Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Editorial

#MeToo and the medical profession

Jayna M. Holroyd-Leduc and Sharon E. Straus
CMAJ August 20, 2018 190 (33) E972-E973; DOI: https://doi.org/10.1503/cmaj.181037
Jayna M. Holroyd-Leduc
Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute of St. Michael’s (Straus), Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sharon E. Straus
Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute of St. Michael’s (Straus), Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

In the era of #MeToo, it is time for physicians to acknowledge that the medical profession is not immune to bullying, harassment and discrimination, and act to abolish these behaviours. Harassment and discrimination of female medical staff and trainees are well documented.1,2 So why, with the MeToo movement, has there been no complaint against a prominent male physician? Could the current culture of incivility and disrespect that is common in medicine be the reason?

Unprofessional behaviour in medicine affects not only women,1 but also goes beyond the individual to cultural and organizational issues that enable these inappropriate behaviours. Organizational factors that lead to unprofessional behaviour in medicine include poor leadership, power imbalances and a culture of silence.3 Implicit (or unconscious) biases within us all, stemming from dominant stereotypes linked to various groups, also play a role.

A diverse and collegial work environment contributes to improved quality and innovation.2 In contrast, a work climate that enables bullying, harassment, discrimination and micro-aggressions can negatively affect a person’s health and career pathway, as well as limit their ability to be productive and advance, or even remain, within medicine.2 Moreover, unprofessionalism in medicine affects patient care.

Medicine is a stressful career, and physician wellness is often neglected within the culture of medicine.4 The lines between health and professionalism can blur: unhealthy physicians find it difficult to be professional. Although beyond the scope of this editorial, harassment can be a criminal offense and, as such, there must be zero tolerance and improved accountability.2

Some Canadian medical schools and health care organizations have begun to promote respect in the workplace. The involvement of deans and chairs in the areas of professionalism, equity, diversity, wellness and mentorship within several Canadian medical schools is a welcome first step. Local and national awards related to professionalism and equity are also to be applauded. However, real change will require changes to current structures and procedures.5

A respectful workplace is one that is healthy, safe and supportive, and values diversity and equity. Interventions such as online and in-person education modules addressing respect in the workplace, which target the individual and attempt to address unprofessional behaviour, show promise.6 However, few studies have looked at interventions addressing organizational structures and procedures. Despite this lack of evidence, steps should be taken to address organizational barriers to a respectful workplace.

Unconscious bias can contribute to power imbalance within the workplace and should be addressed in medicine.7 This should include training on unconscious bias for all medical leaders and for members of grant review, promotion and hiring committees. Additionally, formal job descriptions, as well as standardized and objective hiring processes, are essential for all recruitment, including medical leadership positions. Job descriptions must avoid gender-specific terms, and broad searches should be undertaken to identify and encourage all eligible candidates to apply. Evaluation criteria for hiring and promotion should also be defined clearly and applied universally to avoid discrimination and inequities. Simply said, basic human resource standards that exist in many industries must be applied in medicine.

Professionalism is a required competency for physicians and codes of conduct exist, including the Canadian Medical Association Code of Ethics. As a profession, we need to stop excusing unprofessional behaviour toward colleagues just because physicians are accomplished in clinical care or academia. Periodic review and promotion processes should have measures related to professionalism.

In medicine, it is important to encourage healthy debate and the expression of dissenting opinion. However, silently observing unprofessional put-downs and verbal bullying directed toward colleagues sends the message that this kind of behaviour is acceptable. Rather, allies need to be empowered to speak up. As such, medical workplaces need safe and transparent processes for reporting unprofessional behaviour and for investigations that are fair to all concerned, as well as adequate mechanisms to support those who experience bullying, harassment or discrimination. Finally, strategies to address the unprofessional behaviour, including remediation and changes to the work environment, should be available.

It is time that all Canadian medical schools and health care institutions implement and evaluate initiatives aimed at achieving a culture of respect within medicine. The medical profession — and ultimately patient care — will improve for all when we treat each other with respect, regardless of gender, age, race or stage of career.

Footnotes

  • Competing interests: See www.cmaj.ca/site/misc/cmaj_staff.xhtml for Jayna Holroyd-Leduc. No other competing interests were declared.

References

  1. ↵
    1. Fnais N,
    2. Soobiah C,
    3. Chen MH,
    4. et al
    . Harassment and discrimination in medical training: a systematic review and meta-analysis. Acad Med 2014;89:817–27.
    OpenUrlCrossRefPubMed
  2. ↵
    Sexual harassment of women: climate, culture, and consequences in academic sciences, engineering, and medicine. Washington (DC): National Academies Press; 2018. doi: 10.17226/24994.
    OpenUrlCrossRef
  3. ↵
    1. Pattani R,
    2. Ginsburg S,
    3. Mascarenhas Johnson A,
    4. et al
    . Organizational factors contributing to incivility at an academic medical center and systems-based solutions: a qualitative study. Acad Med 2018 June 12. [Epub ahead of print]. doi: 10.1097/ACM.0000000000002310.
    OpenUrlCrossRef
  4. ↵
    1. Wallace JE,
    2. Lemaire JB,
    3. Ghali WA
    . Physician wellness: a missing quality indicator. Lancet 2009;374:1714–21.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Pattani R,
    2. Marquez C,
    3. Dinyarian C,
    4. et al
    . The perceived organizational impact of the gender gap across a Canadian department of medicine and proposed strategies to combat it: a qualitative study. BMC Med 2018;16:48.
    OpenUrl
  6. ↵
    1. Tricco AC,
    2. Rios P,
    3. Zarin W,
    4. et al
    . Prevention and management of unprofessional behaviour among adults in the workplace: a scoping review. PLoS One 2018;13:e0201187.
    OpenUrl
  7. ↵
    1. Carnes M,
    2. Devine P,
    3. Manwell LB,
    4. et al
    . Breaking the bias habit: a workshop to promote gender equity. Madison (WI): WISELI — University of Wisconsin-Madison; 2015.
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 190 (33)
CMAJ
Vol. 190, Issue 33
20 Aug 2018
  • Table of Contents
  • Index by author

Article tools

Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
#MeToo and the medical profession
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
#MeToo and the medical profession
Jayna M. Holroyd-Leduc, Sharon E. Straus
CMAJ Aug 2018, 190 (33) E972-E973; DOI: 10.1503/cmaj.181037

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
#MeToo and the medical profession
Jayna M. Holroyd-Leduc, Sharon E. Straus
CMAJ Aug 2018, 190 (33) E972-E973; DOI: 10.1503/cmaj.181037
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Shining the light on #MeTooMedicine
  • Considering context within #MeToo and the medical profession
  • Tread carefully with #MeToo in the medical profession
  • Apology from CMAJ’s editor-in-chief
  • PubMed
  • Google Scholar

Cited By...

  • Apology from CMAJs editor-in-chief
  • Tread carefully with #MeToo in the medical profession
  • The authors respond to "Tread carefully with #MeToo in the medical profession"
  • Shining the light on #MeTooMedicine
  • Considering context within #MeToo and the medical profession
  • Google Scholar

More in this TOC Section

  • Intégration des essais randomisés dans les soins cliniques : comment le Canada peut faire mieux
  • Trouver, tester, « tracer » et isoler énergiquement pour battre la COVID-19
  • Soins continus et COVID-19 : Qu’une telle tragédie ne se reproduise plus au Canada!
Show more Éditorial

Similar Articles

Collections

  • Topics
    • Medical education, residency, internship
    • Professional conduct & regulation
    • Medical careers
    • Human rights
    • Health policy

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire