MEdIC Series: The Case of the Overly Attentive Attending

2017-01-20T12:30:40+00:00

medic series overly attending sexual assaultWelcome to season 4, episode 2 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, John Eicken, Sarah Luckett-Gatopoulos, Eve Purdy, and Brent Thoma) is pleased to welcome you to our online community of practice where we discuss the practice of academic medicine!

In this month’s case, a junior resident feels violated and shamed after a sexually aggressive encounter with an orthopedic attending physician.

MEdIC Series: The Concept

MEdIC: The Case of the Overly Attentive Attending

By Dr. Dara Kass and Dr. Stacey Poznanski

Samantha had always been a model student. She was top of her class in medical school and was thrilled when she matched in her top choice of Emergency Medicine residency programs. The city was far away from her family but she felt it was the best fit for her and she knew she would receive quality training.

Shortly after starting residency, Samantha began dating an orthopedic resident. They had a brief, casual relationship and after three months, it ended amicably. A few months into her second year of residency Samantha joined the orthopedic team as a required core rotation. She was excited to start ortho, as it had been one of her favorite rotations in medical school and she knew the experience would enhance her abilities as an EM physician. Her ex-boyfriend was on rotation at a different hospital so she was not concerned about any conflict affecting the team dynamic.

The first two weeks of her rotation were rather uneventful. She alternated between consults and clinic, putting forth her best effort. At night, even when post call, she took extra time to read about fractures and splinting so she could be useful to the team. She was learning, enjoying her time, and had no idea that her life was about to change.

At the start of her third week of the rotation, Samantha was in clinic seeing a patient for follow-up of a fracture reduction in the ED. She asked the attending to come into the room and confirm that the fracture was healing well. As he reviewed the images over Samantha’s shoulder, he hovered close. Closer than he had before. As the patient was in the room, Samantha was certain she was imagining things and decided to think nothing of it. The attending agreed that the patient could be seen again in 2 weeks, and he dismissed the patient to the waiting room to wait for final instructions. As Samantha got up to leave, the attending asked her to stay. There was something he wanted to review with her. Again, slightly out of the norm, but she did as she was told.

He closed the door and stood in front of it. He told Samantha he had noticed her. Noticed how hard she was working on the rotation. “A girl so pretty doesn’t need to work so hard,” he said. He asked if she had dated anyone since breaking up with the orthopedic resident. She was taken aback and hesitated for a moment, then stated that this was not his business and that they should move on to the next patient. But he persisted.

His language was explicit. He described intimate details of relations she had had with her ex-boyfriend. He told her she needed to be with a real man and graphically described how he would satisfy her.

Samantha politely refused and commented on the inappropriate nature of their interaction. The attending physician dismissed her remarks and continued to pursue the issue.

He hovered close to her and whispered into her ear while casually brushing over parts of her body with his hand. She stood there, frozen, until a knock on the door ended the interaction. It was the nurse, asking about a new patient in the waiting room.

After he left the room, Samantha ran out of the clinic and began to sob uncontrollably when she reached the parking lot. Everything was a blur, but somehow she felt like she had brought it on herself. Perhaps she had developed a reputation because of her casual relationship with his ortho resident. Or was she being flirtatious in clinic? Were her clothing too revealing? Samantha couldn’t make sense of what had just happened. She felt ashamed and didn’t know what to do next.

Discussion Questions

  1. As a resident on an off service rotation, what should Samantha do next? Should she go back to the clinic and see patients, but ask for a new attending? Does she activate sick call and go home? Should she tell someone?
  2. What steps should be taken once program directors or emergency staff are made aware of this situation?
  3. Are there any legal actions that should be taken at this point? Where is the line between aggressive flirtation and assault?

Weekly Wrap Up

As always, we will post the expert responses and a curated commentary derived from the community responses 2 weeks after the case is published.

