Using incident reporting to understand and characterize sexual harassment of physicians by patients

INTRODUCTION

The US Equal Employment Opportunity Commission defines sexual harassment as “unwelcome sexual advances, requests for sexual favors, and other verbal/physical conduct of a sexual nature that affects an individual’s employment, interferes with an individual’s work performance or creates an intimidating, hostile or offensive work environment.” [1] A survey found that nearly two-thirds of women faculty and almost half of male faculty reported sexual harassment by patients or their families [2]. Sexual harassment in the workplace has been identified as a challenge to the recruitment and advancement of women physicians [3], and it is unclear whether physicians report or seek redress for these incidents [4]. Using incident reporting, we characterized the nature, impact, and response to incidents in which patients sexually harassed physicians.

METHODS

Incident reporting is widely used to capture health care teams’ concerns about patient safety. We created a nationwide, web-based, structured, incident reporting tool for physicians to anonymously report incidents of sexual harassment by patients. We advertised the tool through email listservs, social media, an academic journal, and two physician blogs (KevinMD, Doximity). We included structured questions about respondent traits, incident characteristics, individual and institutional response to the incident, and impact on the respondent. Respondents also described the incident in free text, which we coded inductively. Our Institutional Review Board (18-26440) approved this study.

RESULTS

Fifty-three physicians from 13 states and nine different medical specialties used this tool. Forty-seven (88%) respondents were women and 24 (45%) were in training at the time the incident occurred. Forty-three respondents shared that the incident occurred between 2011 and 2019, while nine respondents’ incidents spanned 1986–2010.

Overall, 39 (73%) of respondents were White, 13 (24%) were Asian, four (7%) were Latinx, and one (2%) was African American. Twenty-three (43%) incidents occurred in the outpatient setting, 20 (38%) inpatient, and 10 (19%) in the emergency department. Twenty-six physicians (49%) had met the patient on at least one prior encounter and 31 (58%) continued caring for the patient after the incident occurred. Table 1 includes types of sexual harassment, ranging from disrespectful verbal comments to unwanted physical contact, and their impact on respondents, including adverse effects on mental health and decreased work satisfaction. The most common response was telling a colleague or supervisor (Fig. 1a). Only 11 respondents formally reported the incident; four responses involved dismissal of concern/discouragement of future reports (Fig. 1b). Thirty-seven respondents did not report for the following reasons: perceived the incident was not significant enough to report (27/37, 73%), did not think reporting would be impactful (20/37, 54%), did not know how to report (20/37, 54%), did not want the patient to experience repercussions (13/37, 35%), felt ashamed or embarrassed (11/37, 30%), and did not have time to report (8/37, 22%). Five respondents did not share whether or not they formally reported.

Table 1 Nature and Impact of Incidents in Which Physicians Were Sexually Harassed by Patients*

Figure 1

Responses by individuals and institutions to incidents in which physicians were sexually harassed by patients. a) Participant response to the incident (n=50). Participants were able to select more than one option. N reflects the total number of participants who shared a response when asked, “what did you or your colleagues do in response to the incident?” b) Institution or supervisor response to the incident (n=11). N reflects the total number of participants who answered “yes” to formally reporting the incident to a supervisor, human resources department, risk management, law enforcement, or other entity.

DISCUSSION

Respondents in this study reported that sexual harassment had significant impacts on work experience, and many suffered negative impacts on mental health. These results are consistent with large prospective cohort studies on the impact of sexual harassment on mental health [5]. However, many physicians, both in our study and others, do not formally report incidents of sexual harassment by patients. Among those who did report incidents, the institutional responses varied widely, and many of the reported institutional responses do not align with recommendations for addressing sexual harassment [3]. It is likely that physicians did not report sexual harassment incidents perpetrated by patients because they did not expect a supportive institutional response. We recommend that institutions adhere to NASEM guidelines for addressing sexual harassment.

To our knowledge, this is the first study to use incident reporting to capture real-world descriptions of sexual harassment of physicians by patients. As a method, incident reporting cannot be used to estimate incidence or prevalence. Instead, it is intended to surface existing concerns that do not come to light through other mechanisms. Our study likely captures a non-random subset of incidents that may differ from overall harassment experiences. This study includes predominantly White and female-identifying physicians. Because other studies have found that non-White resident physicians experience sexual harassment more frequently [6], future work should focus on the intersection of race/ethnicity and gender. Next steps include determining best practices for how physicians, supervisors, and institutions can better address and prevent incidents of physician sexual harassment by patients.