The patient’s “behavior was egregious,” but if the incident occurred before 2017 and the physician “complained about it, the patient would have reported her,” said Dr. Sharonne Hayes, a cardiologist and medical director of the hospital’s Office of Diversity and Inclusion, who helped create the new policies. “Now our employees feel much more confident about their role in sexual harassment incidents, what they should and should not do, and that Mayo has their back.”
Mayo’s program — and similar initiatives at other hospitals — reflects growing awareness that it’s not just bosses and colleagues who sexually harass health care workers. Often, it’s the patients who are doing the harassing.
More often, in fact, according to a survey last year by Medscape. Of more than 6,000 doctors surveyed, 27% reported sexual harassment by patients within the past three years, whereas only 7% reported harassment from clinicians, medical personnel, or administrators. The majority of those who experienced incidents were women. Another survey of 822 doctors, conducted by STAT and Medscape in 2017, found that almost 60% had to deal with offensive remarks from a patient over the previous five years.
Yet only recently have hospitals begun grappling with the problem. “Most health care programs had 20 policies in place that protect patients, but not one that had a policy to protect staff from patients,” said Hayes, who also is a founder of Time’s Up Healthcare, a nonprofit launched this year to tackle harassment and gender bias.
The new program at Mayo includes a policy to address patient behavior, a reporting structure for providers to use following incidents, protocols for dealing with patients who behave improperly, and training for staff and students.
Hayes said that more and more hospitals are adopting similar policies to combat harassment by patients, driven in part by concern about skyrocketing rates of physician burnout and mental illness, particularly in women. “These two issues often result from the accumulation of multiple factors including stress, anxiety, and a loss of control of one’s work and environment. Since harassment contributes to all of these factors, I have no doubt that being harassed or poorly treated by patients is additive to all the other challenges faced by doctors, nurses and other members of the health care team.”
In the absence of hospital policies, doctors can find it difficult to deal with patients who act inappropriately toward them. They try to empathize with patients who may feel angry, frustrated, or powerless when interacting with the sometimes inefficient and bureaucratic health care system. They know patients are often stressed and frightened, and most physicians feel they have a duty to provide care, even when patients are difficult. So when doctors feel harassed, they often just laugh it off in an attempt to diffuse the situation and avoid offending the patient.
They may also not want to risk a patient complaint to hospital administrators, or a poor rating on customer satisfaction surveys or online review sites. Doctors also worry that reporting such incidents to colleagues could result in embarrassment, or at the very least, an awkward encounter with the patient on morning rounds.
Dr. Elizabeth Viglianti, an associate professor in pulmonary and critical care at the University of Michigan, said that when she asks other providers about sexual harassment and discrimination from patients, she commonly gets the reply, “It’s just part of the job.”
She recalled an encounter a couple years ago with a male patient who was verbally harassing her when they were alone in the clinic. She felt uncomfortable and unsafe, but later, when she went to her fellowship director and hospital administration, she was surprised to find that no system existed to report and deal with these incidents in an adequate and confidential manner. She said, “We didn’t know where to go next.”
That experience motivated her to create an algorithm in August 2018 to guide doctors and medical trainees at her hospital when they experience harassment or discrimination. It instructs doctors that if the harassment continues, they should transfer the patient to another provider and consider placing a warning in the patient’s medical chart, visible only to providers.
Viglianti said progress is slow, as there still is no reporting system in place for harassment events by patients. But the hospital is now working on a policy to change the patient bill of rights to address issues of sexual harassment by patients.