This month, our two experts are:

  • Dr. Christopher Doty
  • Cindy Caplan

On November 11,  2016 we will post the curated commentary and expert responses to this case! After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary. That said, we’d love to hear from you, so please comment below!

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.


Tamara McColl, MD FRCPC MEd(c)

Tamara McColl, MD FRCPC MEd(c)

Associate Editor, ALiEM MEdIC Series
Emergency Physician, St. Boniface Hospital, WRHA
Academic Lead, Educational Scholarship
Department of Emergency Medicine
University of Manitoba
  • Eve Purdy

    Wow. What a case. I wish that I could believe it couldn’t happen but unfortunately exposure to a few much more subtle instances of sexual harassment make me well-aware that something as egregious as this case are within the realm of possible. The pit in my stomach is still here 30 minutes after initially reading this case.

    I’ll address the questions.

    1. Samantha should not go back to clinic. In this particular instance, as an off-service resident in an ambulatory clinic, patient care will in no way be compromised if she leaves. She would be putting herself at risk and her patients will not benefit from having a distracted physician. If she is working only with this physician today she should tell the clinic manager that she is feeling unwell and activate sick call. Even if the clinic is run by two staff physicians that day the practicalities of dodging the staff who physically contained her in a room are not worth it. She should go home and record the exact circumstances and encounter while it is fresh in her mind. There are a few options for immediate discussion of issues. She should talk to a good friend or the wellness counsellor available for her program/university for her own wellbeing. Next she should seek guidance from someone who can help her through what she should do to address this encounter. Again the wellness counsellor or her program director would be good people to go to. This discussion could be had the next day after the initial disgust has settled.

    2. The program director, other emergency staff or wellness counsellor who are informed of this circumstance must take it seriously. There are multiple layers of concerns including this resident’s safety, her learning, the experience of other residents and staff. Immediately, this must be identified as an unsafe learning environment for the resident. Immediate steps should be taken to ensure that she does no clinic, on call, or in the OR work with this physician. The rest can (and needs to) be worked out later.

    3. A formal complaint should be put through all reporting systems including the university, the hospital and the college. This behaviour is unacceptable. The staff physician physically kept her in a room, spoke explicitly to her, touched her in an unwanted way all the while she said “no”. This is not flirting this is sexual harassment. Also, aggressive and flirting should never be in the same sentence.

    Eve

  • Richard van Wylick

    Eve is absolutely correct. It is incredibly disturbing to know that this stuff happens.

    You can bet that this is not the first time this physician has engaged in this type of behaviour, and won’t be the last without action.

    Reporting to regulatory authorities (the College), in addition to hospitals and university, is critical. As a person in a position of trust, the attending must be held to the highest standard of professional conduct. And this type of behaviour is egregious.

    • John Eicken

      Thanks so much for sharing your thoughts Richard, I could not agree more about the egregiousness of the attending’s actions and need for disciplinary action. Beyond reporting the behavior to the regulatory authorities, do you have any advice for Samantha on next steps on how to care for herself following a traumatic event like the one described?

      • Loice Swisher

        John,
        How does Samantha get past this is a great question. Trying to put myself in her shoes, I would want to find a different path rather than “freezing”. If this happens again, what would I do next time. One of the things I sort of liked was just generally screaming “there is something on me- I think it is a roach (or rat)- get it off- get it off”. It would draw attention and likely would have been shocking enough to have him back away. It probably would have stopped the immediate unwanted touching.

        This situation was both a physical and a mental assault. The fact that he knew intimate details of a prior relationship was disarming and likely meant to make her vulnerable and unsure of herself. It makes it hard to think of what one should say. I’m sure there are better lines but maybe something like “real men don’t assault their students”.

        I’m one for matras and to develop positive one- I can’t control what other people do but I can find a response that works for me.

        I’m sure there are other ideas.

        Loice.

  • Shahina Braganza

    The Australian perspective (based on one Emergency Physician…):

    This is clearly a scenario that requires a swift and definitive response that gives a clear message that any type of harassment will not be tolerated. However, unfortunately, the reality is much more blurred than this.

