Avoiding #metoo in medicine

Let me say first that any woman who has ever been harassed or assaulted should NEVER be made to feel that it is her fault. It is always the perpetrator’s fault. Men can be boors, or worse, and testosterone can be toxic.

I went to Princeton University at a time when the ratio of men to women was 8:1, graduated from medical school in the 1980s, and raised two daughters. I’ve had ample reason and plenty of time to think about strategies to deal with harassment, parry a verbal thrust, and maneuver out of a potentially humiliating or harmful situation.

We’re lucky in medicine that we have intellectual qualifications — board scores, professional degrees — that are our primary entryway into medical school and residency programs. We’re not being judged PRIMARILY on our looks. Yet many social media comments recently have underscored the fact that some women in medicine have endured ridicule, harassment, and even assault in the course of their careers. It makes sense to explore any tactic that can help other women avoid similar painful encounters.

Here are some tips — learned through long experience. My hope is that they might help younger women in medicine feel less like potential victims, and more like strategists in a behavioral chess game.

Act like the person you want everyone to think you are

Don’t be fooled. The people who look most self-confident may be pretending. In fact, unless they have Trumpian egos, most people are less self-confident than you imagine. This is a game you can play too, to your advantage.

Stand up straight. Looking meek or unsure — whether you’re a little kid, a woman, or a man — invites bullying. Harassment is just another word for bullying. Don’t clutch your notebook or iPad to your chest. Learn to look people squarely in the eye. Nothing speaks confidence like a forthright look in the eye and a pleasant smile, no matter how much shorter you may be than the person you’re looking at. Social psychologist Ann Cuddy has given a fascinating TED talk on the importance of body language, and it’s well worth your time to watch.

Take a self-defense class for women. Many police departments offer them for free. The message they teach isn’t so much about learning to fight as learning how to avoid a fight. They show you how to adopt a stance that signals you’re not a vulnerable target.

Don’t wear a hairstyle that keeps you pushing bangs out of your eyes like a teenager, or trying to tuck a wayward strand behind your ears. Flipping your hair back could be misinterpreted as flirtatious, even if you mean nothing of the kind. If you wear contacts, think about wearing glasses at work. They protect your eyes against blood or fluid splashes, which is very important in every clinical setting, and they look professional.

Men have it easy in terms of what they wear. In professional, formal settings they wear a uniform:  suit, tie, light-colored shirt, and a narrow range of haircuts. The more conservative the setting, the more they lean toward white shirts and even more conservative ties. Think of this as protective coloration. They don’t want there to be anything to criticize about their wardrobe choices. They want people to listen to what they say, not focus on how they look.

Women have it harder, with too many choices, really. There’s nothing wrong with a conservative suit, or a dark-colored dress or tailored slacks under a white coat. Hairstyles can get even more complicated. The prettier you are, the more important a professional-looking, even severe, hair style is to your being taken seriously. Look at photos of Gal Gadot in what was a silly, but actually very funny, movie called Keeping Up with the Joneses. In the role of an international secret agent, her hair is pulled tightly back away from her face and twisted in a braid. The message: don’t even think about messing with me.

Take sufficient care with your appearance that you look well dressed, well groomed, and competent, even if it doesn’t come naturally to you. Get a personal shopper if necessary. In every career and every setting, having people WANT to look at you and talk to you is an advantage in education, promotion, and success. This is reality, not frivolity, and it applies to men just as much as to women.

Yes, you have a right to wear whatever you like. But poor choices have consequences, whether it’s a very short skirt, too much cleavage, or not bothering to care if you look sloppy. As my late mother used to say, “Act like a lady, and people will treat you like a lady.” Dress for the respect you want to enjoy.

How to respond to harassment

Inevitably, nearly every woman will encounter an inappropriate remark. My usual response has been just to ignore it and let it fall flat. There’s no point whatever in responding. The speaker isn’t likely to repeat it. Pretend you didn’t hear it; pretend you’re busy writing a note or checking your phone. The worst possible response is to look embarrassed. That just encourages a repeat performance. Remember the classic Far Side cartoon about the giant squid:  Just don’t show any fear.

