Harassment in Surgery: Key Findings and Needed Reforms

The medical field, particularly surgery, is characterized by intense hierarchies and a high-pressure environment, which unfortunately creates fertile ground for abuse of power, sexual harassment, and a pervasive culture of silence. Despite growing awareness and movements like Me Too, hospitals often fail to protect victims, allowing perpetrators to continue their harmful behavior with little consequence.

The Pervasive Problem of Harassment in Medicine

Young doctors, especially women, frequently encounter inappropriate behavior, ranging from sexist comments and unwanted touching to sexual blackmail and even assault. This is particularly prevalent in surgery, an intense discipline often dominated by men, where powerful superiors wield significant control over the careers of students, junior doctors, and even department heads.

Personal Accounts of Abuse

Emmanuel's Ordeal: At 22, during her first year of surgical residency at Geneva University Hospitals, Emmanuel was nearly raped by the chief resident. Fearing career repercussions, she remained silent. She later experienced further mistreatment, being made to feel like a "slut or a maid" rather than a valued doctor. This led her to switch to obstetrics and gynecology, hoping for a better environment, but she encountered similar harassment and grueling hours. The cumulative trauma led to severe depression and suicidal thoughts, ultimately forcing her to abandon medicine.

Lea's Experience: A medical student named Lea, who chose to remain anonymous, described a sexist atmosphere during her clinical internship. She was warned beforehand but was still unprepared for incidents like a senior resident making a crude sexual comparison with an organ during surgery. When she refused to answer questions about her sex life, a clinical director blackmailed her, threatening her position in the department. Lea learned that enduring such harassment was often a prerequisite for career progression due to the critical role of recommendation letters from superiors.

Barbara Vilt Harour's Testimony: Even highly accomplished female surgeons are not immune. Barbara Vilt Harour, head of pediatric surgery at Geneva University Hospitals and a leading authority on liver transplantation, recounted experiencing harassment throughout her 30-year career. She described incidents as recent as four years ago where she was touched and kissed against her will by male colleagues, some of whom were her hierarchical superiors. She expressed the deep humiliation of these experiences, even in her senior position.

Systemic Issues Enabling Abuse

Several factors contribute to the persistence of harassment in medical environments:

• Hierarchy: The pronounced hierarchy in medicine, with clear distinctions between senior medical staff, doctors in training, and nursing staff, creates an imbalance of power that perpetrators exploit.
• Career Dependency: Young trainee doctors are highly dependent on the goodwill and recommendations of their superiors for career advancement. This dependency makes them reluctant to report abuse, fearing it will jeopardize their professional future.
• Male Dominance: While women constitute the majority of medical students, their numbers significantly decrease at higher levels of the profession. For instance, at Luzan University Hospital, less than a quarter of senior resident posts are held by women, and in surgery, the figure is even lower. This male dominance can perpetuate a culture where inappropriate behavior is normalized.
• Culture of Silence: A climate of fear and silence protects perpetrators. Many witnesses are afraid to speak out, and some are pressured not to. Victims often feel ashamed and believe that reporting will only prolong their suffering or be disbelieved.

Efforts Towards Change and Their Limitations

Medical schools and hospitals are beginning to acknowledge the problem and implement measures to address it.

Educational Initiatives

• Role-Playing Workshops: Medical schools, like Luzan, are using role-playing scenarios based on real events to prepare students for potential harassment during internships. These workshops aim to teach students how to respond to inappropriate comments and gestures and empower bystanders to intervene.
• Awareness Campaigns: The Clash Collective, founded by students from Lausan, creates posters for hospitals highlighting the types of abuse and sexism interns face, using direct quotes from student testimonies.

Hospital Policies and Enforcement

• Zero-Tolerance Policies: Hospitals like Luzan University Hospital have adopted zero-tolerance policies for harassment and established procedures for receiving complaints.
• Investigations and Sanctions: Human resources departments conduct investigations, which can lead to reprimands, warnings, or even dismissals. In 2024, Luzan University Hospital reported 10 reprimands, 10 warnings, and 11 dismissals related to sexual harassment.

Challenges in Enforcement

Despite these efforts, significant challenges remain:

• Ineffective Procedures: Many complaint procedures are ineffective, with internal investigations and disciplinary actions often failing to materialize.
• Protection of High-Value Perpetrators: Hospitals face a dilemma when accused individuals are highly profitable surgeons or hold prestigious positions. There's a reluctance to take strong action against them, as they are seen as valuable assets. This is exemplified by cases where surgeons with histories of harassment were promoted or allowed to continue practicing.
  • Case 1: A respected chief surgeon at Geneva University Hospitals was known for exploiting junior doctors, particularly women, by demanding sexual favors in exchange for career advancement. He threatened to ruin the careers of anyone who complained.
  • Case 2: A surgeon with a past record of harassment was appointed head of department despite union protests. Hospital management argued that his past incidents were "a thing of the past" and that he deserved "forgiveness."
  • Case 3: Another head of surgery, previously reprimanded and warned for harassment, continued his behavior and even boasted about it.
• Lack of Transparency: Hospitals are often reluctant to disclose how many doctors are dismissed for harassment, reinforcing a sense of impunity.
• Perpetrators Moving On: Abusive doctors can sometimes move to other institutions, even internationally, and continue their behavior, as seen in the case of a senior physician from Geneva who was promoted in France despite his history of harassment.

The High Cost to Victims

Victims of harassment often suffer profound personal and professional consequences:

• Career Stagnation: Rejecting advances can lead to being excluded from operations, discussions, and opportunities, effectively halting career progression.
• Forced Relocation: Some victims, like Jali, an assistant physician, are forced to leave their hospitals or even go abroad to complete their training, paying a high personal price.
• Psychological Trauma: The experience can lead to shame, loss of self-respect, depression, and even suicidal thoughts, as in Emmanuel's case.
• Loss of Pride in Profession: The painful journey can strip victims of the joy and pride they once felt for their chosen profession.

The Path Forward

Breaking the silence is crucial. Victims and witnesses need to feel empowered to speak out, and hospitals must prioritize protecting survivors over perpetrators. Preaching zero tolerance and implementing preventive measures are insufficient if those in power are allowed to continue their abusive behavior without consequence. Openly discussing these issues and ensuring that sanctions follow reports of abuse are essential steps toward creating a safer and more equitable environment in medicine.