This is the second installment in a 番茄社区 series on sexual harassment in medicine. The first story, "When Mentor Becomes Aggressor," examined the reasons why women frequently don't report incidents of harassment. In this story, we look at a possible outgrowth of the new attention on harassment that could hurt women's interests.
Melissa Garretson, MD, a pediatric emergency physician in Texas and an American Medical Association delegate, was concerned about the AMA's own policies for dealing with harassment. At last November's interim AMA meeting, she co-wrote an emergency resolution calling for a review of those policies.
With the broader #MeToo movement still making headlines, she noticed signs of a backlash almost immediately.
When she went to shake hands with a fellow member of her Texas AMA delegation, shortly after the resolution passed, he said to her, "Oh, can we even shake hands anymore?"
"And I said, 'Are you kidding me?'"
"We're not talking about, 'I shook your hand,' we're talking about egregious behavior," Garretson told 番茄社区.
When men start to conflate normal social interactions with behavior that's clearly inappropriate,"I get a little irritated," she added.
Samantha Rosman, MD, a pediatric emergency physician and co-author of the same emergency resolution, said after she publicly shared her own account of being sexually harassed, some male colleagues joked that they couldn't give her a hug anymore.
She viewed their comments as a "fear tactic." These men tried to "minimize the seriousness of the situation" by implying that women are simply "misinterpreting friendly behavior," Rosman said.
One male who responded to a 番茄社区 survey on harassment offered this: "As a male, I now do not feel safe being alone with colleagues of the opposite sex in fear of something may be misconstrued and cost my career."
The idea that men think women will report harassment for any reason at all infuriates Garretson.
"There's not a woman in the world who wants to come forward and say 'Oh hey, I was sexually assaulted,'" she said.
But not all of the men responding to Rosman and Garretson's #MeToo moment reacted this way. Several men congratulated Garretson and spoke of how proud they were of Rosman for sharing her story, Garretson said.
Understanding The 'Pence Effect'
Hugs and handshakes aside, these comments signal a greater concern for women, particularly younger female clinicians: that men in leadership positions may retreat from mentoring women.
The idea of men distancing themselves from women in medicine, as well as other professions, out of fear that they may be accused of some form of impropriety, isn't just hypothetical.
Media reports have dubbed the phenomenon "" after Vice President Mike Pence who, as a rule, avoids dining alone with any woman but his wife.
Much of the backlash against #MeToo from men has taken the form of trivializing the problem and accusing women of being (take your pick) too sensitive, unable to take a joke, too hostile, or gold-diggers.
But the "Pence effect" is also a form of backlash and is a real concern, said Sharon Stein, MD, president-elect of the Association of Women Surgeons.
"So much of opportunity has to do with networking and your ability to relate to people, person-to-person and if you don't have that opportunity to interact with people on a more ... human basis, rather than just about a particular clinical scenario, you will lose out on opportunities. There's no question about that," she said.
What the Pence effect does, said Dara Kass, MD, CEO of FemInEM, an open access resource focused on gender disparities, is imply that "nobody's capable of moderating their own behavior, everyone is out of control and the only way to [regain control] is to create these artificial limits around who you're around."
A recent article in detailed the lengths to which some men on Wall Street have gone to avoid harassment claims: no dinners alone, no sitting next to female colleagues on flights, booking hotel rooms on different floors, and skipping any one-on-one meetings.
"Advancement typically requires that someone at a senior level knows your work, gives you opportunities and is willing to champion you within the firm. It's hard for a relationship like that to develop if the senior person is unwilling to spend one-on-one time with a more junior person," Lisa Kaufman, chief executive officer of LaSalle Securities told Bloomberg.
And right now, there simply aren't enough women in leadership positions to foster the next generation on their own, Kaufman said.
Reshma Jagsi, MD, DPhil, a radiation oncologist and director of the Center for Bioethics and Social Sciences at the University of Michigan in Ann Arbor, agreed.
"This potential chilling effect on the mentorship of women is a real risk," she said.
All Clinicians Need Mentors
"One of the very best things about medicine is that it is an apprenticeship model," Janis Orlowski, MD, chief healthcare officer for the Association of American Medical Colleges, told 番茄社区 in a phone interview.
She recalled a time when, as an intern, she found herself flustered by a difficult case, and an older male physician stepped in to explain a difficult rhythm strip to her, despite it being 11:00 p.m.
"He sat down with me for an hour, and walked through ... why [this case] was unusual, what you should do to treat it."
On one hand, her experience showed how "profoundly important" the apprenticeship model is.
But on the other, "these apprenticeship models are exactly the kinds of relationships where things can go awry," she said.