If the speaker won’t give up, and the comments are hostile, look him straight in the eye and don’t be the first to break eye contact. If the remarks are more cringeworthy than hostile, practice the faint sigh and eye roll, and look around as if you’re bored. Either way, then divert the conversation by asking a question about the case, or bringing the focus back to the next tasks to be done by the team. You look professional and the speaker looks foolish, but you’ve said nothing insulting and you’ve shown your ability to take control of the situation.

A psychiatrist friend, who was an intern with me, gave me excellent advice one day when I was complaining about an arrogant surgeon’s rude behavior. Don’t get angry or feel hurt, he said. Just think to yourself, “Is this what it takes to make your penis get hard?” I’ve thought of that advice often, and it always makes me laugh.

Don’t make the mistake of responding angrily, or making an equally insulting remark, especially to a person who is your superior in rank. This puts you on their level rather than on the moral high ground, and puts you at risk of career and reputation damage. However, if the speaker is at or below your level of seniority, you can say, “Seriously?” Or you may want to ask this simple question, “Where is your mother?” It underscores the juvenile nature of the behavior, and immediately defuses the sexual context.

When I was a resident in anesthesiology, there was a senior attending physician who seemed to be a very pleasant man. But he liked to teach the art of mask ventilation by standing directly behind me and putting his left arm all the way around me to hold the mask while he squeezed the bag with his right. This happened more than once, even after I had learned to mask-ventilate quite well. I compared notes with the other four female residents, and learned that we all had been “taught” in the same fashion.

We made an appointment — all five of us — to speak with the chairman. We explained that we liked Dr. X, we thought he was a fine anesthesiologist, and we didn’t want him fired, demoted, or shamed. We just wanted the behavior to stop. The chairman, who was a highly articulate man, opened and closed his mouth a couple of times. I had never seen him speechless before. Then he said it would stop. We said thank you, and left. The behavior stopped, we all went on with our training, and Dr. X continued to be perfectly nice to all of us.

Be gracious and make friends

People say men and women can’t be friends, but don’t believe it. The best way to avoid harassment is to be on cordial — but not overfamiliar — terms with everyone you work with, even if it’s just a short-term rotation. You want them to be happy to see you and to work with you. The art of good manners is making everyone around you feel good.

Once you’ve had coffee or lunch with someone, maybe shared family photos on your phone, or talked about the unique virtues of your cat, that person is very unlikely to behave badly toward you. With senior physicians, keeping the talk completely professional is best. Asking for career advice or how they would handle difficult cases is the way to learn from them and to get good evaluations. Most of those “old white men” are actually nice people, and they can help you.

Once, as a medical student on my surgery rotation, I had spent a long day in the operating room with a senior plastic surgeon, who then offered to buy me dinner. I accepted, which was a bad idea. In my defense, I was tired and hungry, and since he was married I didn’t think this was a date. He proceeded to tell me how his wife didn’t understand him. I was sympathetic, and said how lucky I was to have a wonderful boyfriend who was also a medical student and understood how hard the work is. I went on to ask his advice about my father, who was developing contractures in his hands from Dupuytren’s disease. The upshot:  I referred my father to the surgeon, who did an excellent repair on his hands, and the surgeon and I stayed on very good terms.

Friendly but not flirtatious behavior is even more important with a man who is aggressively coming on to you. You want to change the dynamic, and get him to relate to you the way he would relate to a sister or a cousin. Getting to know him personally, and making him feel friendly toward you if possible, is the best way to do that. If you’re scared or repulsed, and try to avoid him, the pursuit is much more likely to continue. Think of this strategy in terms of animal behavior; you’re much safer if you’re part of the pack, not prey.