    1. There is no right or wrong answer regarding Samantha’s immediate reaction. Sure, the default position is that she should take time to gather herself, to try to make sense of what just happened to her, and to work out a plan of action. I imagine that, like the stages of grief, this is likely to follow a pattern of Denial, Anger, Bargaining, Depression and Acceptance – following a variable pace and pattern between these.

    However, if she feels “I did nothing wrong – I have worked hard to establish my value to this service – how dare I be obstructed from doing my job?” and she strongly felt that she should return and complete her duties – if only out of self respect – then that would be okay too.

    At some point however, she is probably going to need to pause and reflect on how to proceed.

    Regarding “Should she tell someone?” my response is “Absolutely”. The challenge is working out whom to tell. The onus is on the hospital at large to create an environment where any staff, including junior doctors, know and trust the process whereby this can happen effectively and safely. Professional options include a Medical Education Unit in Australia (who also look after wellbeing issues), Human Resources, or the Executive Director of Medical Services. Personal options include a GP, a trusted friend, colleague or family member.

    The reasons to disclose this event are not only for the processing of the experience for the resident herself, but because her story might add to a mounting weight of evidence against the senior doctor, and will compel action to be taken.

    2. The job of the supervising “home” consultant is challenging. She/he must balance advocacy for the junior doctor with an approach which is fair and just ie. gathering facts globally before making a judgment. The priority however is that the resident is completely and unconditionally supported by an allocated team member. In the midst of this process, the resident must be protected personally and professionally. This is high stakes scenario where many reputations may be compromised.

    Ideally, this process will be supported by an organization-wide strategy. An appointed person who is professionally separated from the resident should make discreet enquiries around the behaviour of the Orthopaedic consultant – this should include nurses, theatre and clinic staff, and allied health staff. Senior nurses are often the best placed to make observations about individual behaviours and team dynamics.

    3. Legal action (or indeed any formal escalation) should be conducted carefully and robustly. Such action should be taken by the organization and not by an individual.

    Ideally a peer support mechanism (eg. Vanderbilt principles) will be in place whereby the Orthopaedic consultant may be approached by a senior peer and an informal dialogue take place. Sometimes this may be all that is needed to curtail improper behavior: being “put on notice” and made aware of how they are coming across. Any further escalation, and the response to the resident, can then be managed accordingly.

    The line between flirtation and assault is where the recipient perceives it to be.

    In Australia, many hospitals are in the process of signing Memoranda of Understanding with the Royal Australasian College of Surgeons: https://www.surgeons.org/media/24659010/racs-and-gold-coast-hhs-sign-mou-to-build-respect.pdf

    • John Eicken

      Shahina – thanks so much for sharing your perspectives! I appreciated your comparison to the stages of grief and agree that Samantha will likely find herself working through the stages in the coming days, weeks, months, and maybe even years. I agree that Samantha needs to disclose the event to allow for an investigation into the matter from a Human Resources standpoint and she will very likely need support from individuals outside the organization (close family and friends). You mentioned a Medical Education Unit in Australia as one of the possible options, could you elaborate on the function/purpose of this team since it sounds like a unique group? I agree with your list of ‘personal options’ for people she could reach out to for help. I could also imagine that if I were a close friend of Samantha’s who she disclosed this event to that she may have reservations about reporting the attending to HR or other authority figure within the organization given a fear of retaliation since she is a trainee and lowest within the hierarchy of physicians. She may also fear the event becoming more public within the organization if she reports the event. If she expressed these types of reservations to you how do you think you would respond to her concerns of retaliation and her colleagues learning of the event?

      • Shahina Braganza

        Hello John (and Alkarim)

        We are fortunate in this country that the Medical Board of Australia mandates a Medical Education Unit (or equivalent) at every hospital that trains interns. The role of the MEU, simply explained, is to ensure the integrity of intern training: orientation, supervision and assessment. By its nature, it also oversees the welfare and wellbeing of junior doctors, and therefore has a strong advocacy role. Many MEUs expand this brief bi-directionally to include medical students and senior doctors.

