Women in Surgery: Should we kneel down and open our mouths, lie back and close our eyes, or stand up and speak the Truth?

Dr Gabrielle McMullin, a senior vascular surgeon in Australia, has recently caused a stir by stating that women in surgery should stay quiet about sexual abuse, harassment or advances from male superiors if they wish to continue in a surgical career.

She was commenting on a case of a female surgical trainee, Caroline Tan, who won her case for sexual harassment but could then not find employment in any public hospital in Australia. Dr McMullin said,

“Her career was ruined by this one guy asking for sex on this night. And, realistically, she would have been much better to have given him a blow job on that night.”

She goes on to say, “What I tell my trainees is that, if you are approached for sex, probably the safest thing to do in terms of your career is to comply with the request; the worst thing you can possibly do is to complain to the supervising body because then, as in Caroline’s position, you can be sure that you will never be appointed to a major public hospital.”

In a follow up article Dr McMullin says she is not ‘condoning abuse’ or these types of behaviours, but states that there is a problem that needs to be addressed.

There have been a number of articles written on this since and some women have come forward anonymously to speak of their experiences of sexual abuse and harassment, in fear that if they speak out they will be ostracised and their careers over.

In the heat of the media glare after making such comments, Dr McMullin may not wish to be seen as ‘condoning abuse’ but in actual fact her comments, if accurately reported, are doing just that. Recommending trainees to just suck it up when it comes to sexual abuse and harassment may appear in some misguided way to be a solution of sorts that keeps the person in a job, but it is definitely not the answer to the problem of sexual abuse/harassment and misogyny in surgery or the wider field of medicine.

Two wrongs do not make a right – and it is wrong that there is abuse in the first place and it is wrong to condone that abuse with advice to permit it by just lying back and closing our eyes or kneeling down and opening our mouths. It is deeply disturbing that this is both occurring within medicine and that the ‘best advice’ a top female surgeon can give is to comply with it.  Indeed such advice only perpetuates the culture that says this is ok and it will not change until more women (and men) speak up and say this is totally unacceptable and take action to expose such behaviour. Silence, saying nothing, doing nothing is only a way of ensuring that these forms of abuse continue. Furthermore, it is a most disempowering approach to take, one that sees women as powerless and helpless victims, who seemingly have no choice but to get on their knees if they wish to continue in a career in surgery.

Dr McMullin’s article has brought a subject that was very much in the dark out into the cold light of day and the responses have been varied. Some have denied that this is a significant problem, stating that only a few complaints to the medical boards concern sexual harassment. But this most likely just confirms the reluctance of female trainees to report such episodes. The latter being confirmed by some coming out and speaking up now following Dr McMullin’s comments, and tellingly so doing it anonymously.

Some point out that it’s not just the overt sexual advances that are the problem but the underlying misogynistic culture that thinks it’s ok to make such remarks as: the only female surgeons that are acceptable are the ones that are ‘childless, single and pretend to be men’.

Dr McMullin’s comments have also now tarred all female surgeons with the sexual brush. All those years of hard work, dedication, study, and on call, for the sake of their greater calling – have now been reduced in some people’s eyes and minds to: ‘She slept her way into the job’ and this will actually provide more fodder for justifying future abuse of women.

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Whilst my own experiences in surgical training have been positive and affirming, I encountered some misogynistic comments as a medical student regarding women in surgery, but that was over 25 years ago when the patriarchal attitudes were perhaps more pervasive. But those comments did not affect me nor put me off a career in surgery – if anything it made me more determined to do it. At the same time, when it came to lighthearted banter I could give as good as I got, and for me personally that wasn’t an issue.  It would be an interesting piece of research to find out the extent of this issue in the UK as well, for even though it wasn’t a significant part of my own experience, I am aware that it does occur and it needs to be addressed.

However, a close friend and colleague Dr Anne Malatt, who is an eye surgeon in Australia, shares with us her experiences:

“When I was training to be a doctor, on my first day at the hospital we went to an ENT (Ear Nose and Throat) clinic. The tall gruff surgeon showed us our first ever patient, an elderly gentleman. He asked him to open his mouth and it was full of maggots, eating his tongue cancer. He then proceeded to demonstrate a mouth examination, using me as the subject. He shoved a wooden tongue depressor into my mouth so hard that I gagged, and laughed and said: ‘Well, you won’t be much good giving head!’

