Crossing the Line
The national conversation around sexual harassment comes to radiology.
Sexual harassment is not a new problem, nor is it unique to medicine. The issue has garnered unprecedented attention, however, from efforts like #MeToo — exploding on social media last year to raise awareness of sexual harassment and assault in the workplace. “Movements like this have opened the door now for men and women to say, ‘This isn’t right,’” says Claire E. Bender, MD, MPH, FACR, chair of the ACR Commission on Human Resources and professor emerita in the department of radiology at the Mayo Clinic in Rochester, Minn.
While the recent national spotlight on the issue began in Hollywood, it quickly spread to the broader culture, including medicine. “Physician groups in general have struggled in dealing with physicians who exhibit problem behavior,” says Lawrence A. Liebscher, MD, FACR, a partner at Cedar Valley Medical Specialists in Waterloo, Iowa. “When someone has egregious behavior, you can easily call that person out, and everyone else in your group will likely support you. If you’re dealing with someone in a practice with marginally bad behavior, that’s more difficult.”
Sexual harassment is defined by the Equal Employment Opportunity Commission as harassing an employee or job applicant because of a person’s sex.1 This includes unwelcome sexual advances, requests for sexual favors, or other verbal or physical harassment of a sexual nature. The commission elaborates that “harassment does not have to be of a sexual nature, and can include offensive remarks about a person’s sex.” The website notes that while federal law doesn’t prohibit “simple teasing and offhand comments,” the law has been broken when behavior “creates a hostile or offensive work environment or results in an adverse employment decision.”
“There are always two sides to every story,” Bender says, “and showing fairness to both parties is important.” Still, steps are needed to eliminate a culture that leads radiologists to tolerate sexual harassment instead of addressing it head on, research suggests.2
According to Bender, sexual harassment is not specific to one gender and can occur in any direction. However, women in radiology are more often victims and witnesses of sexual harassment than men — and also less likely to report these incidents, she says.
In many practice environments, a male radiologist is working with support staff — technologists, nurses, and others — who are largely or entirely women, Liebscher notes. One study by Reshma Jagsi, MD, DPhil, professor and deputy chair of the department of radiation oncology at the University of Michigan and director for the Center for Bioethics and Social Sciences in Medicine, found that 30 percent of female clinician-researchers in the United States have been sexually harassed or assaulted in the workplace — while only 4 percent of their male counterparts had experienced the same. Medical students, residents, fellows, junior faculty, and other non-senior staff are the most vulnerable to sexual harassment. They often fear that reporting an incident may limit career opportunities or label them as troublemakers.3
Radiologists would be wise to reexamine their definition of sexual harassment, Bender says. “Transgressions need not involve physical contact. People think of overt actions, but it’s the covert things that require more education.”
Don’t Dismiss “Kidding”
According to Jagsi, one of the biggest misconceptions about sexual harassment is that anything less than physical assault is harmless. “I think that’s where the big cultural transformation is necessary — in us recognizing that seemingly joking comments can actually be quite corrosive,” she says.
Regardless of intentions, comments that come across as put-downs can make someone feel that their professional abilities and the years of work they have put in are not enough to make them an equal in the eyes of colleagues. “The idea that ‘talk is nothing’ is problematic,” Jagsi says. The systematic experiences of unwanted and inappropriate comments can have a substantial impact on a woman’s work experience. With more frequent experiences comes less job satisfaction, less interaction with coworkers, damaged morale, and overall psychological distress.4
Women often fail to report incidents that meet the definition of sexual harassment. “When you interview them, you realize that they’ve had more experiences than they think to report on a questionnaire,” says Jagsi. And when they do recognize harassment, a fear of retaliation that could hinder career growth, Jagsi says, is often a driver of staying silent.
“It’s been described that women who are in more senior positions are more likely to experience put-downs rather than come-ons, but these are still comments that are intended to harass on the basis of sex,” Jagsi says. “By contrast, younger and less empowered women may be more likely to experience sexual innuendos and advances. All of this constitutes sexual harassment.”
It can be challenging for a woman who doesn’t want to make waves and who has spent a lot of time investing in her career, Jagsi says. “She has entered radiology, a field that’s male-dominated, and naturally wants to go with the flow. It’s tricky deciding what can be dismissed as harmless kidding versus what needs to be called out and changed,” she says.
“Sometimes people make comments that they don’t realize are inappropriate — they don’t really mean to be sexually offensive or use innuendo,” says Amy Patel, MD, breast radiologist at Beth Israel Deaconess Medical Center and instructor of radiology at Harvard Medical School. “They feel terrible when they’re told that it wasn’t okay.”
However uncomfortable it might be, harassment must be called out. “The only way we are going to change the narrative is by communicating with one another and letting everyone know that certain behavior is not okay,” Patel says. “That pushes the needle forward.”
In broaching the subject, however, there is still a huge fear of retaliation and retribution, she adds, “or that someone in a position of leadership will disregard a complaint or try to brush it aside.”
