We are a diverse group of educators, surgeons and advocates who are content experts in the field of gender discrimination, sexual harassment and abuse.

The case we are presenting is an anonymous doctor who experienced sexual harassment in the workplace. Key identifying features have been changed to protect her identity. The case highlights organizational failures which facilitate the perpetrator’s behaviour as well as demonstrates the obstacles victims must overcome during and following the reporting process.

As educators, leaders and advocates, we believe it is necessary that we publicize the culture that condones if not endorses the actions of perpetrators, stifles the reporting process and revictimizes the individual. Only through critical examination and deliberate action will change be made.

In writing this chapter, we realise we have not produced the evidence-based guideline that many would want to see. We remember approaching a senior bureaucrat in Australia and describing what we have tried to achieve. ‘I hope it provides solutions’, she said, ‘and isn’t just another collection of complaints’. While the book is not a ‘collection of complaints’, we have not attempted to provide a solution-focused manual. In the Introduction, we wrote that this book is not a reckoning. It is also not a protocol to support specific action. The reason is simple. We do not believe there is one solution that is universally relevant.

Sexual harassment not only harms survivors; it also has impacts on the team, the organisation and the profession. Harms can include changes in the way teams and individuals interact, which can have a direct impact on the quality of patient care. It can mean survivors and witnesses are less able to be empathic and interpersonally aware, as they are focussed on defensive and protective behaviours. Sexual harassment by a senior colleague changes the way survivors and bystanders see their profession, and this can cause long-lasting harm in their own practice. Many survivors leave or change their workplace, causing workforce deficits and loss of experience and skills. Those survivors who live with intersectional disprivilege provide critical diversity in teams that need to manage a breadth of patient experience. Unfortunately, they are at higher risk of sexual harassment, and so are more likely to leave, restricting the profession’s capacity to respond to community needs across the breadth of the population. The cost is a drop in the capacity of the organisation to provide quality care.

This chapter is authored by Parisa Pakdel, who holds an M.A. in Sociology from Beheshti University in Iran. The chapter focuses on women’s issues, particularly the prevalence of sexual harassment in workplaces. Pakdel delves into the sociological dimensions of sexual harassment experienced by women employees in Tehran hospitals, drawing on extensive sociological research to provide a nuanced examination of its prevalence and dynamics within these healthcare settings. The chapter includes detailed case studies of two victims who endured harassment during their tenure. It underscores the repercussions of inadequate legal safeguards against workplace harassment and sheds light on how organizational frameworks can inadvertently facilitate such misconduct. Furthermore, it explores the challenges victims face in reporting harassment incidents and advocates for systemic reforms aimed at fostering safer and more supportive environments within healthcare settings.

One is not born, but rather becomes, a woman doctor. This chapter addresses medicine itself as a highly gendered institution, constructed around hegemonic masculinity. How a woman learns to perform gender as it is expected for a doctor involves a complex negotiation regarding her body. She must be both present in and absent from her body - one of the many features placing women doctors at increased sexual risk in the workplace. The chapter delves into the historical context of these challenges and their contemporary implications, highlighting the need for continued efforts to promote gender equity in the medical profession.

This chapter defines sexual harassment and its key targets and perpetrators to argue that their attitudes and beliefs are the anthesis of medical values and principles – to do not harm. It identifies the costs to the organisations of this sexual harassment and abuse. Adopting a preventative medicine framework we extend the scale and focus of prior work to consider evidence-based SHA interventions. We aim to advance current understanding about SHA and its detection, deterrence and amelioration within the health workforce through a multi-level and multi-stage SHA prevention strategy that collectively impacts up- and down-stream changes for this workforce and their workplaces. We outline five levels at which awareness raising, education and intervention is required – to include primordial, primary, secondary, tertiary, and quaternary.

This chapter describes the role of medical regulators including the history of the International Association of Medical Regulatory Authorities (IAMRA). It highlights the common key processes of medical regulation agencies internationally and the standards of practice that are relevant to sexual harassment and abuse of doctors by doctors.

Examples of regulatory standards specifically relevant to sexual harassment and abuse of are drawn from the regulatory frameworks of several different countries illustrating the range which varies from specifically condemning sexual harassment to more generic requirements for good behaviour, productive and respectful collegiality and being aware of power imbalances.

In the final section the author documents typical regulatory processes that occur on receipt of a complaint of sexual harassment or abuse by a doctor as well as the range of responses that may occur if an adverse finding is made against a doctor. The advantage of involving medical regulators is that it allows communication about concern regarding perpetrators found to have failed the standard between jurisdictions and between specific clinical settings.

This chapter is the collaborative effort of three Pakistani doctors, all of whom have worked extensively in their home country. Dr Hina is a general practitioner in the UK and clinician and academic in Pakistan. Dr Tehzeeb, a public health specialist, is currently a research fellow and senior lecturer at the Australian National University. Dr. Humaira is a UK-trained general practitioner and educator at Peshawar Medical College, Pakistan.

This case study presents the experience of an anonymous doctor employed at a prominent tertiary care hospital in Pakistan’s capital city. The study, which gained attention in local media, sheds light on how a female trainee overcame significant obstacles and navigated a system influenced by powerful individuals to achieve justice. Unfortunately, not all individuals facing similar circumstances are as fortunate. Additionally, the study underscores the societal and psychological challenges that female doctors encounter when seeking redress for workplace sexual harassment. Understanding this case is crucial for recognizing the need to enhance systemic support for reporting and addressing sexual harassment cases. In Pakistan, addressing this challenge is vital to safeguarding female healthcare workers.

