Month: October 2023

Medical Defence Organisations

Who are they?

Examples include: MDA National, Avant

How might workplace sexual harassment fit into their scope?

MDOs provide advice, free to members, about risk mitigation from a legal perspective. They offer legal advice or advocacy, but their primary function is to support doctors to protect their professional reputations.

Can I open this door?

  • Requires MDO membership. MDO membership is usually required for employment.
  • No timing restriction imposed; MDOs may be called at any time in a survivor’s journey.

Why would I open this door?

MDOs advise on a range of issues encountered during medical work, so doctors may be familiar with their capacity for support and advice in other areas. Good previous encounters may make MDOs an approachable “first port of call” to understand your legal rights and options after experiencing workplace sexual harassment, if you’re not sure who to call. As MDOs offer confidential independent advice free to members without timing restrictions, and as membership is required for employment, doctors with few other resources tend to seek MDO advice first (such as trainees/students in remote or isolated settings, or medical specialties with less access to support such as rural practice registrars).

What path does it take me down?

  • Contact your MDO directly. MDOs often have specific representatives allocated to hospitals or universities, but also have a generic line that is appropriate to call for this purpose if unsure.
  • You will be connected with a real human being in the first instance.
  • This person will not necessarily be trained as a trauma-informed “first responder”.
  • You will be connected with doctors with medicolegal experience or lawyers to discuss what the MDO can assist with.
  • This may include providing personalised risk management advice about options, such as determining the most appropriate time or pathway for reporting.
  • This may include assistance liaising with hospital administration, etc.
  • Some MDOs offer peer support, but this varies between MDOs. MDOs may link with or offer to refer on to doctors’ wellbeing services

Where does it lead to? Can it offer me justice? healing? protection for myself/others?

  • The confidential documentation performed by the MDO during your contact may be helpful in other reporting pathways, particularly if they involve a burden of proof and if reporting is delayed. This is generally more associated with a “justice” focused approach.
  • The advice the MDO provides may support the individual to understand their options so that they are empowered to identify and open the right door for them, whether that involves justice, healing, or protection.

What could this path cost?

MDOs provide advice.

How long and far must I walk the path? Cost of entry?

  • MDO membership costs are often in the tens of thousands of dollars per year but all doctors practicing clinically have medical indemnity in some form.
  • MDO advice is provided immediately, but the MDO does not itself take action and can only support you to pursue action through the relevant door. The nature of that journey will be determined by the next door you choose after MDOs.

Are there cameras behind the door?

  • MDOs offer confidential advice. They are exempt from mandatory reporting, unless subpoenaed.
  • As an independent third party, MDOs are generally removed from conflicts of interest regarding the career or employment of the person reporting or the alleged perpetrator.

Will anyone suffer because I opened this door?

  • If the alleged perpetrator is a member of the same MDO, it is possible that they may experience negative consequences from MDO after advice was sought.

What questions should I ask?

  • How can you help me? (This varies between MDO, e.g. may or may not provide peer support.)
  • Will this increase the cost of my MDO membership?
  • Who/How many people will find out I called my MDO?
  • Who will have access to my MDO history/reasons I called?

Where do I find out more?

Contact your MDO directly.

If you have information about the approaches and processes MDOs use to engage with sexual harassment between doctors (particularly any questions we left un-answered), please submit a comment to help us continually update and improve our Door Directory.

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Mapping prevalence data: sexual harassment of doctors

Every time we present this work, there is a tendency to grapple with the vexed issue of prevalence. In the following table, we have captured some of the studies we have explored in the last 10 years. You will notice that:

  • The definition of sexual harassment varies
  • The choice of target varies
  • The choice of perpetrators varies
  • The methodology varies
  • The context varies
  • The response rate varies
  • and so the results vary.

Nevertheless, we can say a few things about prevalence.

