How physicians can respond to workplace sexism

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Rebekah Bernard, MD, a family physician at Gulf Coast Direct Primary Care in Fort Myers, Florida. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

Recently, a friend who is a seasoned physician shared a disconcerting experience she had with one of her patients. 

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“I called him to review his lab results, and out of the blue, he said, ‘You know, if I wasn’t married, we would be together.’”

My friend was stunned. “I felt like a deer in the headlights. I didn’t know what to say, or how to respond.  I just ignored the comment, and asked if he had any questions about his lab results.” 

Dr. Bernard

Unfortunately, ignoring the comment didn’t work. “Don’t get so excited,” the patient said, his voice dripping with sarcasm. The rest of the phone conversation was incredibly awkward, as my friend tried to redirect the conversation back to the patient’s plan of care.

My friend is not alone in experiencing this type of inappropriate remark, with studies showing that most women physicians-52% in one study[1] and 75% in another[2]-have been sexually harassed at some point in their career by patients.

In general, women tend to find themselves responding to sexual harassment with feelings of embarrassment, anger and frustration.[3] These types of emotions can be particularly problematic for female physicians, as they are likely to create a negative impact on the physician-patient relationship, and make it harder provide the best quality of care.

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Although most women report that they would want to confront sexism, the reality is that when it does occur, we overwhelmingly stay silent,[4] either due to embarrassment, lack of preparation or uncertainty of how to respond, or concern for how our response will be received.

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But our fears of how men will react to being “called out” may be misplaced, with studies showing that confronting sexism can have positive consequences in relationships between men and women. 

In one study, men who were told that they were making sexist remarks by an unknown female partner reacted positively, often trying to justify or apologize for the remarks, and generally did not react with hostility or anger. In fact, men who were confronted were actually nicer and reported liking the female partner more after having been accused of sexism. [5]

Acknowledging that women physicians are likely to experience sexism at some point in their training and career is the first step to deal with the problem, followed by formulating a strategy to respond to inappropriate comments.

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Steven Cohen, Ph.D., a clinical psychologist specializing in communication, recommends always acknowledging sexist remarks, even though it may feel uncomfortable to do so.

“I suggest first acknowledging the comment, responding in a controlled way, and then continuing the conversation as though the comment had no emotional impact,” he says.

So in the case of my friend, simply repeating back the patient’s own words: “You’re saying that if you weren’t married we would be together?” and then responding “it’s not appropriate for you to talk that way to me,” before transitioning back to the medical conversation would have been preferable to ignoring the patient’s remarks. 

Having been through this experience, my friend feels that she is now better armed against inappropriate remarks in the future. “I have rehearsed what I will say so I won't feel so blindsided if this happens again.” 

That’s a great idea, says Cohen, although he notes that it is difficult to predict exactly how to respond to any given scenario. “Instead, practice how you will feel in the moment, visualizing yourself in control of the situation.” He also notes that the simple method of repeating back the sexist remark can provide enough of a buffer to allow enough time to think of an appropriate response.

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The key to decreasing sexism and gender bias is acknowledging and confronting bias in a calm and controlled manner. And as more women speak up rather than ignoring inappropriate remarks, we will eventually have less problems with sexism in the workplace, as studies repeatedly show that the simple technique of confronting bias helps to improve perceptions and reduce bias in the future.[6]

[1]JAMA. 2016;315(19):2120-2121. doi:10.1001/jama.2016.2188

[2] N Engl J Med 1993; 329:1936-1939December 23, 1993DOI: 10.1056/NEJM199312233292607

[3]CMAJ. 1996 Jun 1; 154(11): 1657–1665.

[4] https://www.urj.ucf.edu/docs/Sabbagh.pdf

[5]http://dx.doi.org/10.1016/j.jesp.2010.10.001

[6] https://www.forbes.com/sites/heidigranthalvorson/2011/09/06/3-reasons-why-it-pays-to-not-let-sexist-comments-slide/2/#722f394429a0