What’s worse than experiencing harassment and discrimination? How about experiencing harassment and discrimination with nowhere to turn for help?
What’s worse than having nowhere to turn for help? How about turning to people for help and then later realizing that they are aligned with the perpetrators of the harassment and discrimination in the first place?
New York City (NYC) Council Member Helen Rosenthal, MPH has heard stories of how women medical students, residents, physicians, and other health care professionals have been caught in such situations. They’ve told her how they’ve tried to go through the channels offered by their institutions, such as medical schools or hospitals, only to get little help and even suffer retaliation, resulting in damage that could take years to heal. Learning of such experiences prompted Rosenthal, who is also the Chair of the NYC Committee on Women and Gender Equity, to introduce legislation that, if passed, would establish a Gender Equity Advisory Board for NYC’s hospitals. The Advisory Board would advise the Mayor and City Council on how to keep women healthcare workers in NYC safe at their workplaces.
The key is that this Advisory Board would be independent of medical schools, hospitals, and other healthcare institutions in NYC and consist of people from different diverse disciplines, demographics, and backgrounds. Such a structure could help prevent the institutions and their leadership from having sway over the board. It would also provide a potentially safer, more empathetic channel for people to register complaints about discrimination, harassment, or both. After all, it can be more difficult to understand discrimination and harassment if you haven’t experienced it specifically yourself.
Making sure that women feel safe in healthcare environments should be kind of important to you, assuming that you like being alive and you like your family and friends to be that way too. After all, there’s a darn good chance that a woman healthcare professional will care for you, your family, or your friends at some point. According to Rosenthal, “women make up close to 80% of the healthcare workforce.” And women have been comprising close to half of all medical students for quite a while now, according to the Association of American Medical Colleges (AAMC). That means lots of doctors are currently and will continue to be women. If you still believe that women don’t make as good doctors as men, then maybe it’s time to ditch such antiquated thinking along with the sundial or hourglass that you are currently using to keep time.
So which then would you prefer, when it comes to the people taking care of your health and potentially your life? Would you want them stressed out, distracted, and even burnt out because they are facing discrimination or harassment? Or would you want them to feel safer and more comfortable so that they can make full use of their talents and abilities to help you? So what’s it going to be? Do you even have to think about it?
To say that discrimination and harassment may occur in medicine and health care would be kind of like saying there may be mosquitoes who want to bite people. Studies have found both discrimination and harassment to be quite prevalent. For example, a study published in the New England Journal of Medicine, revealed that 65.1% of women general surgery residents reported gender discrimination and 19.9% reported sexual harassment. As I have reported before for Forbes, other studies have found even higher numbers.
Despite the prevalence of harassment and discrimination, studies have at the same time revealed that many women health care professionals may be reluctant to report such transgressions. An AAMC survey showed that only 21% of medical students who suffered harassment or other offensive behaviors ended up reporting the incidents to faculty members or administrators. The reasons for this silence? Well, for 37%, it was “I did not think anything would be done about it,” for 28% “fear of reprisal,” and for 9% “I did not know what to do.” That’s well over half feeling like there is no real recourse. According to a 2018 National Academies of Sciences, Engineering, and Medicine report, low reporting rates continue well beyond medical school deep into women’s medical and health careers. Reporting rates are even lower for women of color such as Black women, Asian American women, and Latinas. In this case, silence is not golden. Instead, it can be lead, like a lead pipe.
“This is the impact of cultural misogyny, which is insidious,” explained Rosenthal. “It is so deeply embedded everywhere and starts with a ruling class. The old guard were taught and trained to be physicians in a certain way. Since it worked well for them, they are continuing that when training others.”
The majority of leadership of medical schools and hospitals continue to be White men, despite medical school classes since the 1990’s being a majority women and men of color. You would expect several decades of many men of color and women going through medical school to result in more of them in leadership positions at established institutions. However, a Perspective piece in the New England Journal of Medicine estimated that at the current rate academic medicine would not reach gender parity for at least another 50 years. Yes, climate change may be in some ways moving faster than diversification.
Rosenthal has long been interested in health care, having gotten a masters in public health and studied issue about physicians in medicine and medical malpractice. The idea for the bill came after plaintiffs in an age, race, and sex discrimination lawsuit against the Mount Sinai Health System’s Icahn School of Medicine approached her. I previously covered for Forbes the initiation of this lawsuit as the following tweet summarized:
“We started brainstorming and worked with the city council to think about what it is the city has jurisdiction over,” related Rosenthal. “What can the city do to shine a spotlight on discrimination and harassment and change the culture.”