  • It is greater than zero in all jurisdictions and all contexts
  • Women are at higher risk than men, and although we suspect people with intersectional disprivilege experience sexual harassment at higher rates, we are still gathering data about this. All genders can be targets, of course, so this is not exclusively a “women’s issue”
  • Poor gender equality in the workforce increases risk
  • Men are the commonest (but not the only) perpetrators.
  • There is usually a power differential, with the perpetrator holder a greater, or at least an equal, status with the target.
  • There is early evidence that nurses perpetrate sexual harassment , and there is good evidence that doctors are at risk from patients, but the evidence is not as extensive.
StatisticTargetPerpetratorExperienceLocationReference
17%paramedicssexual harassmentAustraliaKoritsas, Coles et al. 2007,
4%paramedicssexual assaultAustraliaKoritsas, Coles et al. 2007,
29%female junior doctors (PGY1 PGY2)sexual harassmentAustraliaLlewellyn, Karageorge et al. 2019,
16%junior doctors (PGY1 PGY2)sexual harassmentAustraliaLlewellyn, Karageorge et al. 2019,
12%ophthalmologists and traineessexual harassmentAustraliaMeyer, Troutbeck et al. 2021,
39%medical students and registrarsmedical staff, students or patientssexual violenceBelgium: FlandersGeldolf, Tijtgat et al. 2021,
83%female orthopedic surgeonssexual harassmentCanadaGiglio, Schneider et al. 2022,
71%male orthopedic surgeonssexual harassmentCanadaGiglio, Schneider et al. 2022,
45%family medicine graduatesspecialist physicians (77.1%), nurses (54.3%), residents (45.7%), patients (35.2%)intimidation, harassment or discriminationCanada: CalgaryCrutcher, Szafran et al. 2011
15%surgical residentsmainly surgeonssexual harassmentColombiaDomínguez, Torregrosa et al. 2023,
7%healthcare workersmost commonly patients, families, then colleaguessexual harassmentEthiopia: GondarYenealem, Woldegebriel et al. 2019,
80%female students (all colleges)sexual harassmentEthiopia: JimmaMamaru, Getachew et al. 2015,
32%female cardiologistssexual harassmentGermanyDettmer, Wenzel et al. 2021,
70%physiciansmostly male, mostly colleagues,  superiorssexual harassmentGermany: BerlinJenner and Oertelt-Prigione 2019,
67%physiciansnon-physical misconductGermany: BerlinJenner and Oertelt-Prigione 2019,
18%physiciansphysical misconductGermany: BerlinJenner and Oertelt-Prigione 2019,
68%female medical studentsnon-patientsVerbal abuseGermany: GöttingenGágyor, Hilbert et al. 2012
12%female medical studentsnon-patientssexual harassmentGermany: GöttingenGágyor, Hilbert et al. 2012
8%medical studentsnon-patientssexual harassmentGermany: GöttingenGágyor, Hilbert et al. 2012
1%male medical studentsnon-patientssexual harassmentGermany: GöttingenGágyor, Hilbert et al. 2012
70%medical studentspatients, superiors, educators and colleaguesverbal sexual harassmentGermany: MünsterSchoenefeld, Marschall et al. 2021,
54%medical studentspatients, superiors, educators and colleaguesphysical sexual harassmentGermany: MünsterSchoenefeld, Marschall et al. 2021,
17%medical studentspatients, superiors, educators and colleaguesforced sexual contact or intercourseGermany: MünsterSchoenefeld, Marschall et al. 2021,
61%female medical studentssexual harassmentGhanaNorman, Aikins et al. 2013
39%male medical studentssexual harassmentGhanaNorman, Aikins et al. 2013
57%female doctors, nurses, attendants, other stafffor doctors, mostly doctorssexual harassmentIndia: KolkataP. Chaudhuri, 2006.
2%female health workerssexual harassmentItalyLa Torre, Firenze et al. 2022,
1%male health workerssexual harassmentItalyLa Torre, Firenze et al. 2022,
58%female residentsmost often doctors (34.9%), patients (21.7%) and nurses (17.2%)sexual harassmentJapan: TokyoNagata-Kobayashi, Maeno et al. 2009
13%medical students sexual harassmentNetherlands: NijmegenRademakers, Van Den Muijsenbergh et al. 2008
