action.
In an era where there is no objectivity (if there ever was or could be), where, if I am feeling harassed or bullied then I am being harassed or bullied, it is possible that colleagues simply may not agree that that perception is justified or valid. If it further results in a disruption of unit cohesiveness or brings the entity into disrepute, then it is not surprising that support may be lacking if the action is thought unjustified or even vexatious.
‘Believe all victims’ is an effective catch-cry to raise awareness: it cannot compel individuals to abandon their own assessments of the world around them or mandate their actions in it.
I note the author pushed for the “calling out” of unacceptable behaviour. In reality the calling out of any unacceptable behaviour or attitudes or policies leads to the individual, especially if they are a woman, being labelled “aggressive” or “difficult”. They also become targets for blacklisting and vindictiveness and often find themselves alone and without any support from colleagues. This is not only the case in most hospitals in Australia, it is also the case when one calls out the regulatory board for unreasonable decisions or analyses. This seems to be the result of a cultural backwardness in this country, with much less openness than is depicted and championed. In reality there is selective consideration here-who you are and who you know have the greatest influence on how you are treated .
‘We must absolutely provide safety and justice within our health system.’ says Anonymous March 24 – and yet year after year, decade after decade the evidence is coming in that over half of our colleagues are lacking exactly these basic ingredients every day at work: safety and justice.
Enough talking allright, when will action follow those hollow phrases of ‘no tolerance’ when we have irrefutable proof that this toxic behaviour is being tolerated year after year by our workplace managers?
I feel that many need to read this article https://www.ausdoc.com.au/practice/when-does-human-interaction-become-workplace-sexual-harassment?mkt_tok=MjE5LVNHSi02NTkAAAF8AZ01GnELR4J-3Tj48KMYQWswu_JNhnMz29H1JNLVeg5SBM5FPikWGmOgvylqBB5hmEo15Srmv5WzA8dVRCjfXhTcv_611-oMZVsBHdUMmfXF to better understand workplace harassment.
There are many different models to explain how the world goes round. One of these sees human interactions as the interplay of power relationships (and without hyperbole can be characterized as neo-Marxist). Adam Smith’s model was instead largely transactional; Freud’s was sexual.
That the power model is in vogue does not make it the only explanation, or even the correct one.
Consent, power, coercion, let alone rape are all absolutely valid concerns, both within the health system and in wider society, and it is undoubtedly true that people in a position of power may sometimes abuse that power and position, with some deliberately and repeatedly setting out to do so.
Those people who are determined to see these issues solely through the lens of power structures will therefore sneer at allusions to romance as a part of what drives some (not all) of hospital/workplace-based intimate relationships. Hospitals are indeed an archetypal hierarchical structure in which power imbalances do exist.
The tenor of this article and others like it, however, is determined to suggest that all interactions that occur where a power imbalance exists must be informed by that power imbalance. What if those interactions are in fact in the minority? And abuse within those relationships are a further minority subset?
Yes Sue: there is now an argument put about that no intimate relationship should ever be contemplated when a power imbalance exists, as it is founded on a false consciousness that it could represent romance, when in fact Theory compels that the relationship be seen as contingent on the power imbalance in the first place.
This rather begs the question of how all those stereotypical marriages in the past between (male) doctors and (female) nurses were navigated, where current thinking would suggest that true consent under this paradigm was never possible; that all relationships where there is a power imbalance are ipso facto flawed. Happy though those couples may seem, are they ‘misguided’, and their relationships in some way invalid. Such relationships look certain to be a non-starter these days under the ‘power model’.
Can consent be informed if one is intoxicated – by the other’s power? What if the power is an aphrodisiac for the ‘weaker’ party. And how do we approach those who actively elect to ride the power wave to get ahead; the more so if a complaint about that ride only surfaces when the ride ultimately dumps them (as can happen in any relationship, ‘powered’ or not)?
Human interactions are messy and sometimes ambiguous. All attempts at social engineering have always run up against human nature. Those social engineering projects have routinely failed as a consequence. Fatuous ‘bonk bans’ – be it in parliaments or in hospitals – and other intrusive prohibitions will similarly fail in the face of human desire. It is wholly unrealistic to try to pre-emptively engineer human nature out of a work environment in order to protect those few who will face abuse.
We must absolutely provide safety and justice within our health system. Our task is to protect those who are being coerced – or disadvantaged through their refusal to be coerced – whilst staying out of the way of those who make a deliberate choice to embrace the power dynamic that they face.
And we might also recognise that Freud had at least as much to say as Marx when it comes to human sexual interactions.
Anonymous commenter #1 says “Sometimes a message of repeated rejection doesn’t get through: does no mean no, or is he just playing hard to get? Is it harassment, or the persistence of ardour (which some used to claim to appreciate)?” If this is the level of understanding of the issue, it is no surprise that these issues still exist in the workplace.
We are taught to appreciate the subtleties of both verbal and non-verbal communication with patients – although different clinicians master this to different levels. The same skills need to be extended to team relationships – especially where there is an imbalance of power. The greater the imbalance of power, the more meticulous the “pursuer” needs to be about consent, including questioning whether that can be assured while the imbalance exists. Relationships between peers are a different matter, as refusal does not carry the same burden. This is not about stifling “romance” – it is about justice and safety.