        As a previous Director of Clinical Training (ie. of our MEU), I have been in the position you describe: having a concerning scenario disclosed to me by a doctor who is equally concerned about their own professional standing and opportunity for advancement. Upon reflection, I decided that my role was (1) to ensure that the doctor was supported (2) to make the organization aware of this issue, which was likely to be systemic, and (3) to ensure that there was a meaningful and sustained outcome.

        I made the decision to escalate the matter directly to senior doctors at executive level within our organization. I was able to do this in a manner that kept the junior doctor anonymous while still articulating the allegations made. The initial response by one senior doctor was “If they won’t come forward, we cannot progress this”. Hearteningly, the other senior doctor responded with “Just because they are unwilling to be named does not mean we don’t have a problem here”.

        The decision was made that the latter doctor would make discreet enquiries. This needed to be conducted over a number of weeks. The outcome was that the department is now aware of the issue, and that senior doctor behaviour is being observed and noted. While it may have been more gratifying to see a more dramatic outcome, a chronic situation requires long term management.

        Alkarim, you raise the point that a more formal response may be required in the first instance (perhaps involving HR?). This is tempting, but some considerations need to be made.

        Firstly (and provocatively), there is the prospect of a vexatious complaint being made by a junior doctor – for a variety of reasons. The risk of reacting quickly and aggressively is that a judgment is made prematurely, without the fair opportunity for the senior doctor to give their version of events. The case vignette is presented as objective fact, but remember that when one first hears this story, it is one-sided and subjective, and will need to be carefully corroborated.

        Secondly, as doctors, one of our most valued skills is to know when to “modify the rules” eg. to recognise the one patient who hasn’t read the textbook, and may be the exception to the guideline. A scenario like this one requires tact, sensitivity and sophistication.

        The HR mechanism is generally very prescribed and protocolised. Once HR are made aware of a situation, they are often mandated to respond in a manner that may be too blunt to protect the “victim” or to effectively manage the perpetrator. I intend this statement not to be a criticism but simply a reflection of my understanding of the limitations and boundaries within which our HR colleagues must operate.

        John, we have also been fortunate in Australia that over the last 18 months there has been increased public scrutiny into behaviours within the medical profession. Media interest began with the sharing of stories of (now senior) doctors who experienced harassment, disclosed their predicaments, and endured detrimental career effects.

        http://www.theage.com.au/victoria/surgeon-caroline-tan-breaks-silence-over-sexual-harassment-in-hospitals-20150311-141hfi.html

        Currently there is a Federal Senate inquiry in process to try to give some structure to how the profession responds to this issue. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/MedicalComplaints45

        Identifying the problem is the first step to fixing it, and I am hopeful that we are on our way.

        • John Eicken

          Shahina,

          Thank you so much for sharing your experiences and perspectives! I really appreciated the quote you mentioned when you were faced with bringing forward an incident in the setting where the physician wanted to remain anonymous – “Just because they are unwilling to be named does not mean we don’t have a problem here”. It seems as though the approach you and your colleagues/institution took enabled the situation to be further explored while maintaining the wishes of the physician who had experienced the event. I also really appreciated your insight about the importance of viewing these events as incidents that can occur in the future and can be systemic in nature and are not necessarily single, isolated events. The MEU program sounds very interesting and seems like a great model that training programs outside of Australia could learn from. Thanks so much for contributing to the conversation!