9%ophthalmology traineesmore commonly male ophthalmologists, other consultants, administration and nursing staffsexual harassmentNZJain, Gill et al. 2020,
13%surgical traineesno mentionsexual harassmentPakistanMartins, Hashmi et al. 2021,
3%residents and facultyfaculty members, patients or their
attendants, and trainees		sexual harassmentPakistan: KarachiZubairi, Ali et al. 2019,
80%physicians and nursesmostly patients visitors, then patients, then co-workersviolencePalestineKitaneh and Hamdan 2012
19%medical residents in academic hospitalsmost often consultants, followed by patients and familiessexual harassmentSaudi ArabiaFnais, Al-Nasser et al. 2013
22%undergraduate and doctoral medical studentsmostly lecturers, doctors and peerssexual harassmentSweden: GothenburgLarsson, Hensing, Allebeck, 2003
19%female medical students and physicianssexual harassmentSwitzerlandNajjar, Socquet et al. 2022,
17%female medical students and physicianssexual harassmentSwitzerlandNajjar, Socquet et al. 2022,
75%medical studentsstaff, teachers, more senior students or peersbullyingThailandNaothavorn, Puranitee et al. 2023,
11%paediatric residentsverbal sexual harassmentThailandTungsupreechameth, Tanpowpong et al. 2023,
4%paediatric residentsmost commonly clinical faculty, nurses, colleagues and other doctorsInappropriate touchingThailandTungsupreechameth, Tanpowpong et al. 2023,
28%female doctorsat worksexual harassmentTunisiaHalouani, Damak et al. 2019,
63%medical studentsdiscrimination or harassmentUKBroad, Matheson et al. 2018,
56%female doctorsverbal conduct related to sexUKCox and Jewitt 2022,
31%female doctorsunwanted physical contactUKCox and Jewitt 2022,
36%female cardiologistssuperior or colleagueunwanted sexual comments, attention or advancesUKJaijee and Kamau 2019,
6%male cardiologistssuperior or colleagueunwanted sexual comments, attention or advancesUKJaijee and Kamau 2019,
70%LGBT+ medicssexual discrimination short of harassment or abuseUKMapara, Munro et al. 2021,
64%psychiatric traineesstaffunwanted sexual behaviourUKMorgan and Porter 1999
16%psychiatric traineesstaffphysical sexual harassmentUKMorgan and Porter 1999
3%doctorcolleaguessexual harassmentUKRimmer 2019,
64%gynecologic oncologistssexual harassmentUSAAmorosi and Chapman-Davis 2019
23%female gynecologic oncologistsunwanted sexual advancesUSAAmorosi and Chapman-Davis 2019
4%female gynecologic oncologistsasked for sexual favours in return for advancementUSAAmorosi and Chapman-Davis 2019
83%female residentssexual harassmentUSAArnold, Zargham et al. 2020,
44%male residentssexual harassmentUSAArnold, Zargham et al. 2020,
55%medical studentssexual harassmentUSABaldwin Jr, Daugherty et al. 2001
59%ophthalmologists and traineessexual harassmentUSACabrera, Enyedi et al. 2019,
24%female radiologists and traineessexual harassmentUSACamargo, Liu et al. 2017,
4%male radiologists and traineessexual harassmentUSACamargo, Liu et al. 2017,
81%female thoracic surgeons and traineesmostly supervisors and colleaguessexual harassmentUSACeppa, Dolejs et al. 2020,
46%male thoracic surgeons and traineesmostly ancilliary staff and colleaguessexual harassmentUSACeppa, Dolejs et al. 2020,
20%plastic surgery residents64.5% of instigators were supervising physicianssexual harassmentUSAD’Agostino, Vakharia et al. 2019,
4%plastic surgery residentsPhysically abusedUSAD’Agostino, Vakharia et al. 2019,
5%academic hospital physiciansnurses and residentssexual harassmentUSADabekaussen, Scheepers et al. 2023,
10%dermatology residentsmostly patients, 15% supervising or faculty, 6% fellow residentsUnwanted sexual attentionUSADeWane, Mattessich et al. 2020,
1%residentsunclearsexual harassmentUSAFitzgerald, Smith et al. 2019,
37%female physicians, while student, intern, resident, fellow or in practicesexual harassmentUSAFrank, Brogan and Schiffman, 1998
72%female medical academicssexual harassmentUSAJagsi, Griffith and Krenz, 2023