“Consider how much damage [perpetrators of discrimination and harassment] are doing to all of the medical students and doctors as well as patients,” said Rosenthal. “If there is an environment that is dismissive of women, they have a bigger challenge in earning respect both from peers and superiors and from patients. How confident then will the patient be of the woman medical student or physician?” She added, “This is not good for anyone. Much like systemic racism, it is embedded in how these supervisors teach and behave.”
The plaintiffs in the lawsuit have claimed that they used the available channels at the Icahn School of Medicine like Human Resources (HR) to complain about the discrimination and harassment that they were facing. According to them, while they initially were assured that these channels would protect them and maintain confidentiality, this didn’t turn out to be the case. Instead, much of the efforts of the institution allegedly seemed to be to protect its leaders and those people chosen by the leaders.
On their website, Equity Now, an initiative launched by the plaintiffs, describes themselves as “a group of current and past employees of the Arnhold Institute for Global Health at Mount Sinai. We are physicians, public health practitioners, administrative assistants and project managers.” The website continues by saying that “Over the last few years, we have all experienced workplace discrimination that damaged our careers and personal lives. Our attempts to address these issues through institutional mechanisms failed, and we found ourselves left with no option but the legal route to have our voices heard.”
As example of institutional mechanisms failing, one of the plaintiffs, Amanda Misiti, EMPA, a Program and Policy Research Manager at the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai said: “There was no integrity to the ‘investigation’ we participated in. Our confidentiality was not respected, there was no transparency and ultimately we were retaliated against and further hurt by institutional gaslighting.”
Another plaintiff, Stella Safo, MD, MPH, an attending physician at Mount Sinai and a Strategic Advisor at Premier Inc. related that she found that “your complaints could get you in more trouble. HR is not your friend. HR works for the institution first.”
Safo mentioned suffering “gaslighting” that tried to “make you think that you are the problem. They try to convince you that what you are seeing isn’t happening and these things that you are experiencing aren’t so bad.” In this situation, gaslighting doesn’t have anything to do with using a cigarette lighter and any liquid or emission that may be referred to as gas. Instead, the Encyclopedia Britannica defines gaslighting as “an elaborate and insidious technique of deception and psychological manipulation, usually practiced by a single deceiver, or ‘gaslighter,’ on a single victim over an extended period.” That single deceiver can be a group of people, an organization, or an institution. The encyclopedia entry continues by saying, “Its effect is to gradually undermine the victim’s confidence in his own ability to distinguish truth from falsehood, right from wrong, or reality from appearance, thereby rendering him pathologically dependent on the gaslighter in his thinking or feelings.”
The following tweet from @EquityNowSinai forwarded a list of “gaslighting” techniques:
Safo explained how such actions “damages your psyche” and how “they tried to separate people, whispering that other people didn’t agree with you to create in-fighting.” Safo, who earned her medical degree from Harvard Medical School, said: “There is no reason so many of us have to work this hard just to keep a few men happy. I want to help other Black women know how to navigate such a system.”
Misiti emphasized: “Third party reporting systems for discrimination are of the utmost importance if organizations are truly committed to equity. This is something I feel very strongly about from my experience.
Of note, in response to the lawsuit and its allegations, representatives of the Icahn School of Medicine at Mount Sinai provided me with the following statement: “Our primary focus remains on delivering a welcoming, safe, equitable environment so that all staff and students thrive. We strongly disagree with the claims made by the lawsuit and will continue to vigorously defend against it.”
Having a truly independent body for those experiencing discrimination or harassment to turn to could go a long way towards changing many existing systems in medicine and healthcare. Again, independent means separate from the influence of medical school, hospital, or other health care institution leadership. After all, you’ve heard the saying about not wanting “foxes to run the henhouse.” In other words, would you want leadership of an institution ruling on complaints that may be about the leadership or people being protected by the leadership? That could be like someone saying, “oh, you are complaining about me,” and then putting a “complaints department hat” on and asking you to trust him. “One of the hopes is a State colleague will pick this bill up and institute a similar bill for New York State, “ said Rosenthal. “The State has authority across all of the hospital systems in New York State and can institute changes.” Until such changes occur, how many more people will either suffer in silence or face retaliation when speaking up about discrimination and harassment? And how in turn could this affect you and other patients?