• Empowering Physicians to Respond to Patient-Initiated Harassment

    Written By: Lauren E. Hock, MD, and Nkanyezi Ferguson, MD

    Before my residency, I never imagined that dealing with inappropriate comments from patients would be one of the more stressful parts of ophthalmology training. 

    But as a first-year resident, I encountered sometimes daily remarks from patients on my appearance, age and gender. Less frequently, a patient might make a sexual joke during his slit lamp exam, or comment on my body during a refraction. These comments embarrassed and distracted me, but I accepted them as normal. 

    One night on call, a patient who had repeatedly commented on my appearance, physically and sexually, harassed my chief resident when she tried to counsel him on his need for emergent surgery. We were caught off-guard and totally unprepared to handle the situation. We realized something needed to be done to prepare trainees to address inappropriate behavior before it escalated and impacted our ability to provide optimal care.

    In response to the lack of training we receive as physicians on dealing with discrimination and harassment from patients, my ophthalmology mentors and I created an interactive workshop and toolkit for responding to patient-initiated verbal sexual harassment. The toolkit provides communication strategies for physicians who experience harassment from patients and to those who observe harassment toward another person and wish to intervene. 

    Our workshop seemed to improve physician preparedness to address inappropriate behavior but was limited in scope. Discussion with hundreds of trainee and faculty workshop participants who had experienced discrimination based on their race, ethnicity, religion, or sexual orientation, as well as institution-wide conversations surrounding systemic racism, made it clear that an expanded curriculum was needed.  

    AMA Innovation Grant

    In summer 2020, a team led by myself and Dr. Nkanyezi Ferguson, director of Diversity, Equity, and Inclusion (DEI) in the Office of Graduate Medical Education (GME) at the University of Iowa, was awarded an Innovation Grant from the American Medical Association (AMA). The grant is part of the AMA Accelerating Change in Medical Education Program. 

    This $30,000 grant supports the creation of a one-hour interactive workshop curriculum that teaches residents and faculty to respond effectively to harassment from patients based on a physician’s identity (gender, race, ethnicity, sexual orientation, religion or disability status). This funding enables us to train new workshop facilitators across our institution who will continue to implement this curriculum in the coming years.

    Our specific goals for the grant are to:

    1. Identify key gaps in knowledge pertaining to the prevalence and forms of identity-based, patient-initiated harassment and impact on the learning environment of resident physicians 
    2. Prepare resident physicians to respond effectively to patient-initiated harassment using a new training program and toolkit of response strategies
    3. Establish training to address the important role of supervisors and colleagues in monitoring and responding to identity-based, patient-initiated harassment
    4. Create a rigorous and sustainable train-the-trainer educational model to allow formal widespread institutional education on best practices for faculty and resident physicians on responding to identity-based harassment at critical points of entry into professional practice

    Our vision for this grant is to empower physicians to address identity-based discrimination and harassment during their clinical encounters, and to intervene on their colleagues’ behalf. In addition to teaching important communication strategies, we hope that these workshops support vital conversations between trainees and faculty on how to improve approaches to diversity, equity and inclusion challenges as training programs and departments. 

    Now, as a chief resident, I continue to receive inappropriate comments from patients, but knowing how to handle them has transformed my experience. Instead of fighting the instinct to flee the room, I calmly address the patient with a phrase from the toolkit: 

    • “I’m sure you didn’t mean anything by it, but I feel uncomfortable when you comment on my appearance. I want to give you the best care that I can so let’s keep our conversation professional.”
    • “I’m leaving the room because I don’t feel comfortable with your behavior.”
    • “I went through the same training as my colleagues and want to be treated with the same level of respect.”

    Patients almost always apologize, and we get back to focusing on their eye care. The other week, one of our junior residents told me that participating in the expanded workshop had given her the confidence to call out a patient who had disparaged her ethnic background. There is much work to be done to improve workplace culture on identity-based discrimination, but these projects can help create a safer, more supportive environment for everyone in our medical communities. 

    Further Resources

    For a list of tips on how to respond to sexual harassment, see Tools for Responding to Patient-Initiated Verbal Sexual Harassment, by Lauren E. Hock, MD, University of Iowa Health Care.

    the Academy extended its policy against sexual harassment to by staff, leaders, members, attendees, guests and meeting exhibitors during or in association with Academy-sponsored events, meetings or social gatherings.

    See an EyeNet® article by Academy CEO David Parke II, MD on Sexual Harassment and Ophthalmology.

    About the authors: Lauren Hock, MD, is a PGY-4 at the University of Iowa Department of Ophthalmology and Visual Sciences and is interested in pursuing glaucoma as her subspecialty. Dr. Hock co-wrote this article with Nkanyezi Ferguson, MD, who is a clinical associate professor of dermatology in the Department of Dermatology and director of diversity, equity, and inclusion in the Office of Graduate Medical Education at the University of Iowa Carver College of Medicine.