The sexual abuse of women is once again in the news as the behaviour of a Hollywood producer is brought into the light. But are we shining that same light on our own profession of medicine and surgery?
Bringing it out in the open
In 2015, an Australian female surgeon, Dr Gabrielle McMullin, stated that:
“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.”(1)
Dr. McMullin was referring to the case of Dr. Caroline Tan, who won a 2008 sexual harassment case against a surgeon while she was completing surgical training at a Melbourne hospital. Dr. Tan was vilified and has been unable to find work at any public hospital in Australasia despite the legal victory. 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.”
Dr McMullin was being provocative to make a point; that this is the state of affairs in the culture of surgery. What gives a person the right to think he can demand sex from another person, under any circumstances, let alone the powerful and delicate relationship between surgeon and trainee, and then proceed to destroy her career when she dares to say no and then report him? And what kind of system are we dealing with that condones and even supports this behaviour?
My story of sexual abuse
I was saddened and outraged to read this article, and then I came to realise why… as part of the damage control, the Royal Australasian College of Surgeons asked its members to fill out an anonymous survey on discrimination, harassment and abuse, and when I filled it in, I had to acknowledge that I too had been abused as a trainee, a truth that I had somehow buried in my body and normalised in my mind to keep going on… for once you admit you are in an abusive relationship, it is very hard to stay in it…
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 throat examination, using me as the subject. He shoved a wooden tongue depressor into my mouth so hard that I gagged, and he laughed and said:
“Well, you won’t be much good at giving head!”
Throughout my training there were numerous snide comments, rude jokes and generally demeaning treatment. I would make light of them, but they were offensive and hurtful. Despite them all, and the attitudes of the people they came through, I passed surgery with honours.
I was inspired to become an eye surgeon.
I studied for and sat the primary exam – which was required for entry into the surgical training programme at that time – and was the only one of the thirteen candidates who sat the exam that year to pass. 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 five years, and while most of our colleagues were welcoming and supportive, some of the old boys were quite put out that we had been admitted into their club.
I remember sitting in the tea-room 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.”
Being a surgical trainee puts you in a position of relative powerlessness; surgery is an apprenticeship system and your advancement in the training programme is dependent on the goodwill of those who are training you. This power can be abused, and I have stories I could tell but to do so may identify people who, ironically, I still care about deeply, as they were also my teachers and mentors and friends.
Of course, not all my colleagues were abusive and many were respectful and honouring of me as a person and treated me with care as a colleague and friend. And not all female surgeons have experiences such as mine. I am not saying that all male surgeons are sexual predators and all women are innocent victims, but there is something in the culture of surgery which allows such behaviour to occur.
Surgery can be a hard road
Surgery can be a hard road for anyone, but particularly so for a woman.
It is well known that you have to be better as a surgeon to succeed as a woman, and even then, it is a big boy’s club, and they don’t really want to let you in.
The surgical culture is worse than the army, where at least it is acknowledged that abuse, and particularly sexual abuse of women, takes place, and there are procedures in place to deal with it.
In surgery, women are belittled, demeaned, abused, and if you speak out against injustice, you are either removed from the programme or just not given the jobs you want.
“They tolerate female general surgeons in small numbers”
A practising female surgeon, who spoke to the media on the condition of anonymity, said:
“They tolerate female general surgeons in small numbers, as long as they are single, childless and pretend to be men.”
The surgeon said it was not uncommon for senior surgeons to publicly quiz trainees and other surgeons about if or when they were going to become pregnant.
She said the idea of pregnancy was used as a weapon to undermine and discredit female colleagues by suggesting they would not be in the profession for the long-term. She said:
“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.”(2)
What are we going to do about it?
So, now that sexual abuse in surgery is out in the open, what are we going to do about it?
As Army Chief David Morrison said:
“The standard you walk past is the standard you accept”.
As a community, are we willing to tolerate this kind of abuse?
For if this is how our surgeons are treating their colleagues, how are they treating you?
While these kinds of outdated attitudes to women prevail, and men are permitted to view female trainees as somehow lesser, and less worthy, then it is a natural progression to think that it is somehow ok to abuse them. Which it is not.
Our whole attitude to women in medicine and surgery needs to change if we are to have any hope of dealing with these issues in a true and lasting way.
Until we see women as equal to men, and indeed having qualities that men would do well to develop in themselves, we will not have a hope of healing the abusive culture of surgery.