There’s no insult in being asked out or asked for your phone number, though it’s certainly inappropriate if the person is your superior in rank. Use your words, smile, and say no, I’m sorry, I’m not available. If you’re really afraid of reprisal or of bruising his ego, say, “It’s so kind of you to ask. I’m so sorry; I’m in a relationship.” Then offer no further explanation, and divert the conversation to another topic. As the Dowager Countess of Downton Abbey says, “Never complain; never explain.” All of us are in relationships, after all, and there’s no need to specify whether it’s a romantic relationship or a special bond with your dog.

If you’re a resident or an attending, take pride in being a physician. Don’t encourage use of your first name. I always introduce myself to patients as Dr. Sibert, and I say “Dr. Sibert” every time I answer the phone or take part in a “time out” in the operating room. Residents are never rude to me. A thoracic surgery fellow joined the staff at my hospital, and after we had worked together for years, I finally said, “It’s fine to call me Karen.” He shook his head and said, “Dr. Sibert, I just can’t.”

The tactic of consistent friendliness and professionalism — not overfamiliarity — also works well with nursing staff. Many young women physicians encounter hostility from nurses, and have trouble even getting their orders followed. This too can be managed.

Smile, and learn the nurse’s name. Don’t get offended or bristle, even if a nurse is rude. Always explain the reason for an order, and treat the nurse as a colleague. If the nurse offers a good reason for doing something, as long as it isn’t outright dangerous, go along and say thank you for the suggestion. NEVER express irritation at being paged, and say “thank you for letting me know” at the end of the conversation. When appropriate, thank the nurse for a good catch or observation. When you’re in a new environment, if you need something, ask where it is and offer to go and get it yourself rather than asking the nurse for it. This engenders immediate good will, and shows that you’re neither lazy nor entitled. You’ll know you’ve won when the nurses invite you to their potluck lunches — well worth the effort.

Avoiding misery

Don’t make the mistake of allowing yourself to be caught alone with anyone you don’t already know and trust. If you’re invited to go into a private office and you’re not comfortable, just leave the door open. Claim a severe headache (accompanied by nausea) and a need for air if necessary. There’s no reason to share a call room; it’s better to doze in a chair, or nap on a stretcher.

Don’t take stairways at night; take the elevator. If you have to go to a deserted parking lot after dark, ask a security guard to walk you out. Any time you feel uncomfortable, even if it seems irrational, trust that sixth sense. Head for a public place, with good lighting, where other people are around.

Yes, it’s unfair that women have to think in self-protective ways while men don’t. It would be lovely if the world were a perfect place, but it isn’t and won’t be. It makes more sense to be smart and in control than to have the unreasonable expectation that life will change immediately just because Harvey Weinstein has been disgraced.

The potential risks of the #metoo movement were outlined well by former US Secretary of State Condoleeza Rice in a recent CNN interview. “Let’s not turn women into snowflakes. Let’s not infantilize women,” she urged. In the worst-case scenario, she pointed out, men in hiring positions could decide that it’s just too much trouble to have women around, and opportunities could paradoxically diminish.

That would be a shame. Women who make it all the way through medical school have worked hard, and we’re neither weak nor delicate. Let’s continue to prove it. The only behavior you can control is your own, but you always have the opportunity to influence the behavior of others. That, with negotiating skills, constitutes the art of leadership. Making absolute demands doesn’t work. If we want to keep the doors open for even more women to achieve leadership positions and political power as time goes on, we need to work hard and concentrate on turning the men we work with into our allies, supporters, and sponsors. Thinking of them as enemies is a path to nowhere.

This post is now closed to comments.

17 COMMENTS

Jennifer

You have precisely articulated my approach to interpersonal interactions in the hospital, and this is a very successful and diplomatic strategy for me also, and allows for a high level of enjoyment for myself, colleagues with whom i interact, nurses and staff. I am impressed you put this in words so well. I have also become a very successful physician leader with this strategy and others. I have never felt it to be a disadvantage to be female in medicine (though was fortunate to start at a time when 50% of my class was female), but rather an advantage. I am saving your article to show students and my own children the steps for success, because this approach works, in spades.

