Correspondence

Sexual Harassment

N Engl J Med 1994; 330:1388-1389May 12, 1994

Article

To the Editor:

The Special Article by Phillips and Schneider (Dec. 23 issue)1 addresses what they define as sexual harassment of female doctors by patients. Sexual harassment is usually defined as the creation of a hostile atmosphere or abuse of a position of power in a relationship through sexual behavior or language. Since the relationship between doctor and patient invests the doctor with most of the power, it seems intrinsically contradictory to define the behavior described by Phillips and Schneider as harassment. The puritanical attitude that all sexual language and behavior constitute harassment has impaired the effectiveness of the medical profession in obtaining histories and altering health-related behavior. Male physicians have always had to deal with flirtatious and seductive behavior in their female patients, which has sometimes jeopardized their careers. Understanding that both attraction and the manipulative use of sex are not limited to relationships characterized by male power and female dependency should be liberating. It is appropriate for all physicians to learn to deal with sexual language and behavior by patients that may be threatening or inappropriate, regardless of sex and the locus of authority. Medical education needs to address such issues. Labeling sexual behavior toward female physicians harassment, however, identifies doctors as victims even though they have the power to define the relationship. Regardless of sex, the doctor needs to learn to use that power. Sixteen respondents to the questionnaire reported experiences with sexual content that they did not consider harassment. That they would mention such incidences in the context of harassment confirms that we still have a long way to go in our attitudes toward human sexuality.

Susan B. Shurin, M.D.
Case Western Reserve University School of Medicine, Cleveland, OH 44106

1 References

1. 1

   Phillips SP, Schneider MS. Sexual harassment of female doctors by patients. N Engl J Med 1993;329:1936-1939
   Full Text | Web of Science | Medline

To the Editor:

The report by Phillips and Schneider is a valuable addition to the growing literature on sexual harassment in medicine. Sexual harassment of male physicians does occur, at least during residency. We reported that 6 of 23 male residents in pediatrics (26 percent) had been the subject of approaches by the parents of patients.1 We stressed, as do Phillips and Schneider, that young physicians must be prepared for such situations.

Howard Fischer, M.D.
Children's Hospital of Michigan, Detroit, MI 48201

1 References

1. 1

   Fischer H, Brenner SL. Sexual and social invitations. J Natl Med Assoc 1990;82:554, 556-554, 556
   Web of Science

To the Editor:

Phillips and Schneider's fine article states that the majority of respondents (53 percent) experienced harassment in the form of “suggestive looks” but fails to indicate what a suggestive look is and whether the “lookee” or the “looker” is making the evaluation. Does such behavior, with obvious exceptions (fondling, rape, and so forth), really lie in the eye of the beholder?

E.J. Neiburger, D.D.S.
1000 North Ave., Waukegan, IL 60085

To the Editor:

Phillips and Schneider imply that all the normal steps of courtship can be described as sexual harassment. It tends to make us feel guilty about a most pleasurable aspect of life: relations between men and women, including the appreciation, the compliments, the banter, and the flirtation. The authors refer to “pressure for dates.” Pressure or request? How else do you start a relationship? Without what Phillips and Schneider call sexual harassment, none of us would have been born. Women can distinguish between banter and vulgarity and answer both appropriately. Am I to assume that North American women receive flowers only when they solicit them? Scarlett O'Hara, come back!

Jacqueline Van Sande, Ph.D.
University of Brussels, 1070 Brussels, Belgium

Author/Editor Response

Dr. Phillips replies:

To the Editor: In response to Van Sande, yes, we do believe that “all the normal steps of courtship can be described as sexual harassment.” Behavior cannot be divorced from the context in which it occurs. Intercourse with consent is often referred to as making love. Intercourse without consent is rape. Van Sande asks how one starts a relationship without engaging in some of the behaviors we define as harassment. But is the doctor-patient encounter concerned with starting a “relationship,” or is it concerned with health care?

Neiburger wonders whether behavior that constitutes sexual harassment can be defined absolutely, or whether that interpretation lies in the eye of the beholder. The definition of harassment established by the Equal Employment Opportunity Commission and used in our study, as well as in many similar studies of sexual harassment in the workplace, begins with the word “unwelcome.” The interpretation of “unwelcome” can be made only by the “lookee.” In medicine we frequently encounter different responses to what seem to be similar stimuli in our patients. One child smiles while receiving an immunization, and another may scream. We do not tell the screamer that he or she is misinterpreting pressure as pain, and discount the response as wrong. Instead, we recognize that there may be a range of interpretations and responses. Though many people may be uneasy with the fluidity of a definition of sexual harassment that allows interpretation by the alleged victim, this has become the standard legislative approach.

Shurin fails to understand one of the conclusions of our study. The power of a man over a woman often overrides the power of a physician over a patient in the doctor-patient relationship. Her suggestion is that physicians “have the power to define the relationship.” In the literature on sexual abuse, the belief that those being victimized should use their power to protect themselves (e.g., judging a woman for failing to leave a violent relationship) is known as “blaming the victim.”

I agree with Shurin that all physicians could benefit from learning to deal with sexual behavior by patients. As Fischer points out, both male and female doctors may be exposed to unwelcome, threatening, or dangerous behavior by patients. Perhaps all medical school curricula should include discussions of the causes and nature of such behavior, reactions to it, and ways to prevent it.

Susan Phillips, M.D.
Queen's University, Kingston, ON K7L 5E9, Canada