      • Eve Purdy

        Going to join this conversation. After my initial gut reaction, I feel that I underestimated the effect/worry about this event going public and the overall implications for Samantha. While reporting is important, practically speaking, especially in a smaller organization this poses very real challenges. Obviously, people talk, as evidenced by the fact that the attending knew so much about her previous relationship and absolutely no one likes to be at the center of drama. Being at the epicenter of the tsunami waves that this is going to create is a HUGE burden to ask Samantha to bear. How can organizations support Samantha? The MEU’s sound pretty awesome, though I still recognize that at smaller centers there really is no such thing as anonymity. This might end up having very real career and social implications for Samantha.

    • Alkarim Velji

      After reading this twice now, I’m still struck by how egregious and unprofessional this behaviour is. I am stunned and left with the same “pit of my stomach” feeling that Eve alludes to.

      I have had to spend a night reflecting on why this case bothers me so much. I think it boils down to the attending-resident relationship. We as residents are transitioning into the role of becoming colleagues with our attendings. However, this is still a hierarchical relationship as well as a teacher-student relationship. Therefore, for me, this behaviour is that much more disturbing because of the power differential.

      While I am no expert on the many definitions of sexual assault, the behaviour described above very much constitutes sexual assault to me. Had this behaviour happened in any other classroom, significant repercussions would occur. Therefore, I would argue that an informal dialogue led by a senior colleague is simply not sufficient. Physicians are held to a moral standard and this behaviour clearly violates the professional standards that we must abide.

      Another issue comes with reporting. Residents, while also learners, are in the constant process of being interviewed for a job. No single resident wants to be the one that “rocks the boat” or is known as being the one who complains. This same very mentality makes it challenging for advocates to address issues with student and resident mistreatment. I am interested about hearing what other places across the world are doing with having a reporting system. I honestly don’t know where I would even start as a Canadian resident.

      • John Eicken

        Alkarim,

        Thanks for sharing your thoughts. I definitely agree with you that there is certainly a power differential present between attendings and residents and that this relationship may contribute to how residents (or trainees) respond when faced with a situation similar to Samantha’s. Without Samantha reporting the incident, either to friends/family/trusted individual or to leaders within the hospital, the incident will be closed off and known only to the individuals involved which I think will prevent Samantha from effectively personally coping with the event and will potentially allow the behavior of the attending physician to continue. Do you have thoughts on how you would approach a colleague who shared experiencing an incident similar to Samantha’s? What advice would you offer assuming the event occurred within a practice environment similar to the one you are in currently?

  • Anonymous

    I was a medical student who went to a conference with an attending and was wined and dined–naively, I thought this was a congratulations of sorts for presenting at a conference. Not so much, because after dinner, I was kissed, hugged, and groped. I was young and drunk, but fortunately still had enough wherewithal to realize how wrong it was and left the restaurant immediately.

    This was an attending that was going to write me a CARMs reference letter, and was to be my supervisor for a key upcoming elective starting a week later. His wife was also a physician with whom I had worked.

    Afterward I went to the dean of the medical school and discussed it. Like many women who have been through this, I had the sense that I had played a significant role in encouraging it, by being drunk and alone with an attending. That was not a happy feeling for someone who had always prided themselves on having a good deal of common sense. It became clear to me that unless I formally reported it (i.e. lost my anonymity) there would be no consequences for this attending. It felt like I had to choose between my future and his punishment, that I couldn’t have both. I was unwilling to formally report it, partly bc I felt I had been stupid about being drunk, and partly bc of my concerns for my future career. I didn’t want everyone to see me as the student/resident that you had to be careful being alone with. Older me, of course, knows that I should have the right to share a dinner with someone and not be assaulted, and that I should not be judged for what someone else chose to do.

    I cancelled my elective, found others to write reference letters and never set foot in that department afterward. It made me anxious about going to conferences in the future. I still feel sick and angry when I see his name. I felt guilty that I hadn’t stood up and done more– I don’t deceive myself that I was the only one that this happened to. It felt worse that I hadn’t felt able to stand up to him because of the power differential between us– assaulted twice, really. The only thing that made this a little better was warning other female students and resident who were about to rotate and suggesting that they be careful around him. This was my own little campaign to right my world again on my own terms.

