In less than 10 characters, this simple phrase summarizes the passion, impatience, frustration, conviction and empowerment that birthed a movement. The phrase also summarizes the global imperative to achieve equity in health care. For many women and men, the imperative holds a personal urgency; for me, realizing my dream to become an empathetic and skilled trauma surgeon so I can provide my patients with the best possible care depends on a safe working environment free of discrimination and harassment. As a survivor of sexual assault, I am well aware of the debilitating impact sexual violence can have on one’s career.
In 2019, sexual harassment and discrimination in medicine prevent patients from receiving the best possible care. We all deserve better. Not only do all who practice medicine and care for patients deserve an equitable workplace, patients deserve optimal care provided by medical teams in which all members are respected and valued. This is why I’m proud to be a founding member of TIME’S UP Healthcare, an affiliate of the TIME’S UP organization. TIME’S UP Healthcare (TUH) is dedicated to ensuring an equitable and safe environment for all who work in the health care industry — from physicians to nurses to lab techs to other support staff, who in turn can ensure the best care possible to patients and their families.
Advocacy is built on history and the legacy of those who came before us. Neurosurgeon Dr. Frances Conley is a legendary example of a woman who did what she had to in order to survive, then used her position to advocate for change for the next generation. In 1975, Dr. Conley became the first female surgical faculty member at Stanford. In her memoir, Walking Out On The Boys, a description of a conversation with a medical student who had encountered an “interpersonal problem” on her clerkship, illustrates the abusive reality for many female physicians and nurses in that era.
“The Dean of Students had no intention of changing the behavior of surgeons; that was the way they were. I was to counsel her so she could adapt to the operating room — a rite of passage for every female medical student. I remember being quite surprised by how offended she had been. After all, the operating room nurses tolerated worse abuses; her breasts were not being fondled, her crotch was not being grabbed, she had not been propositioned. Her complaints were about behaviour I experienced everyday, and I was of no help to her, giving her the standard litany of “toughen up or you’re not going to make it.” She left my office close to tears — I had been anything but the ally she expected, and she was profoundly disappointed. Changing the surgeon’s world was not part of my agenda. So I defended it … Since I saw no evidence of imminent change, I decided it was better to put up with it and shut up.”
The arc of Dr. Conley’s long career embodies many of the qualities — survival, courage, humility, teamwork and resilience — that I wish to emulate in my own career and to apply to my work with TIME’S UP Healthcare.
While Dr. Conley’s response to the medical student may be interpreted as a woman failing to protect another woman, Dr. Conley taught the young woman how to survive in the only way she knew how. Even in her memoir, she minimizes her personal experience — “I was not being pawed or handled in the clinic or office area — that only happened to me in the operating room or at departmental luncheons, away from conscious patients.”
Abuse has been the price women pay for admission to medical school and later for a seat at the table among male colleagues in medicine. For nurses, administrative support staff, and others in medicine, their options have largely been to tolerate the abuse or forfeit their employment. This may be why the National Academy of Sciences, Engineering, and Medicine found in their 2018 report that even though nearly 50 percent of female medical students had experienced harassment, few reported it. To succeed in the health care industry, silence has been an adaptive mechanism for survival. TUH works toward a world in which no one has to suffer in silence.
In 1991, Dr. Conley’s most abusive colleague was slated for advancement to chair of the department; rather than suffer further under his oppressive leadership, she resigned. With hopes of changing things for the next generation, Dr. Conley wrote an opinion letter detailing her experiences to the local media. As a high profile surgeon at Stanford, her story quickly became national news; she was interviewed on Nightline, NPR, and 20/20. Her resignation coincided with Anita Hill’s bravery in the Clarence Thomas Supreme Court confirmation hearings.
Both women ignited a national conversation on the prevalence and burden of sexual harassment. Both shed light on experiences traditionally shrouded in silence. TUH envisions a world in which resignation is not the only way to avoid abuse and courage to speak up is met with inquiry and action.
At the time of her resignation, Dr. Conley did not have language to describe her experience. Later, after listening to medical students’ descriptions of mistreatment and through a conversation with two administrative assistants who had also filed grievances about the anticipated chair, Dr. Conley saw her experiences for what they were — sexual harassment.
