We thank Dr. Satenstein for his interest in our editorial and this important topic.1,2 We completely agree that it is critical to have an appropriate investigation process that is transparent and objective when any harassment allegations are made. We also agree that there are different types of harassment and that the prevalence varies across studies, which highlights the importance of conducting a systematic review on the topic.3 Even if the lower limit of the confidence interval from a review by Fnais and colleagues is considered,3 we think that most people would agree that this prevalence is too high.
Since the publication of the systematic review,3 many studies have reported estimates of how common harassment is, and we have provided references to but a few of these.4–8 We agree that it is difficult to obtain accurate estimates of harassment because of the lack of sufficient safeguarding to protect those who do report concerns, which leads to substantial underreporting. We would also point to the 2018 report released by the National Academies of Sciences, Engineering and Medicine.9 This report highlights that harassment is reported to be a larger problem in medicine than in other disciplines, including engineering.
Everyone brings conscious and unconscious bias into discussions; this is the reality of being human. We are encouraged by work from Carnes and colleagues illustrating how bias might be addressed,10 and hope that other researchers test strategies in such a rigorous fashion.
We hope that we can move beyond discussing how common harassment is and move toward addressing how it can be mitigated. For patients to have optimal care, we need a safe, secure environment for all.
Footnotes
Competing interests: See www.cmaj.ca/site/misc/cmaj_staff.xhtml for Jayna Holroyd-Leduc. No other competing interests were declared.