Search the hub

91% of female doctors have experienced sexism at work, according to a survey published by the BMA in August 2021. 56% of female respondents have experienced unwanted verbal conduct and 31% have experienced unwanted physical conduct.[1] These numbers prove that there is a culture of sexism and misogyny within healthcare. To clarify those terms, sexism is defined as prejudice, stereotyping or discrimination based upon an individual’s sex, whereas misogyny has a more sinister edge, defined as a dislike of, contempt for or ingrained prejudice against women.[2] It is important to highlight the distinction here as the perpetrators of sexist attitudes and behaviours often do not believe that they hate women – after all they have wives, mothers, daughters or sisters. However, whether or not the intention behind treating women differently to men is one coming from a place of kindness or contempt does not matter. Treating women differently to men disadvantages everyone as we all end up consigned to limited gender roles. So what does this look like within healthcare? “I am in a management role and lead a large team. I have had several experiences of men within my team who are much more junior than me being invited to represent our discipline in senior meetings or on interview panels instead of me… despite them not being qualified enough to take on those tasks.” Testimony from Surviving In Scrubs campaign website. “When I was an FY1 working in orthopaedics my supervisor told me that I should go into primary care because as a female that was the best career choice for me. It would make life easier to have children and I would be able work part time to look after them. We had previously never discussed my career options/aspirations or whether I wanted/could have children.” Testimony from Surviving In Scrubs campaign website. These incidences of undermining the authority and expertise of female healthcare workers, favouring less qualified men and making assumptions about a woman’s perceived desire for a ’traditional‘ family life over career aspirations are commonplace in healthcare. They are by no means the only examples of how women are treated as less valuable employees within the healthcare system. “As a house-officer I was groped whilst assisting a mastectomy. The consultant anaesthetist slid his hand under the drapes and groped me between my legs. I was so shocked I froze." Testimony from Surviving In Scrubs campaign. website “A patient threatened to rape me. My (male) manager laughed and said ’well what do we expect, bringing a beautiful woman on the ward?’” Testimony from Surviving In Scrubs campaign website. Sexual harassment and sexual assault occur within healthcare. A paper published in 2021 authored by Simon Fleming and Becky Fisher has shone a light on the issue within surgical training.[3] Again more work needs to be done on defining the prevalence of these criminal behaviours throughout the whole of the healthcare workforce. This is where the Surviving in Scrubs campaign comes in. This campaign was set up by myself and Dr Becky Cox earlier this year. We are currently collecting anonymous testimonies from ANY healthcare professional who has experienced sexism, misogyny, sexual harassment, sexual assault or even rape whilst in work. This can be at the hands of colleagues or patients. So far, we have over 120 testimonies and we have more coming in every day. We are collecting this data to show the human cost of these cultural problems. But also, to demonstrate the strength and power that each individual voice and testimony can have in bringing about change. The collective narrative that we have already established from a variety of healthcare backgrounds – doctors, nurses, physiotherapists, clinical psychologists, administrative staff, paramedics, etc – has already led to key stakeholders taking notice. We have had meetings with the GMC, NHS England, representatives from royal colleges, the BMA and other unions and governing bodies. There is buy in, and a drive to bring about change. But we need to keep pushing! We need more stories and voices so that we are able to represent survivors of this terrible culture within healthcare. Every voice that speaks up makes a difference. If you’ve experienced issues like these, we need your voice too! Email Surviving in Scrubs with your story or use one of the following social media platforms: Website: www.survivinginscrubs.co.uk Twitter: @scrubsurvivors @ByChelcie Instagram: @scrubsurvivors References 1. BMA. Sexism in medicine. British Medical Association, 2021. 2. Wolf N, Bindel J, Power N, et al. Sexism and misogyny: what's the difference? The Guardian, 2012. 3. Fleming S, Fisher RA. Sexual assualt in surgery: a painful truth. The Bulletin of the Royal College of Surgeons of England, 2021; 103 (6): 272-322.