“All those years of toughing it out and not thinking about how I was being treated ended abruptly as my conversation with [them] continued,” she wrote. Dr. Conley’s comfort in learning from a younger generation of women empowered her to effect change she had never dreamed possible. TUH aims to empower each other through our experiences, unique perspectives, and wisdom across generations.
In her own words, “the ‘heroine’ of the ‘Conley story’ is not Conley.” After her resignation, Stanford opened an investigation into Dr. Conley’s allegations. By Dr. Conley’s estimate, “there were approximately twenty ‘heroines” … mostly nurses, who along with some clerical staff, who were willing to break a covenant of silence and tell the truth about unacceptable ‘flirtatious’ behavior … The angels demonstrated extraordinary courage in telling the world about abusive behavior in the medical school, clinics, and hospital.”
Later, Dr. Conley supported other members of the Stanford community — from premedical students to support staff to attendings — in reporting their experiences of sexual harassment. She was aware that this was a pervasive problem in all of health care and that to incite change we must support each other. TUH aims to unite health care workers across all fields, at every level of health care delivery.
When the University agreed to investigate her allegations, Dr. Conley retracted her resignation. Her return was not easy — “the Neurosurgery Department back at Stanford was anything but warm or compassionate.” Simultaneously, Dr. Conley found herself inundated by women seeking advice in dealing with harassment and discrimination. She was invited to speak nationwide on the need to establish safe working conditions for women in medicine. On the lecture circuit, she was “always greeted enthusiastically, with compassion and warmth” — a reprieve from her strained work environment. She describes her depression as lifting as she engaged in advocacy. TUH builds on our inherent resiliance, providing a network of engagement and advocacy.
I read Dr. Conley’s book when I was a medical student at a school proud to have a woman as chair of the general surgery department. While my surgery rotations were overwhelmingly positive, I cannot describe them as entirely free of inappropriate comments or physical gestures. Nonetheless, I was grateful for Dr. Conley, her contemporaries, and their predecessors. Because of their courage and my medical school’s strong surgeon role models who were also parents, I was never told that women did not belong in surgery or that the career is incompatible with family.
Nearly 20 years after Dr. Conley’s resignation, I became a preliminary general surgery resident. As a preliminary resident, I was acutely aware of the uncertainty of my future in surgery. I found myself laughing off inappropriate comments and uncomfortable gestures. Just as Dr. Conley had felt she had no options but to endure abuse to maintain her place at the table, I found myself silenced and incapable of speaking up for fear of throwing away a lifetime of preparation for the singular goal to which I aspired. Eventually, new departmental leadership changed the culture to one of ubiquitous respect. This experience taught me the tremendous regional, institutional, and departmental variation in the experiences of women in medicine, as well as the role of the leadership in determining the culture of an organization.
In the afterward to her book, Dr. Conley acknowledges she derives “some comfort in knowing that [her] story is owned by a multitude of career women and some of them will continue its telling … progress in that narrative will come from women who recognize and capitalize on the power that comes from coalitions and alliances with each other as well as the sympathetic men who believe in true equality. Only with a collective movement can women empower themselves to change the future for all of us.” A quarter century since Dr. Conley’s historic resignation, the torch she lit has been handed to the next generation; the collective movement is now.
TIME’S UP Healthcare shines light on inequities and advocates for change that is long overdue. The time for coalition, alliance, and collective movement has arrived, and residents and fellows bring an essential perspective.
- We are vulnerable. The majority of our careers are yet uncharted. Our trajectories are dependent on sponsorship and letters of recommendation. Clear reporting mechanisms and protections for reporters are essential.
- We have high expectations. As medical students in largely gender-balanced classes, we expect the same balance and equity in leadership and advancement.
- We have the most to gain, and our patients do, too. With years of practice ahead of us, countless patients will benefit from safety and equity in health care.
For these reasons and more, we are changing the narrative for ourselves and for the next generation. Health care practitioners deserve an environment free of discrimination and harassment. Patients do too. Now is the time to make this our reality. #TIMESUP.