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Boroff-Forman Lecture Tackles a Persistent National Problem

May 28, 2019
by Jane E. Dee

Esther Choo, MD ’01, a founding member of Time’s Up Healthcare, discussed the national issue of sexual harassment in health care during the Boroff-Forman Lecture, “Time is Up: Gender Equity and Safety in Medicine” in The Anlyan Center auditorium on May 23.

Choo, a Yale School of Medicine (YSM) alum and the strategic lead for Time’s Up Healthcare, is visiting medical schools across the country, offering context and solutions that can be applied to the problems of racial and gender inequality, and sexual harassment in the workplace, and to support health care organizations in making the issues central and visible.

The lecture was presented by the YSM Department of Radiology & Biomedical Imaging, and co-sponsored by the Committee on the Status of Women in Medicine, the Department of Emergency Medicine, and Women’s Health Research at Yale.

Howard Forman, MD, professor of Radiology & Biomedical Imaging, has presented the Boroff-Forman Lecture at Yale for seven years. He introduced Choo as “a trailblazer as an advocate for marginalized groups, especially women, and especially women in healthcare.”

Inequality – pay gaps, opportunity gaps, and respect gaps – can impact the standard of care that physicians apply, Choo said. “We are seeing downstream impacts.”

Experimental evidence from Oakland, Calif. found that Black men seen by Black doctors agreed to more preventative services than those seen by nonblack doctors, an outcome that appeared to be driven by better communication and trust. “This could be affecting the mortality difference between White and Black men that we are seeing,” Choo said.

Choo, an emergency medicine physician at Oregon Health & Science University, discussed another study that showed how female patients experienced better outcomes in emergency departments that have a higher percentage of female physicians.

“When we bring gender diversity into emergency departments, it improves outcomes,” she said.

“If gender disparity in health care is a workforce issue, why don’t we diversify the workforce?” she asked. “Why are we having a hard time doing that?”

According to a 2018 report in The National Academies Press, “Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine,” while the diversity of people participating in those fields, especially women, has improved in recent years, women entering science, engineering and medicine often face biases and barriers including sexual harassment.

“We have optimism that these problems will solve themselves,” she said. “What people are surprised about the most when I talk about this is that the problem is not getting better.”

Solutions start with acknowledging challenges such as inertia, tradition, and motivation. “Numbers are not reported out – the problems are silent and invisible. The process of sexual harassment happens under duress. It is shut down and made private, and becomes a cause of fear and anxiety,” she said.

“I think the next step is to start having a conversation, to make this unspeakable problem one we talk about all the time,” she added.

She suggested using health care metrics with the same rigor that a physician would approach a medical case. Some of those metrics might be tracking types of harassment in an annual survey, and the incidences of complaints over time.

“Apply existing, familiar frameworks to this problem,” she said, such as the chronic disease model of prevention and early detection. “If sexual harassment was a chronic disease, we would wait for it to become metastatic,” she said. “You’re waiting until there is no fix. But when you start with prevention, we still have a chance to preserve people’s careers.”

“We can learn from cases that take place at our institution and other institutions,” she said. “The key thing is to talk about it without freaking out. Let’s talk about it, and talk about it, and talk about it. This is on you,” she said. “What are the forums at your institution?”

Submitted by Angel Machon on May 28, 2019