The recent BBC dramatisation of Adams Kay’s memoir of his time as an obstetrician and gynaecologist, 'This Is Going to Hurt', has hit a nerve with many. For some it’s a thought-provoking work of brilliance – that highlights the real-world fragility of the NHS and its workers. For others, the deep vein of misogyny that runs through it is unacceptable, and the dehumanised portrayal of childbirth triggering for many. Whilst the BBC series is semi-fictional, the objections are part of a trend of women speaking up about being mistreated/disbelieved by medical professionals, resulting in delays in diagnosis and serious harm (in addition to the psychological burden of being gaslit). It’s not surprising that many of these stories are gynaecological. The uterus may no longer be seen as the source of hysteria, but it has now been replaced by the female mind (or the unpredictable female hormones, which are felt to ultimately control their minds). We view female pain differently to male pain. Female pain is normalised, as women’s natural physiological processes are presumed to be inherently painful. This myth seems widespread among obstetricians and gynaecologists; for example, frequently using the yardstick of ‘period cramps’ when describing female pain. This comparison manages to both ignore the fact many women do not find menstruation painful, and simultaneously belittle those who do have pathologically painful periods. It’s easy to forget that for most of western history, women’s reproductive health was not even considered worthy enough to be in the domain of the medical profession (that role being filled by midwives or lay women). Last year, I spoke at the Royal College of Obstetricians & Gynaecologists (only founded in the 20th century) about the origins and development of our speciality; and how that history still impacts our views, particularly on female pain and decision making. The response was predictably mixed, but there was a degree of defensiveness I had not anticipated. Perhaps because we see ourselves as the good guys; trying our best to care for women in a broken, understaffed system. It’s that broken system that’s the setting for ‘This is Going to Hurt’. While the book was nearly universally praised when it was released in 2017, I had found it almost unbearable to read at the time. The sexism, overconfidence, bullying and ‘rag-week’ humour were too painfully familiar to me, as a junior in the speciality; and the praise heaped on the book amplified that feeling. I am also not alone in doubting if the punitive treatment of the (largely white) women in the book would still have been seen as funny if the protagonist was a Muslim man? Would the sarcastic quips be as witty if the arrogance was from a black woman? There was more nuance in the TV series; with the recognition that (the more fictionalised) anti-hero’s attitude to women was not acceptable – but it was still glamourised. The arrogant, complex, maverick battling inhuman fatigue (while still maintaining excellent hair, and no professional boundaries) is a TV doctor trope. It’s a shorthand for clinical brilliance that sadly persists in the real world. It’s that lack of humility that is particularly dangerous in our speciality and puts women at risk. Because our patients are female, it is also particularly easy to fall back on the cultural misogyny we have inherited, and blame women themselves when we can’t explain symptoms. But my experience is that these attitudes are waning, and the obstetric culture of the mid-2000s depicted by Kay increasingly dated. Junior doctors would find his description of ‘Brats and Twats’ bewilderingly alien. But the real change is being forced by women themselves. The public is increasingly questioning and insisting on improvement; and we are rightly having to listen. Further reading Medicines, research and female hormones: a dangerous knowledge gap Dangerous exclusions: The risk to patient safety of sex and gender bias My endometriosis hell and why chronic pain patients need an end to 'medical gaslighting' Regulatory flaws: Women were catastrophically failed in the mesh, Primodos and Sodium Valproate tragedies The normalisation of women’s pain ‘Women are being dismissed, disbelieved and shut out’ Gender bias: A threat to women’s health

In Spring 2021, I was due to meet a senior NHS official, along with a group of pelvic mesh campaigners, to ask for consistent training of all surgeons performing mesh removal procedures. That meeting was cancelled, and I’m calling for it to be reinstated, and fast. We desperately need action to sort out the inadequate, piecemeal approach the NHS has taken to redress the harm caused by surgical mesh. I manage a Facebook support group of over 9,200 women, most of whom are still living with debilitating pain and side effects caused by pelvic mesh. Each experience tells of harm added to harm - of mesh removal surgery being hard to access and inconsistent, and of hopelessly long waiting lists. Mesh specialist centres - inconsistent and inaccessible There are seven mesh complication centres in the UK[1] - six in England, one in Scotland and none in Wales or Northern Ireland - but assessment and surgical procedures vary hugely between these centres: There is no consistent training for surgeons undertaking mesh removal, with each centre taking its own approach. This needs to be addressed urgently with centralised training and standards to ensure that the most effective, evidence-based approach is taken for each and every woman. Some surgeons seem reluctant to undertake mesh removal and many women are sent away with no treatment other than to ‘keep taking painkillers’. It shouldn’t be that the care a patient is offered depends on a surgeon’s preference. There are only seven mesh specialist centres, meaning some women have to travel hundreds of miles for every appointment. Many have to undergo surgery without a family member or friend with them because of travel costs. In addition, there is only one centre in the country, in London, that will consider removing rectopexy mesh. This mesh may have been implanted in a smaller number of patients, but the incidence and severity of harm seems to be even greater than for women with transvaginal mesh. When patients are offered mesh removal surgery, waiting times are often in excess of two years. As with many other areas of the healthcare system, the problem has been worsened by the Covid-19 pandemic. Emerging victims of the surgical mesh scandal The Cumberlege Review began to shed some light on the harm caused to women who had pelvic mesh implanted. But the story is so much bigger than pelvic mesh - new patients who have had mesh implanted in other areas of the body are increasingly approaching Sling the Mesh, reporting pain and other side effects. There has been no review in England into the use of mesh to treat hernias[2], and we are seeing an increasing number of women reporting complications after mesh has been inserted into the abdomen following TRAM flap surgery[3], a procedure where abdominal tissue is used in breast reconstruction. Many of these people report being told by their surgeons that their pain is caused by ‘anxiety’; much the same story women with transvaginal mesh complications were given six years ago before the media started covering this issue extensively. This amounts to medical gaslighting and adds to the harm caused by the initial insertion of mesh devices. The NHS needs to learn from the hard lessons of the pelvic mesh scandal and take a joined-up and patient-centred approach to dealing with these emerging issues. The NHS needs to listen and take action Baroness Cumberlege’s review should have marked a sea change in the treatment of women who have suffered harm as a result of transvaginal mesh. But the NHS response has lacked will and focus, leaving thousands of patients still living with pain and distress as a result of surgical harm. Those individuals and agencies with the power to bring consistency and compassion to mesh removal surgery need to listen to the patients who have suffered life-changing injury. And taking the time to meet with us would be a good first step. Suggested reading Regulatory flaws: Women were catastrophically failed in the mesh, Primodos and Sodium Valproate tragedies - a blog by Kath Sansom Ineffective medical device recalls are a patient safety scandal - a blog by Kath Sansom A year on from the Cumberlege Review: Initial reflections on the Government’s response (Patient Safety Learning, 23 July 2021) Transvaginal Mesh Timeline (7 December 2017) References 1. 'England Mesh Complication Centres Announced'. British Society of Urogynaecology website, 5 February 2021 2. 'Hernia mesh complications "affect more than 100,000"'. BBC website, accessed 22 November 2021 3. 'Breast reconstruction using tissue from your tummy'. Macmillan Cancer Support website, accessed 22 November 2021