Entrenched sexism in surgery

For decades, the Royal Australasian College of Surgeons turned a blind eye to the entrenched sexist culture within surgery. After recent publicity, they have finally opened their eyes. They can no longer deny sexist surgeons operate within hospitals around Australia.

The college appointed a group of independent experts – Rob Knowles, Helen Szoke, Graeme Campbell, Cathy Ferguson, Joanna Flynn, Judith Potter and Ken Lay – to advise them on what should be done.

The first thing was to determine the extent of the problem. Was it just a few rogue sexist surgeons? Or is sexism pervasive within surgery?

The Expert Advisory Group found sexism is commonplace in surgery. A survey found 49% of fellows, trainees and international medical graduates were subjected to "discrimination, bullying or sexual harassment."

The large number of victims comes as no surprise to those of us who have worked in a hospital. Hospitals operate on a hierarchical structure with surgeons positioned at the top of the pecking order. They call the shots.

Sexist surgeons do not leave their bullying behaviour at the operating theatre door. They bully other health care professionals and patients. They also take their bullying behaviour home.

Sexist surgeons have a strong sense of entitlement. They are in command, both at work and home. Not surprisingly, the expert committee found protagonists had a lack of insight about their bullying and sexist behaviour. This lack of insight into their internalised misogyny will make changing their behaviour difficult.

The expert committee noted that sexist behaviour has negative implications for patient care. I recently observed a senior surgeon disagree with a colleague about a female patient's analgesia. The surgeon spoke very loudly whilst the patient lay quietly in her bed. Afterwards, the patient was very distressed. She asked me if the surgeon wanted "to euthanise me?"

I later asked the surgeon not to talk about the patient within her earshot. I explained how upset she was about the altercation at her bedside. He stormed off, shouting: "I will not listen to this."

The Expert Advisory Group found "known bullies" are untouchable. Bullying among surgeons has become normalised as a culturally accepted behaviour. Perpetrators are more likely to be promoted than held to account.

Most surgical departments have at least a few bullies. It is likely that these bullies are well known to the hospital's management. Yet, despite legal obligations to provide a safe workplace, hospital managers rarely reprimand surgeons for their sexist behaviour.

The demonstrable lack of consequences for perpetrators encourages some surgeons to continue to abuse their power. Hospital managers may be reluctant to take action on badly behaved surgeons for a range of reasons. They may fear the financial and reputational consequences. Hospitals fear both publicity and litigation.