5%pediatric residentsmost commonly clinical staff, patients families, facultysexual harassmentUSAKemper and Schwartz 2020,
73%female internal medicine residentswomen’s harassers were of higher professional statussexual harassmentUSAKomaromy, Bindman et al. 1993
22%male internal medicine residents (and as students)sexual harassmentUSAKomaromy, Bindman et al. 1993
15%emergency medicine residentsmostly patients and family, followed by nurses and staffsexual harassmentUSALall, Bilimoria et al. 2021,
2%female otolaryngologistsSignificant harassment in the workplaceUSALawlor, Kawai et al. 2021,
23%emergency medicine residentssexual harassmentUSALi, Grant et al. 2008
96%women physicianscolleaguesgender harassmentUSAMathews, Hammarlund et al. 2019,
69%women physicianscolleaguesunwanted sexual attentionUSAMathews, Hammarlund et al. 2019,
38%women physiciansinappropriate sexual incidentUSAMathews, Hammarlund et al. 2019,
69%ObGyn traineessexual harassmentUSAMenhaji, Pan et al. 2022,
47%vascular surgery traineesmost commonly attending surgeons in the operating roomsexual harassmentUSANukala, Freedman-Weiss et al. 2020,
27%female radiation oncology residentssuperior or colleague.unwanted sexual comments, attention, or advancesUSAOsborn, Doke et al. 2019,
4%physiciansonline social mediasexual harassmentUSAPendergrast, Jain et al. 2021,
60%female radiologistssexual harassmentUSAPitot, White et al. 2022,
54%women in academic medicine sexual harassmentUSARaj, Freund et al. 2020
32%women in academic medicine Threats or coercive advancesUSARaj, Freund et al. 2020
41%vascular surgery faculty membersmajority from hospital staff or colleaguessexual harassmentUSASmeds and Aulivola 2020
71%Gynecologic oncologistssexual harassmentUSAStasenko, Tarney et al. 2019,
64%gynecologic oncologistssexual harassmentUSAStasenko, Tarney et al. 2019,
64%gynecologic oncologistssexual harassmentUSAStasenko, Tarney et al. 2020
70%oncologistspeers or superiorssexual harassmentUSASubbiah, Markham et al. 2021,
3%female oncologistssexual coercionUSASubbiah, Markham et al. 2021,
70%oncologistspeers and/or superiorssexual harassment in the last 12 monthsUSASubbiah, Markham et al. 2022,
83%female medical school facultyinsiderssexual harassmentUSAVargas, Brassel et al. 2020
40%female medical studentsfaculty or staffsexual harassmentUSAVogel 2018,
25%vascular surgery residentssexual harassment during trainingUSAWang, Tanius, 2019
37%medical studentsgender discrimination and sexual harassmentUSAWitte, Stratton et al. 2006,
33%female academic oncologistssexual harassmentUSAYerramilli, Williams et al. 2023
12%surgery residentsexual harassmentUSA: LouisianaPololi, Brennan et al. 2020,
7%internal medicine residentssexual harassmentUSA: LouisianaPololi, Brennan et al. 2020,
2%pediatric residentssexual harassmentUSA: LouisianaPololi, Brennan et al. 2020,
24%academic pediatriciansinstitutional staffsexual harassmentUSA: WashingtonRosenberg, Barton et al. 2023,
53%female gynecologic physicians and traineesworkplacesexual harassmentWorldBrown, Drury et al. 2019,
17%male gynecologic physicians and traineesworkplacesexual harassmentWorldBrown, Drury et al. 2019,
16%headache professionals68.6% by a boss, supervisor, senior staff or employer; 39.8% by patients; 29.0% by colleagues; 8.6% by subordinatessexual harassmentWorldde Boer, Ambrosini et al. 2023,
59%medical traineesmost commonly, consultants; then patients or families; then nurses or peersHarassment or discriminationWorldFnais, Soobiah et al 2014
63%female neurosurgeons and residentsmost often other neurosurgeonssexual harassmentWorldGadjradj, Ghobrial et al. 2021,
20%neurosurgeons and residentssexual harassmentWorldGadjradj, Ghobrial et al. 2021,
27%surgical residentsmost commonly attending surgeons, senior co-residentssexual harassmentWorldGianakos, Freischlag et al. 2022,
4%cardiologistshostile workplacesexual harassmentWorldSharma, Douglas et al. 2021,
Data table
Map of prevalence studies