In all the consternation about harassment and bullying, people seem to forget that, firstly, the workplace is where a great many people meet their future life partners; and secondly, that suitors of either sex can be cack-handed and clumsy or even just inexperienced in their approaches to a potential partner. Sometimes a message of repeated rejection doesn’t get through: does no mean no, or is he just playing hard to get? Is it harassment, or the persistence of ardour (which some used to claim to appreciate)?
How can we know for sure what was meant? How can we know for sure how it was received?
This is/was all part of the game of life outside: are we seriously proposing to engineer all courtship rituals, nuance, fun, playfulness and ambiguity out of human relationship interactions?
Of course the scolds in the system and on these pages will say yes. Have a think about what our current predilection for authoritarian edicts will look like.
At this rate, the brave new world of a swipe right will be the only way to meet anyone.
I do not condone sexual assault. But as a male junior doctor sexually harassed by a male orderly in the public hospital system a couple of decades back, I can attest to the fact that the discussion is not uniquely about power structures. And I would still not wish to banish the frisson of attraction from the workplace.
We need still to allow for human fallibility, frailty, imperfection and longing.
The sad reality shown year after year, decade after decade in all serious surveys and research is that medicine in Australia is a toxic workplace and that not just the offenders but especially the ones in charge, the directors, supervisors and consultants are enabling, perpetuating and profiting from bullying, discrimination, sexism, racism, cover-ups and black-listing of whistleblowers.
Until that changes nothing will change.
In response to “anonymous”. I find it incredibly difficult to believe that in 30 years in the hospital system you have not witnessed bullying or sexual harassment. I worked in the hospital system for 7 years and I experienced and witnessed both. The blatant sexual harassment I experienced was obvious, but that didn’t occur when there were a lot of people around – it tended to be after hours when it was just my consultant and I present. I elected not to file a complaint for many reasons. In retrospect there were many, more subtle incidences that constituted sexual harassment of other female staff and myself, however I was so caught up in the system and it was so common place that I didn’t pick up on it at the time. Likewise with the bullying. There were obvious instances, but it wasn’t until I had left the hospital system that I had the distance to see it for what it was. Sadly, for this reason, when I was in the midst of training and really just trying to survive, I didn’t call out behaviour that I should have. I put up with a lot during my hospital years – as do most of us, but the system needs to change, because that environment is NOT what I want for my daughters should they choose a medical profession.
In response to Randall Williams: As a JMO in the ‘70s I can tell you that we simply didn’t complain about serious incidents – we didn’t really think we could, or that any good would come of it. It appears that things have improved and that the vast majority of bosses, male and female, are decent and kind – but that doesn’t mean that we don’t need to keep on improving.
It is interesting that in the 1990s medical schools started looking at personality, empathy and communication skills as part of the admission assessment process and selection interviews. Those students selected would now, in many cases be senior clinicians and despite this, accusations of bullying and harassment ( including sexual ) by junior doctors against their seniors seem to be more frequent. I can’t remember many complaints when I was training in the 1970s ( accepting that times and mores were different, and also many might have been kept quiet ) , nor did I personally witness any sexual harassment of my female colleagues or overt bullying . As juniors we were “told off” if we made significant mistakes but we accepted this as part of our learning–one wonders if this is called “bullying ” today. I accept that sexual harassment is entirely different and to be utterly deplored. I am making the point that maybe the old medical school selection processes were not so bad in retrospect.
Not all men assault or harass women is a gross understatement which I find insulting.
The majority of men do NOT. And in my 30 years of working in hospitals I and my colleagues have never witnessed any such actions nor turn a blind eye. So whilst I sympathise with any victim of assault or harassment, there is nothing for me to call out. And by the way, the statistics continue to show that whilst the vast majority of violence perpetrators are male, the majority of violence victims and also murder victims year after year are actually males. So violence is a problem for anyone not just females.
Let’s remember that “the standard you walk by is the standard you accept”. We need all health professionals to take sexual harassment and assault seriously enough to be supportive & assertive “bystanders”, and not just ignore/walk away from behaviour that is inappropriate. If you’re not sure – maybe check in with the person being targeted by the behaviour, you can see how they are, whether they feel safe, and if they need support from you in some way.
We need the medical administration and hospital seniors to not value the reputation of one doctor over the safety of others (which could also include their patients).
I am currently editing a book on the sexual abuse of doctors by doctors. The problem is indeed endemic, internationally. Authors from Japan, Zambia, South Korea, Israel, Russia…the list goes on…. tell me endless stories of women’s careers truncated by male bad behaviour. They also tell me about simple solutions proposed (a webinar on professional conduct, a change in policy, a peer support network) that are manifestly inadequate in the face of a complex problem. Enough is clearly not enough for many in power. We are good at complexity in medicine. Not so good at complexity in this field. And it’s time we were.
When the survivor of John Kearsley’s sexual assault wrote her victim impact statement, she told us her world was broken and will never be the same. How many more junior doctors need to speak? How many continue to be silenced because of the structural inequities in the system?
It’s time to be clever, not just compassionate. And we need everyone: lawyers, peers, therapists, Human Resources personnel, management, medical regulators, insurers, medical educators and survivors to reshape the future of professional behaviour.