Sexual harassment in medicine is a common, global problem hiding in plain sight. (1–3) It is difficult to detect, measure and eradicate, (4; 5) partly because there is a complex web of medical organisations involved in managing the doctors involved. Multiple organisations are responsible for responding to harassment, but individual policies and processes are often opaque, complex and partial. (6) Survivors describe reporting mechanisms that are difficult to navigate, and many survivors experience considerable harm arising from the reporting process. (6; 7) Few feel there was significant benefit to reporting sexual harm. (8)

At the start of this book, we wanted to ensure that readers have the opportunity to familiarise themselves with current thinking about sexual harassment, gender in medicine, and the historical context of sexual harm and its prevention, regulation and management. We are aware that readers will come to this book with particular learning needs and particular areas of expertise. We are expecting that some readers will be survivors; others will have policy responsibilities for managing sexual harms in the workplace or responsibilities. Some may have advocacy roles in teaching, research or policy, and many will come from other disciplines or contexts different to our own.

This chapter discusses the role of men in abuse of doctors by doctors. The chapter considers the role of men at all levels including victim, bystander, perpetrator, employer or those within the regulatory and legal systems. The chapter helps us to understand and look beneath the obvious drawing on the evidence of men’s roles at all levels. It also speaks to the potential of men to positively influence for change and prevention of abuse, as well as drawing our attention to possible risks of abuse occurring. It raises our awareness of the ‘not so innocent bystander’ and the significant potential of engaging bystanders, colleagues, and system leaders into positive action.

This chapter has been written by one of the researchers from a qualitative study on sexual harassment in medicine (Louise Stone), a doctor with lived experience of sexual harassment in medicine, Yoo Young (Dominique) Lee, and a third editor, Elizabeth Waldron who is a researcher in psychology, with an interest in gender studies.

Louise Stone is a General Practitioner (family physician) and medical educator with expertise in mental health primary care, teaching, research and policy. She is a qualitative researcher and has been leading the research in sexual harassment in medicine for ten years.

Elizabeth is undertaking PhD studies in psychology at the Australian National University. They have a similar passion for equity and have been responsible for many of the co-ordinating tasks that have made this multicultural and multinational volume possible. All three authors believe deeply in the role of context, which shapes experience and understanding.

Yoo Young (Dominique) Lee is a radiation oncologist in Sydney and a survivor of sexual trauma. Her case is the only successful criminal prosecution of a doctor who has sexual assaulted another doctor. Her case is discussed in the chapter on Law. She has not only supplied the story in these chapters, but she has written the Foreword of this book. Her story was incorporated into our early studies in this area, and her wisdom has been central to our understanding. Her courage is inspiring.

The medical profession, often seen as a bastion of healing, is itself wounded by sexual harassment and abuse. This chapter delves into the experiences of doctors who have suffered sexual trauma, highlighting the silent struggles and complex barriers that prevent them from seeking help.

Survivors often grapple with feelings of shame, fear of retaliation, and a lack of understanding of their own experiences as trauma. The chapter emphasizes the importance of breaking the silence surrounding sexual harassment and abuse in medicine. Survivors can regain agency by understanding and incorporating their trauma into their own personal and professional narrative, as long as they are supported with wise therapists who are able to help them do so. Healing not only benefits individual doctors but also improves the overall culture within the medical profession.

Advocacy is a broad term, arising from the Latin word ‘advocare’ meaning ‘coming to the aid of someone’. Implied in this definition is the concept of lending one’s own power to the cause of another. The power to direct the goals of any advocacy effort should remain with the individual or group that will benefit from the advocacy campaign. Advocacy can be misdirected if the voices of the individuals for whom advocacy is sought do not speak, or are not sufficiently heard.

Many of the authors in this book have shared their experiences advocating for change. In this chapter, we will explore how advocacy can occur by examining where within the system advocacy efforts can be directed, the process of planning, implementing and evaluating advocacy, and how an individual can determine where to focus their efforts. We will also draw on examples from various authors, illustrating how and why they undertake their work, and the lessons they have learned through their advocacy journeys.

This chapter offers insight into some of the kinds of positions people can take in their emotional and personal journeys as advocates within medical training. It includes people in different positions in their advocacy journeys, offering their visions for the kinds of changes that need to happen to make a difference to sexual harassment in medicine. May Erlinger writes from her perspective as a medical student, describing the personal and emotional journey of becoming mobilised around sexual harassment in Australia. Becky Cox and Chelcie Jewitt are the co-founders of ‘Surviving in Scrubs’, an online campaign to tackle the problem of sexism, sexual harassment, and sexual assault in the healthcare workforce. They launched Surviving in Scrubs as doctors in training in the UK, giving a voice to women and non-binary survivors in healthcare to raise awareness of the problem, and to demonstrate the diversity of lived experience that needs to be addressed. Louise Stone and Fiona Moir are senior medical educators, who have had senior roles in medical student and GP training in Australia and New Zealand. They discuss the range of roles and challenges they have addressed in managing professionalism, wellbeing and professional identity formation in policy, teaching and leadership.

This chapter discusses an integrated and holistic approach to preventing, responding to and managing sexual abuse of doctors, at organisational as well as individual level. Organisational factors which can predispose to abuse are discussed, alongside opportunities to engage in work to prevent abuse. A case study illustrates themes and impacts in cases of abuse, and the holistic lens through which support can be offered. The authors are experienced across the medical career spectrum including the support and case management of a number of doctors in training affected by sexual abuse. This includes organisational level interface with employers, regulatory bodies, health and legal services in relation to matters resulting from sexual abuse of doctors.