Standing in my white coat with his hand on my chest, I thought to myself,
“Is this really happening right now??”
T, an unfortunate man who suffered from a stroke in his early 50s, came in with his daughter for his annual physical.
As I reviewed his chart before entering the room, I remarked to my scribe, A,
“This is why we screen for cholesterol elevation in young adults with strong family histories of heart disease and stroke – to rule out familial high cholesterol or hyperlipidemia… hopefully to prevent outcomes like this. Fortunately, he was able to get quite a bit of motor function back, but you’ll see he still has Broca’s aphasia, so difficulty with speaking. He can still write though.”
Entering the room together, I greeted T.
“Hi! Do you remember me from last year?”
“Ming ming?” he looked questioningly.
“I’m your doctor, Dr. M.”
His daughter interrupted,
“Dr. M, I just had a few questions about his medications.”
“Of course.. what do you have for me today?”
We hashed out the details of converting everything to his mail order pharmacy, routine health maintenance items such as cancer screenings, labs and finally, immunizations.
Turning to T, I said,
“I’m going to examine you, but did you have any questions you wanted to write out for me?”
Reaching out for my lapel to presumably find my name embroidered on my white coat, his hand landed, palm open over my left breast. He was just a squeeze away from a full on grope.
“Is this really happening right now??”
Immediately my hand grabbed his right wrist and placed it in his lap.
Shaken, I blurted out the first thing that came to mind.
“Dr. M. My name is Dr. M.”
I waited for A and T’s daughter to say something, but nothing came.
That couldn’t have happened. That didn’t just happen. They would have said something. They were right here!
Your back was turned to them, M. They probably didn’t see anything.
He clearly didn’t mean to do that. He’s had a stroke, for goodness sake. He’s not in full control of his motor function.
Collecting myself, I started examining T on auto-pilot.
Eyes, ears, nose, mouth, neck, heart, lungs, abdomen, extremities. All normal.
Neurological exam – Strength 5/5 in upper and lower extremities, proximal and distal muscle groups with exception of right elbow extension, 4/5. Hand grip 5/5.
Looking into T’s eyes to tell him he could let go of my fingers now, I saw a content gleam flash quickly, turning into a smug smile. No facial droop.
His neuro exam was damn near normal, M. You know. You know he meant to do that. You’re not just imagining things.
Finger to nose, rapid alternating movements, heel to shin – slower on the right side but intact.
“I’m just going to order his flu shot and labs, and someone will be in shortly, OK?”
Not waiting to hear a response, I ran out of the exam room as quickly as I could.
Fortunately, it was the last appointment of the morning.
“My next appointment is at 1:30.. I’ll see you then, A.”
Grabbing my keys from my office, I escaped to my car and let out the deep breath I’d been holding in.
WTF just happened?
Stunned by the gall that T would do this in front of two other people, I started to retrace the encounter.
You didn’t imagine it, M. That happened.
No.
You saw the glimmer in his eyes. He meant to do that.
No. You’re conjuring something up that wasn’t there.
And you FELT a hand that wasn’t supposed to be there! Why are you making excuses for him?!
2nd year of medical school: Community based longitudinal patient experience
On a visit to a patient who agreed to have med students come into their home periodically for 2 years to show us how they lived with their chronic diseases, my partner N and I were introduced to our patient’s friend.
“Well, look at you,” he ogled while shaking my hand. “If I knew I could have pretty girls like you just come on over to visit, I would’ve signed up for the program too!”
N shifted uncomfortably as I tried to extricate my hand from a handshake that lasted just a little too long.
“If this is what doctors are now, I guess I’ll actually go in for my visits!” he cackled.
Don’t awkwardly laugh too long now, M. You’ll just encourage him.
After enduring 45 minutes of “compliments” and the things this man would do if he were only 30 years younger, N and I finally left.
“Well, that was awkward… sorry,” he said.
Sorry for what? For not stepping in to tell him it was enough? Wait.. why was it his responsibility to make it stop? You could’ve said something too, M.
“It’s fine. This was the last visit anyway.”
Not fine, M. You should report this. Although… you probably don’t want to rock the boat. It wasn’t the patient anyway, it was his friend.
That’s why I didn’t report.
3rd year of residency: Internal Medicine inpatient rotation
Dreading rounding on this male patient for the 5th day in a row, I suppressed a shudder when I entered the room.
“Oh, there you are, doc. I’ve been waiting for you to come in all morning.”
As anticipated, his hospital gown was hiked up just a little too high and his bedsheets just conveniently too low. Just enough open space to air out his junk for all to see.
“It’s chilly in here. Let me help you pull up these sheets.”
Don’t let him know he’s getting to you, M. Keep that face blank.
After the encounter, as I charted in the alcove just outside his room, his nurse came up to me.
“When are you going to discharge Mr. Peter* here? I’ve had it with seeing his genitals all over the place.”