It's critical to find a way for this kind of mentoring to continue, so that every student and intern can learn from great teachers, Orlowski said, but there also must be mechanisms to report complaints when necessary.
After publishing a study on in JAMA, Jagsi said she received a slew of emails from men as well as women.
Some men "wanted to make meaningful change," she said. Others wrote to say they were encouraging their male colleagues to keep "appropriate distance from women," apparently intending to protect their more junior female colleagues and trainees.
Jagsi said that's not helpful. Some 84% of medical deans and department chairs are men, and cutting women's interactions with them amounts to "protecting women from opportunity," she said.
Said Kass, "It's really privileged to say, 'Well I'm going to take my privilege and go home.'"
Medicine puts responsibility on experienced physicians, "and that includes training the next generation of physicians," she said. "If you're only looking out for what you think are your best interests, even though none of the data support the fears that you have, then you're doing harm to both the patients, and the physician workforce," she said.
Senior physicians who decide they can't be mentors to women should leave medicine, she argued.
"It will not help women if men mentor men and women mentor women," Jagsi added. That kind of stratified mentoring won't help close the massive gender gap at the healthcare hierarchy's higher levels.
"Ultimately, if you want to create a profession that's not vulnerable to sexual harassment ... women need to be actually represented in positions of true authority," Jagsi wrote in an email.
Men's Place in #MeToo
"Ending sexual harassment is not about any one individual or group of individuals, it is rooted in implementing system-wide changes that ensure a healthy, safe and respectful environment for ALL individuals," wrote Apoorve Nayyar, MBBS, a postdoctoral fellow at the University of North Carolina School of Medicine, in an email.
Nayyar, who co-authored a , said he often hears men saying they support #HeForShe -- a campaign focused on promoting gender equality, "because I have a daughter" or out of concern for their wives.
"I think that men need to play a bigger role in equity, because it's the right thing to do," he said. "As a decent human being, you want the other human beings to have the rights just as you."
Garretson agreed that most men are "nice, upstanding people" and aren't engaging in inappropriate behavior.
"We need for [those] men to speak up ... I think that would turn the tide faster," she said.
Some "well-intentioned" men may be concerned about misstepping -- saying or doing something to offend someone -- Nayyar said in an email.
"It's okay if you don't know, ask. Ask your female colleagues, friends and co-workers. Be open-minded. If someone tells you that a particular action or comment made them uncomfortable -- try and understand why and avoid repeating that," Nayyar continued.
False Reports
Kathryn "Kate" Clancy, PhD, an anthropologist at the University of Illinois Urbana-Champaign, and co-author of a 2018 on harassment, acknowledged that false reports do happen.
Nevertheless, she said at an last June, there seems to be a fixation on false claims out of proportion to their actual prevalence. Estimates suggest about 2%-8% of sexual harassment reports are false, she said. Nayyar cited a similar figure, based on a review by .
"The issue is not that false reports are impossible. The issue is that we hold overwhelming skepticism towards credible claims of harassment and assault," Clancy said at the June event.
Moreover, she said, it's also the case that men are markedly more likely to be victims of harassment incidence than of false claims. She cited estimates that up to 40% of men are sexually harassed in the workplace.
Last year, by the nonprofit Stop Street Harassment that found 43% of men experienced some type of sexual harassment in their lifetime.
And data from the indicate that, in fiscal 2018, 15.9% of sexual harassment charges were filed by males.
Kass also pointed out that false claims of harassment and assault that have occurred have been "rooted out quickly."
"If you're a man of influence, the idea that you would be falsely accused and not be able to defend your case successfully ... is unproven," she said.
Nayyar agreed with Clancy and Kass that critics' focus on false accusations is overblown, only a minority of claims are "unfounded or baseless," "suggesting that the vast majority of complaints have some basis behind [them]."
Concerns about false accusations are an even greater reason to support establishing policies for reviewing and investigating complaints "with due diligence," Nayyar said.
"If you have done nothing wrong, you have nothing to worry about."
What Now?
"[W]hile minor changes [such as] keeping the door open when having [a] one-on-one meeting with a female colleague/mentee/mentor ... are somewhat okay if they make you feel more comfortable, major changes in behavior like avoiding mentoring or interaction[s] with women would be catastrophic," Nayyar said in an email.
It's bad for institutions and will "thwart progress," he said.
"Preventing sexual harassment in our workplaces needs to be at the front and center of our healthcare policies, with strong, effective reporting and actionable investigation mechanisms. Only then will the goal of #ZeroTolerance be truly achieved," Nayyar added.
Next: Time's Up