It starts with us
There is another aspect to this story of abuse though. As a young woman, I did not hold myself in high regard, and treat myself with the love I deserve. Whilst what happened during my training is by no means my fault, the woman I am today would not have allowed it for a moment. Abuse may be forced upon us, but it is up to us to silently accept it, or not. And to call it for what it is if we experience it ourselves or if we see others being subject to it. We have to learn to deeply value ourselves and what we bring, not just to surgery, but to the world, and to support each other so that we do not feel isolated and alone, which is what the energy of abuse does. It shames us into feeling that it is somehow our fault, that we did something to deserve it, so that we stay silent and allow it to continue.
We are naturally loving and tender; abuse is not in our nature. If men, or women, are abusing men, or women, it is up to us to support them to come back to who they truly are by calling the abusive behaviour for what it is and standing up to it.
Surgery can be challenging, but there is no need for it to be abusive. There is no excuse for abuse, including sexual abuse. We have a responsibility to call it out in its tiniest detail and to treat ourselves and each other with the respect we all deserve, so that we are able to deeply care for ourselves, each other and the patients we serve in what is, after all, a healthcare profession.
Fabulous article, Dr Malatt, and an area of keen interest of mine since the news of the Royal Australian College of Surgeons endemic and systematic abuses of its women (and other minority group) trainees. There is ever so much to change and develop in this space, and it is a privilege, I must say, to walk into this space and see it for what it is, in all its detail. There is a large part of me that feels strongly about this such that I would choose surgical training in a heartbeat… but it remains to be seen what occurs on the path ahead in the coming years. Certainly, it is well worth watching this space 🙂
We will watch the space in and around you with the honour, wonder and awe it deserves, Stephanie…
Beautifully expressed, deeply caring and respectful to all parties involved.
Thank you Jasna, indeed, it is about asking women to hold themselves in the beauty and sacredness we are, and asking men to arise to the deeply caring, sensitive and tender beings they are, so that we may all support each other and serve together.
Hi Anne, it’s interesting how we can have quite different experiences as my surgical training was not like the one you have described. At the start there were a couple who made a few comments re the life of a surgeon being tough – and hence hard for a woman to combine family and career and there is some truth in that – but overall I enjoyed good relationships with my bosses and felt very supported by them in my career choices. I didn’t feel I had to be better than the men – just do a good job as one would expect from a man or a woman and I felt I was fairly treated along the way both by my bosses and the training committees. Perhaps there is a difference culturally between UK and Aus? Not saying it doesn’t happen here – but may not be as prevalent – or certainly in my experience anyway that was the case. I’m also not so sure about the comparison with the army – I’ve seen some pretty brutal things go on there in documentaries and as for having ways to deal with it I think they still have some way to go as well.
As you say there are more factors at play and I feel it’s important to ensure women feel empowered to speak up and call out abuse when it does occur and not stay silent as that just perpetuates the culture of abuse. We have our part to play in this and rather than being seen as victims, the more we take responsibility for our part, the sooner we will be able to bring an end to this dynamic. I have been privileged to work with many great male surgeons, who were supporters of good surgeons irrespective of their gender and likewise perhaps tough on those who were not, again irrespective of gender and it’s important to acknowledge the many that are fair in their management and treatment of trainees – at least that has been my experience, whilst not negating nor dismissing that abuse does occur as well. Also even though not all male surgeons abuse women on a personal/sexual level – the actual culture of surgery is itself abusive and engenders a self-abusive lifestyle and if we can address that I feel that will also go some way towards addressing the more interpersonal forms of abuse as well.
I agree Eunice, the culture of surgery itself is inherently abusive and needs addressing at this level first and foremost…if we are treating ourselves and each other well, there will be no room for abuse, be it sexual or otherwise.
And I agree that many of our colleagues were very supportive and great teachers, mentors and friends, but some were not and I know from our students and trainees that abusive practices still go on today…and this needs to be addressed.
Eunice, I have been pondering on your comment. What I experienced still stands, and I know that such abuse continues because of my work with medical students and registrars, but I have expanded the blog a little to be more inclusive of the many men in our profession who are wonderful colleagues, mentors and friends.
Great that you speak up about this Anne, I had no idea about surgery and how it is so male dominated. When more of us know and understand what is going on, things can’t continue the way they have.