Medicine thrives under patriarchy and misogyny. As a matter of fact, it goes to great lengths to ensure the survival and sustainability of this model.
Without some background this discussion may not be fruitful. Patriarchy was borne of social constructionism in a process that took nearly 2500 years to complete (1). As a narrow spectrum of gender roles and behaviors was established, so too were leading metaphors that became woven into the cultural construct and explanatory system. Contrary to Darwin’s sociobiology defense, among others, male superiority and dominance is not a default state of the human condition. Femme subordination is not inherently human. It is a construct - one that institutions and society operate from. This narrative of inherent inferiority is why we do not believe women trainees and learners when they bring their harassment and assault to light, much less offer them tangible forms of justice or real change. It is how institutions maintain order and remain predominantly male and exclude underrepresented groups of all colors.
Learners and trainees in medicine are faced with choices when they have been met with harassment or worse. Maternal discrimination, a subset of gender discrimination, in medicine is my personal interest and a perspective from which I advocate. I intimately understand the progression from shame and disbelief to righteous anger and justice-seeking.
The leap from ethical injury to action is riddled with choices offering specific ends, and not always in favor of the learner or trainee. Whether it means seeking help from a supervisor-figure, or reporting the incident to a governing organization (example: anonymous reporting at an institution, educational boards, or even Human Resources), these options have varied outcomes that include action, gaslighting, retaliation, or complete silencing.
Furthermore, departments like Human Resources bare a burden of proof as they are entrusted with preventing institutional legal exposure and financial risk. This is the problem of too many zeros: established professors and attending physicians are more profitable, salaried and even tenured. That means their behavior, however negative or even violent, is weighted against the financial risk they carry versus a potential legal threat from an inferior party (a trainee or learner), who, they hope, will not follow through or will at least encounter barriers. Sometimes it takes flagrant violence and injustice to emerge before action is taken (2). Justice is rare, and justification is common. The human collateral in that void is palpable yet unquantifiable. This must change.
The way violent patriarchy survives in medicine is cooperation of the involved parties, including women. That is not to blame women for not speaking up and seeking justice or improved conditions. Rather it emphasizes that there is benefit to subordination at both extremes - avoiding action for fear of retaliation, or furthering the marginalization of women to exert some form of personal leverage. Change requires solidarity and tangible resources. While the former is a question of personal ethics and internal narratives, the latter is logistically difficult to navigate. Please remember that being in medicine confers privilege even for those of us from marginalized groups. None of us are powerless in spite of the culture of infantilization that medicine is founded on.
Institutions do not change out of benevolence. Pressures in forms that threaten their stability and welfare do, however. It is time we stop gaslighting ourselves and our peers, empowering one another, and pushing forward in tangible ways. That is how we change the game.
If you have experienced harassment, violence, or retaliation it is important to know your options. The following does not constitute legal counsel or advice. If you believe you are in need of legal help, please seek out an attorney. Helpful resources include your state’s ACLU, the TimesUP legal fund and now the TimesUp Healthcare legal fund.
Important resources to consider:
- If you are a resident or fellow, then you are an employee and may seek out an Equal Opportunity Employment Claim (EEOC.gov). Be mindful that incidents are limited by state-determined deadlines and that your legal recourse may be limited if not filed in time.
- Residents and fellows may also seek out the ACGME reporting feature. Complaints may be filed anonymously in some cases.
- If you are a student, institutions often have confidential reporting. You may also consider escalating experiences to educational boards directly.
- Lerner, Gerda. The creation of patriarchy. New York: Oxford UP, 1986.
- https://www.latimes.com/local/lanow/la-me-ln-usc-fellowship-accreditation-loss-20190425-story.html
