How is it being a woman in surgery?

Questions regarding sexual abuse in comment to the article “Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights”

[Begeny et al. Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights. BJS, 2023, 1-9.]

Having recently read the article published on British Journal of Surgery, I reflected on whether anyone would be truly surprised by its conclusions, or would it be in line with what we would expect?

Reading the article made me remember an episode I experienced alongside a colleague, also a female surgeon. We were on call when a male colleague asked for help in the operating room. He was performing a bladder cancer surgery and suspected the patient also had a sigmoid colon cancer as he felt a mass in the colon. We diagnosed not a mass but faeces in the colon, which caused some embarrassment to our colleague. Later we found out that that he made inappropriate and sexist comments to his Director about us. Nothing happened to this colleague, not a censure or warning about his behaviour.  This example, although not one of sexual harassment, typifies the prevailing environment in surgery.

As the authors write in the article, “sexual misconduct in the surgery is not new”. Maybe what is really new is the courage off those that now are reporting it.

Looking at the results of this published survey, what draws most attention for me is the high frequency of witnessing sexual harassment: 89.5% for women and 81% for men, with difference between sexes of 0.26 (0.19,0.32), p<0.001. Regarding this situation, another question come to my mind – how many offenders are aware that these practices are not normal and constitute a sexual offence? And maybe because of this issue, the results were different between sexes – the definition of what is and what is not a sexual offence is regarded differently.

When the authors also asked for the frequency of being the object of sexual harassment, the results showed a big difference between sexes: 63.3% for women and 23.7% for men, with difference of 0.25 (0.20, 0.30), p<0.001. As a female surgeon, these results are disturbing, although from my own experience, especially at the beginning of my surgical training and professional activity, it doesn’t surprise me at all.

As a healthcare leader, the results force me to focus on the future and to contribute to a solution. As the authors so many times refer to “these are illegal and criminal acts”. In the future two important things should be made: to create a secure channel of complaint, ideally with an external auditor; and, in the long run, to change the culture, so that everyone understands what is accepted and normal, and what is an example of not accepted and sexual harassment.