This section presents the author’s conclusions and offers some outlook for further research.

This chapter has been written by four medical doctors (Jane, Maria, Sharon and Ketty), a gender specialist (Grace) and a state advocate (Chali). There have always been some discussions among medical students and doctors about the occurrence of sexual harassment in the medical fraternity. However, without any published evidence, it would appear as though it is gossip or name tarnishing to some. This chapter begins with a real-life narration of Maria’s experience of sexual harassment when she was a young doctor. We also delved into investigating sexual harassment among Zambian female doctors by utilizing an anonymous online questionnaire that was sent via the Medical Women Association of Zambia (MWAZ) mailing platform. Eight brave doctors responded to the call; their stories will leave you in tears. This book has given us an opportunity to shed light on sexual harassment and break the silence.

Sexual harassment in the medical workplace is a complex, multifaceted problem that needs evidence-based solutions. Medicine is, of course, not unique in having to manage this. For decades, consciousness-raising groups have created spaces to find ways to speak the unspeakable, raising awareness of gender-based violence at work and at home, in order for survivors to begin to heal. Hashtags such as such as #MeToo, #MeoQueridoProfesor, and #UtanTystnadsplikt perform this function in a digital landscape, exposing entrenched toxicity across a range of workplaces, and agitating for legislative and political reform in a number of global contexts.

This chapter explores the complexities of pushing for cultural change from a leadership position. After examining the barriers leaders may face in changing their workplace culture, we provide practical actions and key considerations to inform a strategy that improves workplace accountability and eradicates sexual misconduct. By outlining a framework for change and including examples of the framework in action, we look at how leaders can implement measures that are person-centred, collaborative, integrated and measurable. Our recommendations focus on the prevention of sexual harm as well as creating a culture where impacted people feel safe to report inappropriate behaviour because they trust their organisation to take swift, fair and decisive action.

In the 1950s, Michael Balint wrote one of the signature texts for general practice: The doctor, his patient and the illness. (1) Balint was a psychoanalytic psychiatrist who pioneered a type of small group learning for GPs which came to be known as Balint groups. Balint groups encouraged doctors to reflect on the nature of therapeutic relationships, and to consider how these might be leveraged to improve care. Balint was an advocate of whole person care, and one of his core concepts was the ‘collusion of anonymity’, which described the situation where the patient is passed from one specialist to another with nobody taking responsibility for the whole person. The concept of collusion implied avoidance, the idea that each specialist chose to complete the relevant task at hand, but avoided engaging with the patient as a person.

The introduction in this chapter has been written by Josephine Canceri, a newly graduated doctor in Sydney, Australia. She gives an overview of the experience of International Medical graduates (IMGs) across the globe. International Medical Graduates are at higher risk of harm from sexual harassment, and are less familiar with their options for reporting. Women are at higher risk.

Valeria Chua writes from her lived experience as a doctor from Brunei who trained and worked in England and Australia. As a young, Asian female practicing and training in these countries, she was already disadvantaged in the medical world. She experienced sexual harm from a relative and from several male doctors. She describes the ways her upbringing, past experiences and circumstances as a foreign-trained doctor which is likely to have increased her risk of harm. She hopes that her contribution to this book will prevent others from falling victim to sexual assault by doctors and will raise awareness of this little-known subject.

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.

Relative clauses are generally introduced in the archaic Indo-European languages by a relative pronoun. In some languages, this pronoun is descended from a form *kwí-/*kwó-, while in others it is descended from a form *yó-. This chapter surveys the syntactic and semantic behaviour of the descendants of these pronouns in the attested languages. This includes a discussion of both their relative and non-relative uses. The author concludes that neither *kwí-/*kwó- nor *yó- can be excluded as a relative pronoun in Proto-Indo- European, and that together they reflect what was a unitary syntactic category in the proto-language: *REL.