“I’m sorry… me too. I’m working on it right now.”
“Oh, thank God. Frickin’ dirty old men… I swear, those guys all have a certain look to them.”
Heading into the elevator to see my next patient, I heard,
“Oh hey darling. Look how beautiful you are! And you’re a doctor! You can be my doctor any day.”
Looking up, I faced 2 men chuckling to themselves. They did have a certain look to them.
NOPE.
Spinning around, I stopped the elevator doors from trapping me in with these 2 fine gentleman and walked out.
“Aw, where you going sweetheart?”
Well.. they’re not my patients, and if the nurse couldn’t get someone to back her up against the patient who’s indecently exposing himself to everyone with an XX arrangement, what am I really going to accomplish by complaining? I’m just a resident.
That’s why I didn’t report.
Inpatient psychiatric rotation: 3rd year of med school
“I don’t like women,” he said menacingly, taking a step toward me.
He was a burly man, his frame taking up the entire hallway toward the door. Just as his shadow fell on me, my attending Dr. Strange* stepped in between us.
“M, I’ll just meet you in my office.”
30 minutes later, Dr. Strange sat across from me, shaking his head regrettably.
“I want you to remember this, M, because some day it might be very important. If you ever feel unsafe or threatened, never let a patient get between you and the door.
…
You’re an easy target.”
What does that even mean?, I remember thinking to myself.
8 years later, I understand exactly what that means.
Easy target
My femininity. My “pretty” face. My Asian-ness that exposes me to the submissive subversion tropes of leering male fantasies.
Over the years, I’ve soaked in tips to scrub this from my identity so I could be taken seriously as an actual physician.
- Make it seem like you’re not wearing makeup, but for the love of God, put some makeup on ✔️
- Be well groomed, but remember, you need to look like you’re a low maintenance kinda gal ✔️
- No form fitting anything: Scrubs, white coats, even your shoes – only Dansko’s allowed ✔️
- Absolutely no skirts – doctors don’t have visible legs. But don’t make those pants too baggy – what are you, a slob? ✔️
- Make sure you’ve stripped away everything that makes you a woman. But keep your smile. You’re always supposed to smile ✔️
Unfortunately, no matter how much I’ve tried to follow these rules, it hasn’t been enough.
My white coat doesn’t protect me from the unwanted advances.
Because I’m still a woman. And as such, in a matter of seconds my personhood can be and has been diminished into an object up for commentary, or available for others to reach out and touch without my permission.
Fortunately, I haven’t had to encounter very much of this from my male colleagues or superiors. However, the system doesn’t care to protect its female workers against patients, because after all, the customer is always right. Even going back to 1993, in a study published in the NEJM by Phillips and Schneider entitled Sexual Harassment of Female Doctors by Patients, more than 75% of the respondents reported sexual harassment by patients at some point in their careers.
75%.
How many of us report?
Not 75%.
Why didn’t I report?
Because I’ve been subconsciously coached over my lifetime to accept the tired excuse: Boys will be boys, which then graduated into Oh, dirty old men, am I right? Let’s just laugh about it and be on our merry way.
I’ve learned how to ignore the screeching warning sirens of someone coming on too strong, because who am I to hurt someone’s feelings? And if they do feel hurt, what other insanity are they capable of?
Self-doubt of my experience is much easier than deciding to come forward with an admission, because who’s going to believe me anyway? I’m just a girl playing pretend in a white coat.
In this week’s encounter with T, who would believe me when there were 2 other people in the room who wouldn’t be able to corroborate my story?
How could I prove the 2 seconds of violation that now sits with me in this very moment, 2 seconds that I’m not even sure was intentional?
What would there be to gain from it?
So why am I coming forward now?
“I’m tired of all this #MeToo bullshit. Can’t we just move forward with our lives?” someone posted on social media.
Yes, I’m tired of all this too. I would love for us to move forward with our lives.
But not until we acknowledge that 75% of us female physicians have been sexually harassed by patients. 100% of women have been sexually harassed, period. Only a small minority of us report.
Because what we have to gain is so minuscule and unlikely to bring about any change, but there is much to be lost as our characters get torn apart.
I’m sharing my story today because I’ve realized many of my readers are male and while I have your attention, I implore you to listen to and support your female colleagues as they come forward with their stories – it’s not something we share openly.
Though we may be strong, authoritative doctors, the moment we encounter an inappropriate touch or become victim to unwanted sexualized attention, the power differential shifts and we may not know what to do.
So we do nothing.
I did nothing.
Just like every other time.
***
This is not meant to be an indictment against all men. As Devin McCutchen writes in The Good Men Project Lessons from #NotAllMen/#YesAllWomen,
“More often than not we missed the fact that #YesAllWomen wasn’t an attack; it was an almost unprecedented invitation to listen. It is very rare for people to speak openly and frankly about victimization. It’s even more rare for them to do it en masse. With so many women talking about their experiences of being on the losing end of privilege, our first job as men in this situation is to listen.”
