This chapter introduces the potential legal consequences of occupational sexual harm of medical practitioners by medical practitioners, and outlines some of the reasons for non-reporting in the criminal context. The challenges of reporting of sexual harm in the workplace are discussed and followed by three illustrative case studies from Australia one from a criminal court, one from a civil court and one case brought by the Medical Board to the Administrative Appeals Tribunal. The chapter concludes with the recognition that complex structural and cultural environments exist which deter some victims from pursuing legal redress and can inadvertently harm those who do pursue it. Solutions are not simple or easy and, irrespective of the prevalence of occupational sexual harm, pursuit of legal claims is likely to remain low due to the personal and professional risks a complainant endures.

Female physicians in Japan face significant career barriers due to societal expectations surrounding childcare and family responsibilities. Traditional gender roles, exacerbated by long working hours and limited childcare options, hinder their ability to challenge stereotypes. In this chapter, we initially elucidate the challenges Japan encounters, as derived from literature reviews, and subsequently delve into specific instances.

The four authors in this chapter are from different stages of their medical careers in Japan. Dr. Watari has a Masters degree in Healthcare Quality and Safety from Harvard Medical School (USA) and has worked clinically in Japan, Thailand, and the USA. He has been actively researching gender bias in Japan’s medical field, aiming to promote gender equality among physicians. Dr Kono is a senior resident in surgery at Tokai University Hospital, and has published an article on gender inequality in Japanese academic medicine. Dr Yasuhisa is a junior resident at Shonan Kamakura hospital, with a background in pharmacy and engineering. Ms Mizuno is a medical student at Shimane University, with a background in French and linguistics. The case they present is a conglomerate of several interviews they have recorded during work on sexual harassment and discrimination in Japan.

We were both part of the team that conducted the first systematic study about sexual harassment in academic medicine in Germany and this has informed our following practice and our contribution to this book. Coming from a background in clinical medicine and public health, as well as knowledge about organizations, and personal encounters with the topic, we feel that more awareness, prevention and actionable consequences are necessary to improve working conditions in academic medicine in Germany. The anonymized case study we present showcases many of the structural problems survivors encounter and, most importantly, the fact that they often shoulder the consequences of actions they have not called for and did not want. The #metoo movement supported public discussions about sexual harassment and led to some positive change, yet much still needs to be done to structurally change our workplaces and the hierarchical culture that characterizes academic medicine.

We are a group of academic authors from the National Autonomous University of Mexico (UNAM) who are in direct contact with students and professionals in the medical doctor’s career, as well as specialties and subspecialties. We have learned firsthand about cases of abuse of power, harassment, and gender violence by physicians towards physicians. Therefore, we are very interested in the deeper analysis of an issue in the search for strategies to curb these acts that have been legitimized and normalized with the excuse of the hierarchical tradition of medical education or the path to follow to achieve professional goals.

The case we present is a conglomerate case based on a series of questions presented to us as part of an investigation entitled “Gender violence during medical training in Mexico”. UNAM, as an institution of higher education, must contribute to generating a change in mentality and education to achieve a more egalitarian, fair, and equitable treatment so that women and men are treated with the same respect and dignity and have the same rights to work and have a life project. Without this implying being left without work or being relegated to less essential and even trivial functions that require little or no creativity, human talent is wasted, which, in the long term, causes losses for any health institution and society.

Lived experience narratives are often used to provide depth of understanding to an area of study in medicine, using ‘real world’ exemplars that explicate theory and models of practice. In our case, the narratives in this part help us understand how the social context of the authors and the people they discuss shape collective experience, and drive the way institutions and individuals respond to sexual harassment within their profession.

This chapter draws from work and social-cognitive psychology, which is concerned with understanding people at work, and specifically the social and individual cognitive dimensions to these serious misconducts. It offers a distinct perspective on sexual harm, by focusing on three interconnected elements: the individual, the specific types of behaviours, and the environment. Understanding these distinct elements and how they combine, alongside insight into different inhibitors is critical not only understanding why these events occur, but also why they persist. This lens highlights the role of power and its abuse by elites, and why others may be reluctant to challenge and raise their concerns. It also reveals why a professional, undertaking morally praiseworthy activities may paradoxically be more at risk from the distorting cognitive processes of moral licensing. Psychology offers new perspectives into these phenomena and more critically into upstream preventative responses, to show why remediative sanctions may not be so simple here.

Medicine is a profession built on the pillars of compassion and healing. Paradoxically, the medical community is plagued by a pervasive culture of bullying, harassment, and abuse. Women in medicine face particular challenges, often experiencing gendered forms of harassment that further marginalize them. The fear of retaliation, stigma, and career repercussions deters many from reporting such incidents, perpetuating a culture of silence.

This toxic environment not only harms individuals but also compromises patient care. Early exposure to such behaviors during medical training can have lasting negative effects on professional and personal identity and well-being. To address this pressing issue, it is imperative to foster a supportive and inclusive culture within medical institutions, where individuals feel empowered to speak up and seek help without fear. When organising care, providers need to be aware of the complexity of treating doctors who may themselves be therapists. The complexities of the relationships between doctors and their doctor patients need to be considered, especially when stigma and shame influence care.

The framework of human rights has permeated international discourse and has evolved into standards that are replicated at international, regional, and domestic levels. This chapter utilises the human rights framework to explore the value it may offer in addressing the issue of abuse between medical practitioners. Beginning with a brief description of the overarching instruments from which the modern understanding of human rights stem, the chapter progresses to look at the specific human rights instruments at an international, regional, and domestic level. This analysis concludes the human rights framework offers little to an individual in terms of timely redress, however, the value of this approach lies in collective advocacy. Utilising a common language, global criteria, and data, human rights act as a point of agitation which can assist in exposing archaic notions around appropriate workplace behaviours and transforming rights into enshrined legislative materials with the full protection of the law. The human rights framework should be pursued alongside a more responsive methodology, such as though legal options and mechanisms, until such a time as neither are required.