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Zoe

As a young physician working in the emergency department I found this to closely mirror the habits I’ve adopted. Some of it I think is basic professionalism, and it never hurts to remind people that acting professionally does help people treat you in a professional manner. But some of it is boots-on-ground practical advice about navigating some of the terribly inappropriate things that happen when you are a woman working in the settings we work in. I think you made it clear that it would be ideal to not have to take any special care with your appearance, demeanor, or diplomatic abilities in order to avoid sexual harassment. But until we reach the ideal, women need some tools to help them get through the day!

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Yvonne

With all due respect, this sounds like something that belongs in the
1955 ‘Good House Wife’s Guide’ . Many professional women will find parts of this offensive and out of touch.

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karen

Dear Yvonne,

I have to wonder if you read the entire column. Housewife? 1955? We’re talking about professional women in the workplace, or at least I am. Nearly every woman has to handle some sort of gender-based harassment. Is it better to think proactively about ways to decrease the odds, and manage it when it does arise, or not? I read about women becoming speechless, embarrassed, or looking like a paralyzed deer in the headlights when men say or do stupid things, and I know that those responses only invite further bullying. We all have choices about how to prepare and how to respond, and if you don’t like mine, please add your own!

All the best,

Karen Sibert, MD, FASA

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Eliza G. Bruscato MD

I wrote this as a reply in another site. Sorry so blunt. Had to be said.

Nope. I had a headband, glasses, an Oxford, jeans and penny loafers on the first time the DEAN of Medicine made terrible comments about my big brown eyes and my big tits. The next time, I had a ponytail and glasses on w jeans and a T-shirt when 4 fellow med students told me that a ponytail is great for men to hold on to while women give a blow job.
I was in scrubs and zero makeup having a very professional conversation re the next case with my onc Attending when he said I should wear a smaller scrub top like the other women to show off what I’ve got.
I was the intern on my 20th hour (looking and smelling great) when the med student decided to take his clothes off to sleep in the only call room with me (I nipped that in the bud!)
I was an Attending when an asshole anesthesiologist grabbed my ass at a nurses station when I ran in for a delivery with a skort and gym shirt on. I wasn’t even talking to him. I was asking the nurses if I made it in time.
I had chest pain while coming out of a patient’s room (likely gas) and I grabbed my chest and 2 asshole anesthesiologists
laughed and asked if my implants exploded and if I needed an exam.
Shall I go on!?! NOT ONCE does the fine doctor address the men’s behavior. Her talk is for interns and medical students. She should stay in her imaginary lane.

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karen

Dear Dr. Bruscato,

It sounds as if you have had some truly terrible male colleagues, and I am very sorry that you had to experience those things. I can’t imagine what you think you read in my column that gave you any impression either that I think you invited those behaviors, or that I am excusing them. I made clear at the very start that I do NOT blame any victims, or condone any boorish (or worse) behavior.

I have read many social media comments about awful experiences, and from many of them I concluded that the women had no idea how to respond. I don’t know how you handled the ones directed at you, but I have at least offered ways to respond that might be useful. Being speechless or embarrassed, or looking like a deer in the headlights, is the worst possible response, and just invites more. Having spent most of my entire working life in overwhelmingly male environments, I think there is no question that some protective coloration in terms of dress and attitude helps women project an image of strength that reduces the LIKELIHOOD of harassment, though the real jerks can’t be stopped that easily.

I genuinely hope that as you get older all this will diminish, as it does for most of us.

All the best,

Karen Sibert, MD, FASA

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Rae Brown, M.D.