Thank you for listening.
***
*All names mentioned are clearly not their real names*
Photo of Beacon Rock and the Columbia River Gorge taken at Hamilton Mountain, WA.
Wow. So sorry you had to go through that. I didn’t have a clue that happened on a patient level but I guess it should not have surprised me.
Unfortunately/fortunately, it’s really only happened to me ON a patient level in my short medical career. This is just a small sampling of the experiences I’ve had since starting med school over 10 years ago, and it pales in comparison to other stories I’ve heard from other female colleagues. What’s even more disheartening is they haven’t been met with responses of support, but rather comments such as, “Well… you knew what you were getting into by going into this profession (surgery/ENT/EM/etc). What did you expect?”
It’s just another variant of shaming when the onus should be on the perpetrators, not the victim.
Sorry to hear that you’ve had to deal with that. I fortunately have not had to deal with unwanted sexual advances in my training, but I still remember being disturbed by a patient I performed an angiogram on at the VA. I asked him how he was doing and he said “Pretty darned good. I just had my groins scrubbed by a pretty young nurse for about ten minutes.” I only hope the nurse didn’t have to endure abuse while she was doing her job to prepare the patient for his procedure…
In my experience, female nurses have had to deal with sexual harassment WAY more than female physicians, simply due to the fact that they spend much more time at the bedside. I’m sure there’s data to support that anecdote somewhere, and if there isn’t, we need to get on it!
Thanks for sharing these experiences with us. Practicing medicine is already hard enough under the best of circumstances. Our female colleagues deserve better. Testimonies like this remind me that it is not enough for me to root for change on the sidelines. We all need to be part of the solution.
Glad we can count on your support!
It’s unfortunate that you and many other female physicians, nurses etc . . . have to contend with a wide spectrum of sexually related situations in the workplace, from unwanted comments, innuendo, attempts at quid pro quo to outright assault.
Unfortunately, upwards of 90% of physical sexual assaults go unreported, for a myriad of reasons. I can only imagine workplace issues, although serious, but of a lesser nature than frank assault, are not brought forward very often either. Although drawing attention to this is important and airing these issues is part of the solution, there are existing remedies that exist in our society and I think it is important that woman, such as yourself, avail themselves of these, otherwise true change will not come. Put another way: blogging about this is important, but our legislators have established some of these actions are crimes and have punishments for them.
1. BAsed on your story, the patient that grabbed your breast perpetrated a criminal act against you. This is the lowest level of sexual assault or indecent contact that would exist in your state (your blog says you live in the PAcific Northwest, so in WA this is indecent liberties and OR this is third degree sexual assault). You should discuss this with your hospital legal counsel, as you need to know if you can breach patient confidentiality to report this to the police, and then you should report this to the police.
Yes the lack of corroboration from witnesses is an issue in your case, but you are a doctor and society, the police and the courts have a ton of respect for you. You are way more credible than a creepy 50 year old patient who would grab your breast and his family/home health aid and you can take that to the bank. Plus, why would you come forward if this weren’t likely legit? You have patients to see and better things to do with your time. Unless you have a track record of frivolous police reports and suits behind your name, the best your story can be impeached is the other witnesses didn’t see it; however, you are as credible a witness as the courts and police ever see.
I suspect the penalties for the patient would be relatively minor, as this is likely not a felony, but he could need to register as a sex offender, pay a fine and if he has a criminal record, possibly face jail time.
Your exposure is needing to discuss this with the police and in court and there could be exposure if this is a grey area on violating patient confidentiality — I do not know the answer here, but it is possible breaching that may not be allowed for a crime of this nature. Your hospital counsel will know.
2. You should fire the patient. There is no grey area here. You have every right to terminate the doctor patient relationship and assign him or suggest other providers he see. You must do this, as this is completely reasonable, ethical and frankly you do not need to care for him in the future. Verbal comments are one thing, but this is different.
3. Unfortunately when it comes to comments from patients, their families etc . . . that’s a tougher area. There are generally no legal implications of what is being said. Plenty of patients do plenty of things, sexually oriented or not, that many of us find repulsive and to some extent that’s part of the business of dealing with people. The best you can often do with these things is just walk away, as the remedies for you aren’t that robust and the time it takes to contest such issues are really not worth it.
Again, you should feel free to fire the patient if it crosses the line, but this isn’t as cut and dry as patient 1.
I do hope you file a police report. What good will come of it? I don’t know, but that is what we have decided the penalty is for that behavior and if it never is investigated and a DA doesn’t get a chance to look at it, it will lie where it is. For all you know he has a bunch of prior convictions and he could serve jail time . . . .
Best of luck.
I appreciate your comments, and I have been looking into my options. Thank you.