There were numerous snide comments, rude jokes and generally demeaning treatment through my training. I would make light of them, but they were offensive and hurtful. Despite them all, I passed surgery with honours.

I was inspired to become an eye surgeon.

I was the only one of 13 candidates to pass the primary exam at the time that I sat it. This exam was required for entry into the surgical training programme at the time. Yet I was frequently, and sometimes to my face, accused of sleeping my way into the job.

My friend and I were the first women to be accepted into the programme for 5 years. We were given second-rate surgical jobs, and ignored when we questioned why, given we were the most ‘worthy’ of the ‘good’ jobs, on paper.

I remember sitting in the tearoom one morning and the senior consultant saying to me: ‘It is a waste of time and money training you girls – you are just going to get married and have babies.’ ”

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Pregnancy has been used as a weapon to undermine and discredit female colleagues, by suggesting they would not be in the profession for the long-term.

And from another female surgeon in Australia: “I was told when I was an intern that there are only two types of women surgeons: women who shouldn’t be surgeons and surgeons who shouldn’t be women,” she said.

It is clear that with attitudes such as these, true equality in surgery is but an illusion in such environments. What is perhaps astonishing to consider is that most, perhaps even all, of these men are probably married, could have daughters, sisters and have had mothers – do they treat these women in the same way? Would they like their nearest and dearest women to be treated in the same way as they are treating others? Do they think it’s one rule for the workplace and another for home? But that too is an illusion – showing such disrespect to one woman is in effect showing disrespect to all.

Only when women are accepted as human beings and women first and foremost, not pretend men, or even as doctors /surgeons, will there be true equality.

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The issue here is not just the few or the many men that are involved in such cases, it is the culture of surgery and medicine in general which has allowed such incidences and more to go unchecked for many, many years. The culture of medicine itself is toxic and abusive – little wonder then when it churns out doctors who are also abusive, not just to others, but to themselves. The system of medical training is abusive – long hours of study and work to swallow copious amounts of information, training/teaching by humiliation was just par for the course and there was definitely no sense of care for how the students were coping and living on a daily basis.  

The caring profession has spectacularly failed in its first duty of care – which should be to the students and staff within that profession.

Hence we have higher rates of addiction and suicide in medicine than the general population and rates of burnout of 1 in 2. Astonishing facts that are just another face of the abusive and toxic culture of medicine.

So what is the answer?

• As a profession we need to state categorically that this type of behaviour is unacceptable and in no way condone such practices.
• Women need to speak up at the time the incidents occur, to say no and to know they do not need to prostitute themselves to be successful in their career.
• Empowering female trainees to know how to address sexual abuse when it comes their way, to know they are worth more and that they are not helpless victims.
• Empowering male doctors to also speak up and call out such incidents when aware of them.
• A mechanism for reporting incidents of abuse and harassment that trainees can trust and which has effective powers – one that may need to be independent from the mainstream medical culture and ‘old boys club’ approach to such issues.
• A change of culture is required and that will only come about by the individuals within that culture changing and saying no to the current abusive and toxic system.
• Developing a culture of medicine that is based on care for the human being first and foremost who is training to be a doctor – such that they develop a care, love and respect for themselves to the point that such abusive ways towards another or to self are eliminated.

 

Changing the culture of medicine will not happen overnight, but let us not underestimate the power we have to bring about that change by using our voice and saying no. Men and women all need to take responsibility for their part in perpetuating this toxic system and for bringing about change – for each of us it starts with ourselves and what we are prepared to accept or not accept. It starts with each of us standing up and speaking the Truth and not accepting anything less.

The following is an adaptation of the words of the Army Chief David Morrison regarding the army, made relevant to surgery and medicine:

Every one of us is responsible for the culture and reputation of surgery and medicine and the environment in which we work. If we become aware of any individual degrading another, then we need to show moral courage and take a stand against it. No one has EVER explained how the exploitation or degradation of others, enhances the capability, or honours the traditions of the Medical Profession. The standard you walk past, is the standard you accept.   

That goes for all of us; leaders have the onus of responsibility of their position to set an example, but that is no excuse for others to be silent bystanders – we all have a voice and can use it.

So what do you and will you walk past? What do you and will you accept?