Musings on Sexual Harassment

Dr Alper is Clinical Professor of Medicine, University of California, San Francisco, and Visiting Scholar, HooverInstitution, Stanford University, Calif.

Some patients are uncomfortable with the prospect of being examined physically. They can be of either gender, though more have been female in my own experience. I have always thought of this as a matter of individual variation, to be dealt with as we deal with so many other individual differences among patients, including cultural taboos.

The extent of exactly what is to be examined becomes the central question. A typical evasive rejoinder by a reluctant patient may go something like, “Why do you have to listen to my chest if all I have is a sore throat?” Answering, “It’s to rule out early infection in the lungs” generally settles the matter.

My internal medicine training prompts me to be thorough, to consider systemic manifestations of suspected diseases and, when doing consultations, to perform enough of a general examination to exclude obvious evidence of other diseases. While it’s still only occasional, lately I believe I’m encountering more distrust than in the past. The motivation behind a suggested general examination comes up especially with regard to the thyroid gland.

One woman who’d been asked to get an endocrine consultation because of abnormal thyroid function went so far as to interrogate me in an intimidating fashion that put me very much on the defensive. I felt as if I had to prove that I wasn’t either a voyeur or a patient-molester. It made me so uncomfortable that I asked a female assistant to come in and I abbreviated the examination considerably.

Was it something I did or said that was provocative, I wondered. A bad experience with another doctor? A history of sexual abuse? Was it relevant that I was chosen as consultant by this patient only because I was listed in the carrier roster of preferred providers with a name at the beginning of the alphabet? And had she (and perhaps others) come in disappointed that I wasn’t their provider of choice?

Or might it be just a sign of the times? Sexual harassment is now so high profile that organizational policy on the subject is likely to be the first document to be put in the hands of new employees and affiliates. (It happened to me at Stanford.) This kind of strained prominence has to have some spillover effects.

An informal inquiry I did quickly showed that the very mention of “sexual harassment policy” elicited strong reactions. Among women, they ranged from openness to discussion, to a viscerally protective stance on behalf of all the hard-won progress women have made in achieving freedom in the workplace in recent years. On the other hand, one very attractive woman physician suggested that the pendulum may have swung too far—she made an obscene gesture in the direction of the groin of a male colleague and then smiled beatifically, saying, “See, you can’t get away with that and I can.” (We all laughed.)

Men generally have not wanted to say much. But one who did was a male patient whose story can only be told by altering all identifying details. I’ll paraphrase what he told me.

He is a middle manager in a large software company with an impeccable record. One day, he was asked to meet with his boss. The director of human resources was also present when he arrived. Both looked somber.

“You’ve been charged with sexual harassment,” he was told. Taken aback, he asked what he might have done to offend whoever it was who complained. “We’re not at liberty to say,” they replied. (Nor were they at liberty to say who complained.) Nevertheless, he was told to take an online course to become better informed about sexual harassment and to pay more attention to his behavior in the future.

Two years later, he was surprised to learn that the complaining employee was someone walking by, who overheard him asking one of his group of researchers who was going to get coffee to also bring him a cup. She considered it demeaning to the other employee. And the exposure to that kind of offensive behavior, in her view, created a hostile work environment.

My patient somewhat bitterly said he now had an undeserved black mark on his record that could not be expunged. In his case, everyone in the group who goes for coffee brings coffee for the others, if they ask. “I’ve brought more coffee to my female staff than they have for me,” he said. Yet the standard of harassment is so far from objective that it is based on circular logic—if someone feels harassed, they are harassed.

This incident is banal and trivial in comparison to larger issues of unequal salaries, promotions, and the historic expectation that women essentially should “grin and bear it” if exposed to sexual innuendo and other forms of exploitation at work. But it does illustrate how redressing the rights of one party may have unintended but easily predictable consequences on the rights of the other party. In my patient’s case, he has become too self-conscious to enjoy his once-friendly relations with fellow employees and remains resentful of his boss’s request to “avoid any publicity about the incident.” (That could be harassment, too.)

Does this anecdote represent a kind of sexual affirmative action that paralyzed senior managers and converted a misunderstanding into an “incident”? I think so. And, as in other instances of affirmative action, awareness of past wrongs, a desire to set precedents for future directions, and the need to protect complainants against retaliation all serve to color the handling of allegations of sexual harassment—and not entirely beneficially.

But back to the medical office. I would guess that consumerism, with its encouragement of increased assertiveness, is another important influence that affects patients today. Add the role of the media in sensitizing the public to actual instances of patient abuse by rogue physicians. The result is heightened skepticism. Where I may consider my own role in caring for patients to be a sacred trust, today’s patients may be more inclined to reserve judgment about that than to take it for granted.

Heightened awareness may be uncomfortable, but it can be useful—even for doctors. The latest uneasy patient to see me came in suspecting—and fearing—that she had diabetes. She was a professional woman and a single mother who had little help with her many responsibilities. In a few moments it was clear that she didn’t have a good story for diabetes, or, as I put it, “from what you’ve told me, you’re no more likely to have diabetes than anyone else walking down the street.”

I offered to do the appropriate blood tests, and I then said, “My training is to delve deeper, but that would involve asking more questions and having me check you physically. It’s as you wish.”

She agreed. I was pleased with the go-ahead to do as I was trained to do. And my patient visibly relaxed also. We had begun on our journey toward that most wonderful place in a good doctor—patient relationship: a meeting of the minds.