Oh Karen,
It so hurts my heart that you need to write this. After a career of trying to be sensitive to the issues of all of the women (and men!) around me, I am left with the unfortunate feeling of guilt by association. As we come to grips with a societal change for the good, I hope that women in healthcare and throughout the world will acknowledge and support their colleagues and friends that are born with an x and a y chromosome but try their best to be supportive and to do the right thing every day. Testosterone can be an adjuvant for bad behavior, but it is not an explanation nor a reason why bad behavior should be countenanced. Most men that I know are professional and sensitive to the behaviors that they manifest. All men should not be painted with the same harsh brush; it makes for a sad day in the life of a physician whose wife is a respected and loved physician, and whose daughter is a well trained, feisty nurse.

Thank you for your comments.

Rae

Rae Brown, M.D.
Professor of Anesthesiology and Peddiatrics
University of Kentucky/The Kentucky Children’s Hospital

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Bahareh keith

You are setting us back at least 50 years with this kind of nonsense. It is the objectifying and harassment of women that needs to stop not the way that women look and act. This is yet another example of blaming the victim. What you are describing is exactly the problem. Women should not feel the need to change who they are or how they look out of fear of what immoral or assulting men might do. It’s the men that need to change!!! You did what you had to in order to survive because you had no other choice but we need to eliminate that bad behavior from men that drove you to this not continue to bend under their assault!
Dr MeToo!!!!

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karen

Dear Dr. Bahareh,

Really? How much experience do you have as a woman in medicine? As a woman who has worked in the hospital setting for 30 years, I would simply say that I have seen many women who would do well to heed some of this advice. Much of it holds true even more so in the corporate setting. I’m not saying that you can 100% avoid sexual harassment. What I am offering is some advice to reduce the odds, and give some guidance in managing it if it does occur. It would be lovely to eliminate all bad behavior from men, but I hardly think that’s likely, do you? The one bit of good news — today’s politically correct environment makes the overt offenses less likely, but I’m quite sure the locker-room talk continues on.

All the best,

Karen Sibert, MD, FASA

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Clare Wilson

I have a question. How do we work out if we are too pretty and need to uglify ourselves or too ugly and need to prettify ourselves? What if we go in the wrong direction?

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karen

Dear Ms. Wilson,

These are simply suggestions born of long experience, both my own and watching other younger physicians over the years. Frankly, women in medicine have a lot more latitude in appearance than women in the corporate world, for instance. The fun of having your own blog is that you’re free to state your own opinions and observations.

All the best,

Karen Sibert, MD, FASA

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Ann Ruscher

Dear Dr. Sibert;

I am also an anesthesiologist, professional, and mother. I graduated not long after you did. I lived through the time when there was no recourse for vile behavior other than keeping your guard up, ignoring it, and moving on. I now have an 18 year old daughter, who happens to be training to be a military officer. Putting up with harassment in any form is no longer necessary. Confronting one’s harasser is not to be expected. Reporting and consequences are to be expected. It is the responsibility of our generation to recognize that harassment and demeaning comments are unacceptable, and to be advocates for our colleagues and trainees. In the words of the United States Military Academy; “It’s on us!” We must all be watchful and not allow this. It is NOT the responsibility of women to prevent men from behaving poorly. Your entire post belongs in the past. Things are changing. For the better. Please consider joining this century.

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karen

Dear Dr. Ruscher,

Thank you for writing. So many of the hurtful comments I’ve read about happen in one-on-one situations, and there isn’t possibly an option to report on them all. It would come down to he-said, she-said, and if the woman is junior, her career and future recommendations would be more likely to be damaged. Many young women I know do not have the advantage of the physique or cultural upbringing that allows them to easily project an image of strength, and I don’t think they have ever thought that they could. Those are the ones who are most at risk of bullying and harassment, and the least likely to report or stand up to it.

There has never been an instance when an inappropriate remark has been made to one of my medical students or residents in my presence, and I like to think that the presence of senior women is enough to extinguish it, especially in today’s world. But it hasn’t nearly gone away, and you and I both know it. Is it better to offer some tactics, or to cherish the illusion that “It’s on us” and “#metoo” have already completely changed the world? And, as I said, I think Secretary Rice has a valid point in fearing that opportunities for women may diminish if men in high positions decide that it’s just too much trouble to have us around.

