AMA House of Delegates Vote to Address Sexual Harassment

“All in favor, please rise.” Without hesitation, every seat in our American Medical Association’s (AMA) House of Delegates emptied to urge that our AMA develop a process to handle claims of harassment from their members, staff, and meeting attendees.

That same day, Annals of Internal Medicine published “What Can Medicine Learn From Social Science Studies of Sexual Harassment?” (1). I read the piece on my phone, scurrying back to my hotel room before dinner with other members of the American College of Physicians (ACP) delegation to the AMA House of Delegates.

The authors of the Annals article cite the latest National Academies of Sciences, Engineering, and Medicine (NASEM) report finding that “female medical students are 220% more likely than students from disciplines other than science, technology, engineering, and mathematics to have experienced sexual harassment by faculty or staff.”

I thought of the sponsor of the AMA’s resolution, who had explained that in the 2 years since her own experience of harassment, she had heard of more and more individuals (mostly women) experiencing similar things. I thought of my own experiences throughout my training and career. I don’t know how often students from other disciplines felt harassed, but my anecdotal count for women in medicine was pretty high.

We talked about the resolution over dinner. Some of my male colleagues were shocked to hear firsthand descriptions of the frequency and diversity of sexual harassment in medicine. Physicians—like many other women and men inspired by the #MeToo movement—have been speaking up about these issues for the last few years, but my friends assumed it wasn’t happening around them. Immediately, they just as freely admitted that not knowing it was happening around them didn’t mean it wasn’t.

The resolution, though, wasn’t just about recognizing the problem. The Chair of the AMA Board of Trustees, had prefaced the resolution by saying that our AMA was aware of the issue and was actively working to develop a plan. Other physicians have described well the specific issues of harassment at large national meetings, where the anonymity that often comes with their size can seem protective from repercussions (2-4). So the author of the resolution requested not just acknowledgment, but action.

Testimony was unanimously in favor of the resolution with leaders from some of the largest subspecialty and state organizations, speaking in support. I was proud that our own President of ACP, Dr. Ana Maria Lopez, spoke up, and I was equally as proud to see men of all ages and specialties speaking out against this kind of behavior.

The Annals piece highlighted studies that show higher rates of female medical student harassment were driven mostly by gender harassment, which is described more as “a ‘put down’ not a ‘come-on’”—demeaning someone for their gender rather than directing unwanted sexual attention toward them. This behavior is more common in fields disproportionately representative of—and led by—men. Conversely, “organizations that recruit and promote more women, and appoint more women to leadership positions, may see a reduction in sexual harassment.” (Again, proudly, I noted the gender not only of ACP’s President, but our Executive Vice President/Chief Executive Officer, Dr. Darilyn Moyer.)

Although organizations like AMA and many others don’t have formal policy on the books, we know we are not alone in addressing this issue. Our entire country is working to figure out what these next steps might look like. Even without having read the Annals work, the House of Delegates asked for almost exactly what the authors suggest: to “clarify, disseminate, and enforce policies that govern reporting, investigation, and disciplinary actions.”

As we progress, we will use terms not found in our usual glossary, and we will likely need tools outside of our traditional doctor’s bag. Our colleagues in social sciences have suggested focusing on “positive rather than a punitive focus” by building supportive and open work environments where this behavior can be identified and discussed.

Until we have rebuilt our culture, diversified our leadership and fields, and built reliable mechanisms for identifying and eliminating harassment in medicine, having a forum in which to talk about it is a good start. The very acts of hearing the resolution in the House, inviting opinions to go on record, and literally standing to urge our AMA to create policy laid the foundation for that new environment. The House looked ready for change. #MeToo

References

1. Cortina LM, Jagsi R. What Can Medicine Learn From Social Science Studies of Sexual Harassment? Ann Intern Med. 2018. [PMID: 30422273] doi:10.7326/M18-2047 
2. Poorman E. Why does America still have so few female doctors? The Guardian. 14 January 2018.
3. Durkin M. Medicine's #MeToo movement. ACP Internist. May 2018.
4. Peters AL. A Physician's Place in the #MeToo Movement. Ann Intern Med. 2018;168:676-7. [PMID: 29710264] doi:10.7326/M18-0271