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June 2022 is ALS Awareness Month in British Columbia. This post is part 2 of a 4-part series about ALS.

June 2022 is ALS Awareness Month in British Columbia. This post is part 1 of a 4-part series about ALS by Dr Mark Seger.

“It is the Sunday of the long weekend, you know,” the voice stated on the other end of the dental emergency line. Of all the times for my wisdom tooth to erupt with viscous fervor, the long weekend before my medical school graduation was the time. My dentist was closed, and an emergent oral X-ray at a clinic an hour away would put me back $200. Even with access to a significant line of credit and transportation, few personal bills, and social supports, I said no.

BC Cancer has launched the Lung Screening Program, the first organized provincewide lung-screening program for high-risk individuals in the country. Lung cancer is the leading cause of cancer death in Canada and worldwide. In BC, seven people die of lung cancer every day. With 70% of all cases currently diagnosed at an advanced stage, the Lung Screening Program aims to detect lung cancer at an earlier stage, when treatment is more effective.

A recent Lancet editorial[1] quotes a survey of 2458 doctors in a report on sexism in medicine for the British Medical Association that found that 91% of women doctors in the UK have experienced sexism in the workplace.[2] Sexual misconduct includes assault, rape, and other forms of gender violence, but the medical or surgical setting examples of harassment more commonly include sexist or harassing language, whispering sexual innuendos into the ears of female surgeons while they were performing a procedure, or uninvited close physical contact. Of the women in the survey, 42% felt that they could not report their experiences to their organization or their training program. Speaking out within the profession is very difficult—even in the face of evidence that a psychologically unsafe environment has a negative association with patient outcomes.

The editorial recognizes that most medical jurisdictions have various bylaws declaring that sexualized behavior is unacceptable in any kind of doctor-patient relationship, but there are no formalized regulations when it comes to doctor-doctor or doctor-trainee sexual misconduct. When reports are made, a cycle of inaction recurs: some shock, condemnation, and promises to act on recommendations, which do not get enacted.

In a recent issue of the Bulletin of the Royal College of Surgeons of England, Philippa Jackson, now a senior plastic surgeon, recounts her experience of being sexually assaulted and sexually harassed at work, predominantly during her surgical training, and concludes that “there is a swathe of (predominantly) young women who are being subjected to inappropriate and criminal behaviour on a daily basis.”[3]

In British Columbia, the College of Physicians and Surgeons defines professional misconduct of a sexual nature in very clear terms, carefully excluding touching or behavior and remarks by the physician that are of a clinical nature appropriate to the service being provided.[4] There is a well-written paragraph about registrant-learner and registrant-coworker relationships. In essence, it tolerates no sexual comments or gestures, no personal or sexual relationship “while mentoring, teaching, supervising or evaluating” that individual.[4]  

To focus on our own medical community, it is likely that we are no exception and there is some unreported sexism or sexual misconduct aimed at colleagues or trainees. Without data we can make only assumptions. It would serve each physician and each trainee, and each patient too, if the stories of untoward sexual experiences endured or observed between colleagues and trainees could be collected (even if anonymously), the findings reviewed, and appropriate actions taken. Doctor to doctor or doctor to trainee sexual misconduct has no place in medicine. 
—George Szasz, CM, MD

References
1.    Bagenal J, Baxter N. Sexual misconduct in medicine must end. Lancet 2022;399(10329):1030-1032.
2.    British Medical Association. Sexual harassment at work. 2022. Accessed 17 March 2022. www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/gender-equality-in-medicine/sexual-harassment-at-work.
3.    Jackson P. Sexual assault in surgery: A personal perspective – A letter to the authors. Bull R Coll Surg Engl 2022;104:7-8.
4.    College of Physicians and Surgeons of British Columbia. Practice standard: Sexual misconduct. Accessed 16 March 2022. www.cpsbc.ca/files/pdf/PSG-Sexual-Misconduct.pdf.