All the best, and thank you again for taking the time to write.

Karen Sibert, MD, FASA

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Ann Ruscher

Dear Dr. Sibert;

I understand your experience and your perspective; however, I vehemently disagree. Even if the comments are made without a witness, they are reportable. It is highly likely that the harasser has said similar things to multiple people. I also detect in your response, a willingness to believe the he in the situation over the she, or at least to question the reporter. As has been so amply demonstrated in the world outside of medicine, there is really not a lot of reward in reporting harassment, true or false. That doesn’t make it less important. We haven’t changed the world just yet, but that doesn’t mean we shouldn’t be trying. It is imperative that those of us who are experienced, and especially those in leadership advocate for our colleagues. It is NEVER appropriate to blame the victim. I note that you are the president of the California Society of Anesthesiologists. I invite you to participate in the AMA forum on sexual harassment in the academic environment that starts tomorrow. We can take the lead in educating our constituency on the issues of sexual harassment. And we can make progress. It doesn’t have to be the victim’s responsibility. Your article reminds me of a woman neurosurgeon, Francis Conley, who spoke at a meeting early in my career. She implied that one could not have children and succeed in medicine. I hope that sooner rather than later your advice will be as outdated as hers is now.

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karen

I’ve learned that the only behavior I can control is my own. However, I can definitely influence the behavior of others by how I choose to behave. That, along with negotiating skills, is the art of leadership. Reporting every puerile or insensitive comment only makes lifelong enemies of men who could potentially be turned (educated, led) into being allies and supporters. Women who seek to advance in leadership can’t be seen as the enemy. And yes, there are a lot of young women in medicine who need to learn how to behave and dress professionally. They apparently didn’t learn that growing up, but it becomes important if you want a seat at the table with grown-ups. No one is saying “blame the victim”. I’m trying to emphasize tactics and skills that can KEEP women from becoming victims, as well as lead the process of improving the work environment for everyone.

Best,

Karen Sibert, MD, FASA

[Reply]

Cori McBride, MD

You have described some reasonable advice on how to behave like a professional.
-look people in the eye
– treat nurses with respect and as fellow professionals whose priority is patient safety
-dress for the role you want

But the mistake you have make is somehow implying that dressing and comforting yourself as a professional will insulate you from harassment.

I was a surgery resident in the 90’s. I had experiences that ranges from “socially akward” to inappropriate offers,and unwelcome touching. This was not about my behavior but theirs as well as the leadership at the time that did not perceive it as harassment but said “it just letting off steam” and did not do anything about it when the women said anything except say the things you did.

As leaders we have evolved and changed. We expect all our people of all genders to act as professionals. Women need to act as professionals, not to protect themselves from harassment but to be good doctors and Men and Women need to be professionals and that professionalism means not harassing or bullying others.

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Laura

Carrying oneself in such a way as to command the already-deserved respect is not, on its own, a bad suggestion. However, your suggestions to “Pretend you didn’t hear it; pretend you’re busy writing a note or checking your phone,” are backward. I agree with your points above that it’s helpful to provide women with a pre-planned response to help them avoid looking embarrassed or fearful. However, that doesn’t mean that we should be teaching women to accept men’s inappropriate behaviors. With these words, you are, in essence, telling women to grin and bare it – that this is the way of the world. Unchangeable and without recourse. This is the backward thinking that reminded me, too, of a guide for 1955 housewives. “Don’t give them the satisfaction of seeing you flustered” does little to point out the danger of these remarks. Sexual harassment is more than childish teasing, and we must recognize it for what it is and deal with it. Let’s instead advise women to pre-plan empowering scripts. “Would you like to rethink your inappropriate remarks?” or “How about if we discuss this in the Chairman’s office?” We needn’t show anger, fear, or embarrassment, but we also needn’t accept those comments. Do we not all consider guilty a man who doesn’t speak up when he witnesses these events? Let’s not let teach other women to quietly and meekly tolerate this behavior.

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