    So to the case– this is egregious on so many levels, but even with its clarity of wrongness it is still complicated for the resident. Rightly or wrongly, I would bet she went back and thought about every moment of their interactions, wondering if she was flirtatious or inviting in some way. I appreciate the nuance in the case of her previous relationship with a resident, because even tho that should make no difference whatsoever, the mind is a funny thing. Guilt and shame can arise from a very small nidus– worthy or not.

    So my thoughts would be

    1. yes, by all means leave the clinic. She would be too distracted to take care of patients, and she isn’t safe there– what happens if he is able to engineer them alone again at the end of the clinic when the staff have left? She should feign illness, and buy herself some time to think and talk to trusted friends, family or a mentor. Hopefully her PD can be part of her support network. All the PDs I know are a very special and wise bunch– simultaneously a mentor, parent, sibling, and honest advisor. If she is lucky enough to have someone like this, the whole matter will be much less unsettling.

    2. PDs have a duty to take this very seriously. The challenge is, everyone is different– some may feel very comfortable being identified, others (like me) would prefer to remain anonymous. Some time needs to be spent with the resident getting a sense of their values and concerns about disclosure. Governing bodies that can help sort it out are the licensing body, dept head and university. I would bet that this is a repetitive behaviour, and so effort should be put into making sure others do not have to endure it– but not at the expense of the resident’s feelings. I would hope that things have progressed over the past few decades, so that learners are not forced to make the choice that I was.

    3. I’m not sure about legal consequences, that would depend on the jurisdiction as to whether the crown takes the case on her behalf or she has to initiate it. It certainly should have teaching consequences– if this had happened with a geography (or any other) prof then you can be sure that there would be sanctions placed in order to keep students safe. Medicine should be no different.

    • Tamara McColl

      Thank you so much for your courage in sharing your experience. I’m almost left speechless. No student/resident should have to worry about the potential of sexual harassment/assault while in the presence of their teacher. You raise an important point regarding the process of filing a complaint (anonymously vs publicly ) and the potential consequences/implications of each – on the one hand justice may be served, on the other, unfortunately there is a certain amount of stigma and judgement that comes with such accusations and I think you played into this stigma with your own inner dialogue – “perhaps I was a little too drunk, or maybe I was too flirtatious”. How do we change this line of thinking? And how do we as staff physicians create an environment for our learners such that they will feel comfortable, even empowered, to come forward and report such incidents?

      • Loice Swisher

        Tamara,
        I these are great questions.

        My husband is a minister and he is required regularly to do “Boundary Training”. For physician, I think there is little training or awareness of boundary issues- with patient, staff or trainees. My guess is most have never heard the words. It feels like doctors almost get a pass on knowing ethics and the right thing to do so they don’t “need” that kind of discussion. It feels soft in taking up valuable time.

        There are courses out there for those that have gotten into trouble- and likely highly encouraged to attend to rectify a situation. From those experts research (dealing with patients) it is 3-10% of docs
        ————————————
        Healthcare professionals lack training as to acceptable and unacceptable behavior about sexual boundary issues. Results from several reports indicate, “the number of physicians struggling with sexual boundary problems appears to be 3-10% (Swiggart & Starr, 2002) of the U.S. physician population (reported incidents). Physicians are not familiar with the FSMB Guidelines addressing sexual boundaries.
        https://cme.mc.vanderbilt.edu/hazardous-affairs-sexual-boundary-violations-medicine-course-practicing-smart
        ———————————–

        The information seems to be more available in the patient-doctor realm-
        https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/GRPOL_Sexual%20Boundaries.pdf

        In going to search google, the ACGME website and other; I really couldn’t find any documents to help if this theoretical resident was mine.

        The first step likely is to recognize that there are some problems out there.

    • Loice Swisher

      Dear Anonymous,
      Thank you for your courage to share your story. Yours is not isolated and I don’t want you to fill isolated. Although my story is not one of resident-attending, my experience had many of the same elements of self-doubt and non-disclosure.

