Lead author and Canberra GP Associate Professor Louise Stone has appealed for help to ensure the book is freely available to everyone.
Australia’s medical profession is no stranger to Associate Professor Louise Stone’s mission to keep the spotlight burning brightly on sexual assault and harassment in medicine.
The Canberra GP has co-authored papers, organised the nation’s first summit on the topic last year, spoken at countless conferences, and written hundreds of thousands of words on the subject. And she has no plans to stop there.
Her latest project is ambitious on a global scale, but she needs support to make it happen. Professor Stone has led a team of 75 authors from 23 countries to put together a book on sexual harassment between doctors.
The book – Sexual harassment of doctors by doctors: International perspectives, experiences, and responses – is the culmination of 10 years of work which began with a consultation at her clinic 10 years ago.
“In 2014, I looked after a young intern who was sexually assaulted by her supervising consultant while on the way to the car park after a night shift,” Professor Stone details in the book’s preface.
“As a general practitioner with a long-standing interest in mental health, I had seen hundreds of survivors of sexual trauma in my clinic, but this consultation felt profoundly different.
“The therapeutic relationship felt fragile, trust was hard-won and the shame in the room was deep. In retrospect, these difficulties were unsurprising.
“After all, the intern was a doctor, the consultant was a doctor, and I was a doctor, so there were complexities in the therapeutic relationship. I was part of a community that had been complicit in the abuse.”
With little literature around at the time to guide her in understanding the nature of sexual trauma in the medical workplace, she embarked on a quest to find out more.
An international meta-analysis on harassment and discrimination in medical training, published in 2014 in Academic Medicine, a journal of the Association of American Medical Colleges, showed that 57% of medical trainees experienced bullying and harassment, and 33% experienced sexual harassment.
Professor Stone teamed up with Professor Kirsty Douglas and Professor Christine Phillips to undertake a qualitative study to better understand the lived experience of young doctors who had survived sexual abuse within the medical profession. Their findings were published in the journal Medical Education in 2019.
“We found that the experience of abuse and its management was complex, and caused long-lasting harm,” Professor Stone wrote in the new book’s preface.
“In keeping with the existing research around workplace sexual trauma, we found that the culture of bullying and harassment within medicine made junior doctors vulnerable to more serious sexual trauma.”
Even before that, they knew they were opening a can of worms.
“We also knew that the medical workplace was toxic, and despite considerable efforts within and outside of the profession, occupational trauma remained high,” wrote Professor Stone.
“Medical workplaces are hierarchical, and junior doctors depend on their seniors for career progression, making them particularly vulnerable to abuse. There are high rates of depression and alcohol use among doctors, and high levels of vicarious trauma. Doctors are reluctant to seek help, and tend to believe that mental illness is a sign of weakness. Racism and sexism are common. Suicide risk is high, particularly among junior doctors.”
Professor Stone told Rheumatology Republic that in the months and years following this paper’s publication, it was clear that the problem was international.
Researchers came from all over the world to share their own experiences, thoughts and frustrations. And so, the idea for the book was born.
It is far more than a catalogue of personal stories and case studies – although there are harrowing accounts – and aims to provide an international picture on incidence and solutions for meaningful change.
The book is split into four main sections: context, interdisciplinary perspectives, international perspectives and looking to the future. Countries explored include Australia, Austria, Egypt, Germany, Iran, Japan, Malaysia, Mexico, Nigeria, Pakistan, the UK, the US and Zambia.
Professor Stone told RR it was not a comfortable book to read, or write, but it was necessary to bring the subject out of the shadows and acknowledge that it remains a problem in medicine – not just in Australia but around the world.
It was also a practical book that looked at solutions and practical steps that could be taken to improve the problem, while acknowledging that sexual assault and harassment in medicine would likely never be completely eradicated.
“If you’re a predator, you’re going to pick a position of power. We’re always going to have predators in medicine, in law, in politics, in the military, because if you’re a predator, you’re going to pick a profession where there is power,” she said.
The book also includes a chapter on the role of men. Although sexual harassment is often seen as a problem limited to women, men play critical roles as leaders, bystanders, champions, advocates, colleagues and survivors. The book has outstanding authors of all genders.
“While perpetrators are commonly male, survivors are from all genders,” she said.
The next big challenge for Professor Stone is to fund the publication of the book to ensure that it can be open access when it is published later this year. She said finding a publisher had itself been a challenge given the content, but Cambridge University Press had agreed to release it.
“We would like to get this book published open access, so anyone around the world can use it,” she said.
“It seemed wrong to charge doctors and students from developing countries to access the book when they have written for us.”
It’s going to cost $20,000 to make that happen. Professor Stone has launched a GoFundMe campaign to raise the funds. So far about $1500 has been collected.
She told RR she had spent many hours applying for grants and seeking funding from organisations to no avail.
“It’s been a long, hard road, and there has been no funding at all to get it written,” she said.
“This is more than a collection of case studies – it’s a really valuable resource we hope is going to make a big difference on an international scale. We need to ensure it is available to everyone.”
Professor Stone puts it best in the conclusion to her preface in the book.
“This book was created to bring these diverse approaches into one text,” she writes.
“We wanted to bring the insights of multiple disciplines and multiple contexts into one space so those of us involved in the complex problem of sexual abuse in medicine could examine the problem from multiple perspectives.
“We do not claim to provide answers to this problem, but we do provide honest and open analysis. We sincerely believe that it is only by engaging with the complexity of the problem that contextually appropriate solutions can be found across the world.
“One third of our junior doctors have experienced sexual harassment. Many of those doctors have survived deeper psychological trauma from senior members of our profession. We have a responsibility as a profession to enact primary, secondary, tertiary and quaternary prevention strategies: to protect the whole profession from harm, to identify and support those at risk, to provide a restorative justice framework for those who have already experienced harm and to manage the harm of the investigative process.
“As a profession dedicated to healing and avoiding harm, we have a responsibility to our colleagues, as well as our patients. We trust this book will provide a way to understand and address this trauma in our own unique contexts, and ensure future doctors can thrive in a safe and secure medical community.”
You can support the project here. More information about the book is here.