Stopping sexual harassment relies on awareness, communication, and a zero-tolerance policy, says Katarzyna J. Macura, MD, PhD, FACR, chair of the ACR Commission for Women and Diversity. Those things have to come from people in positions of authority.
“Practice leaders are responsible for creating the right climate and morale,” Macura says. “If they lead by example with no tolerance for harassment in general, that creates a culture of no sexual harassment.” Leaders must let staff know that they care if someone is making them uncomfortable or if something inappropriate has already happened. “Let them know you will listen and then take action,” she says.
As a leader, leaving no doubt about your position on sexual harassment when communicating with employees is vital, says Scott M. Truhlar, MD, MBA, MS, FACR, chair of the ACR Bulletin Advisory Group and a partner with Radiologic Medical Services in Coralville, Iowa. “You have to set expectations immediately. Make it known to your employees that if they are ever made to feel uncomfortable, you will take care of it,” he says.
However, it’s critical that women and men continue to work together and form professional relationships within the workplace. According to Patel, being a mentor, for example, can be a hot-button issue today, particularly in radiology. “Some men are afraid to mentor women,” Patel says. “That’s a shame, because many of us from my generation have flourished because we had, and continue to have, exemplary male mentors.”
Have Zero Tolerance
The new generation in medicine doesn’t have the same mindset as many of the older generation, says Macura. “They expect their leaders to be their champions,” she says. “If current leaders don’t have a zero tolerance mindset, they shouldn’t be trying to lead.”
It comes down to creating a respectful work culture in which everyone can perform well. When someone feels anxious, uncomfortable, demeaned, or threatened at work, they aren’t as productive and don’t perform to their maximum ability. “The patient is the loser when you have a workforce that doesn’t work in a collegial, respectful manner,” says Macura. “Feelings translate into how we approach each other and our patients. If our mission is to serve patients, then we need to respectfully work together to present our patients with the best team.”
“Institutions must proactively shape the culture of the workplace, not simply react after the fact when there are no reporting mechanisms in place,” says Jagsi. All staff should be reminded periodically of the basics of respectful and professional behavior. Legal experts say employees should be informed — to know where they can turn if they feel they have been harassed.
“It’s okay to ask for help,” Bender says. If you feel ill-equipped to tackle the issue at your institution, professional and local groups offer training to both small practices and larger healthcare facilities. “Everyone deserves to be educated on the beliefs of your group — and to know what will happen if they violate a policy,” says Bender.
Advance the Conversation
Acknowledging that sexual harassment feeds on inequality and disrespect is overdue. “The #MeToo movement has really made this something that’s now acceptable to discuss,” Jagsi says. “It has promoted reporting, and it’s no longer taboo to talk about harassment. It’s time to realize that the problem has nothing to do with weakness or flaws in the victim — it’s the fault of the transgressor.”
“The literature on workplace harassment suggests that it is more common when women are in the small minority,” Jagsi says. “The increasing participation of women in medical school is a heartening trend and should have a salutary effect, but other changes are also needed, as there are other aspects in medicine — including its hierarchal nature — that can foster harassment.”
“There is an opportunity now for the whole of medicine to change behaviors,” Macura believes. “Plus more women are now seen in leadership positions, which means things are moving in the right direction. Also, the new generation has a mindset in which discrimination and harassment are unthinkable.”
“We’re coming to the tail end of where the most senior radiologists in a group — the ones holding the most power — are men,” Liebscher says. “It can be extremely difficult to move from acknowledging the problem, to understanding it, to solving it. But I’m confident we’re going to have more women in positions of authority, and with a continued discussion and attention in the press and in the courts, issues of sexual harassment will be addressed.”
In 1992, RadioGraphics published the following, and it remains relevant 25 years later: “The challenge is to create radiology departments in which interpersonal relations are based on sensitivity and mutual respect. Radiologists who deny the possibility that sexual harassment exists in their departments could be right, but they owe it to themselves and to their staff to find out the truth.”5
- U.S. Equal Employment Opportunity Commission. Available at bit.ly/ SH_EEOC. Accessed on April 25, 2018.
- Camargo A, Yousem DM. Sexual harassment in radiology. J Am Coll Radiol. 2017;14(8):1094–1099. Available at bit.ly/SH_Radiology.
- Jagsi R, Griffith KA, Jones R, et al. Sexual harassment and discrimination experiences of academic medical faculty. JAMA. 2016;315(19):2120–2121. Available at bit.ly/Jagsi_SH.
- Cortina LM, Magley VJ, Williams JH, Langhout RD. Incivility in the workplace: incidence and impact. J Occup Health Psychol. 2001;6(1):64–80. Available at bit.ly/Workplace_Incivility.
- Heilman RS. Sexual harassment in radiology departments. RadioGraphics. 1992;12(1):34. Available at bit.ly/Radiographics_SH.
By Chad Hudnall, senior writer, ACR Press