      A little more than two decades ago, when a was a young attending (at the same place that I did residency rotations), the attendings were highly encouraged to go to bed at night to allow the upper year resident to develop confidence and ability to be on their own before graduation. In fact, if you were still visibly around after 2AM the unspoken message felt by the residents was “you don’t trust me”.

      One night, one of the long time night nurses brought a pillow (which we almost never have) into the room where I was stretched out on the stretcher. He said good night, turned off the light and the next thing I knew he was on top of me kissing my neck. Shocked since 1) nothing like that had ever happened before and 2) I had no indication of any prior interest, I blurted out “We are not going to do that”. He got up and left. I put it in the “serious miscommunication category”. We actually worked together for years amicably- like it never, ever occurred.

      I chose not to tell anyone. It would have been a he said/she said thing- and since he stopped when I said no I didn’t believe anyone would think that there was only harm- and would be framed as a miscommunication that some how (in ways I had no idea) it would be construed that I did something to make this happen and I was making a big deal out of nothing. He had worked there for at least a decade without a problem so surely it must have been something about me.

      My thing on disclosure, is that women should be supported in however they want to pursue it. I think many feel bad/guilty if they don’t because they “might” be doing disservice to other women. I had personal priority that could not survive the risk at the time.

      Regardless of what happens- I think it is always twice assaulted. The first is the actual assault and the second is the guilt/inquisition from others. If the potential path and potential repercussions were made transparent prior to a situation occurring, then I believe woman would have less angst about their decision to come forward or not.

      • John Eicken

        Dear Anonymous and Loice-

        Thank you both for your courage and selflessness in sharing your personal stories, both of which are gut wrenching and disturbing. It seems as though you both experienced a sense of isolation following the events that transpired and I think your willingness to share your thoughts and perspectives are extraordinarily helpful to others who may have experienced situations similar to yours and may be struggling with their own sense of being ‘alone’. I think the course that Loice posted from Vanderbilt is a step in the right direction, however, I think as a profession we can and should do better in providing reporting mechanisms and emotional support that meet the desires and needs of all individuals who experience these types of horrible encounters. I don’t have concrete answers (hopefully our expert respondents and further community response may shed some light!) but I definitely think that raising awareness of the presence of inappropriate and unacceptable behaviors that occur within the medical profession is the first step towards meaningful change.

  • drallewellyn

    A perspective from another Aussie at the invitation of https://twitter.com/TChanMD

    Many would be aware that DBSH (discrimination, bullying and sexual harassment) has been quite topical in Australia of late. I’ve been involved in both the system responses as well as researching the problem and designing training solutions.

    What we have discovered is that junior trainees are very reluctant to report such events based both upon personal experience as well as the anecdotes of others personal experiences. Sadly it seems that many Program Directors (we call them Directors of Training) despite good intentions get the response wrong. The reasons for this are multifactorial but appear to include: these are often complex matters, right to initial privacy of individuals is a concern, competing loyalties and conflicts of interest they often require a good knowledge of policy as well as strong skills in having a difficult conversation.

    Trainees in Australia have suggested independent processes by which complaints can be made and an opportunity to complain anonymously (even if this means that a complaint cannot be progressed).

    My focus from a training perspective has been on developing face to face communication courses for Medical Managers and Directors of Training to deal with these sorts of issues both as bystanders as well as post event.

    1. I’d certainly support Sam going home sick.

    2. The first responsibility is to support Sam, this may require a bit of time so that she is able to make informed decisions about what she would like to happen. An issue at stake for Sam is that if there is an organizational response to protect her this will alert the harasser and has the potential to make the situation worse for her.

    3.
    This is sexual harassment plain and simple. He is conducting himself from a position of power and covertly. Formal advice should be obtained early from the HR department and in the Australian context the Attending
    (Consultant) would be at the minimum be given an official warning.