Narrative study

Sexual abuse of doctors by doctors: a narrative study into sexual abuse in the medical workplace

Background 

This qualitative study was designed to explore the way women construct narratives around their experience of sexual abuse, and to identify narrative typologies in these stories which suggest opportunities for therapeutic interventions. Understanding and sharing these narratives will be a beginning step in breaking the silence around this issue and enabling cultural change.

Research questions

  1. How do doctors describe sexual abuse and its impact? Are there common narrative elements within those stories?
  2. How does sexual abuse affect the personal and professional identity of doctors?
  3. How can we build an empirically-derived framework that can underpin therapeutic guidelines for the management of these young doctors?
  4. What interventions can be developed to address organisational cultures that enable or tolerates abuse in the workplace?

Methods

Narrative inquiry is a method of generating data, interpreting data and representing data analysis using narrative. Given the traumatic nature of the events under discussion, it is important to choose a methodology that enables the participants to choose the nature and manner of story-telling. This methodology has a rich tradition of working with participants on sensitive topics, and with marginalised communities for this reason.

Critical theory is a methodological framework which focuses on social justice and social power. Based on the Marxist tradition, this methodological framework is oriented toward critiquing and changing society, and grounds a number of social science research, including the work of Pierre Bourdieu and Michel Foucault.

Critical theorists “study how the construction of knowledge and the organisation of power in society generally, and in institutions such as schools, hospitals, and governments specifically, can lead to the subjugation or oppression of particular individuals, groups, or perspectives. Critical theorists are concerned with equity and justice in relation to issues such as race, socioeconomic status, religion, and sexuality.” ( Reeves S. 2008 Why use theories in Qualitative Research?  BMJ 2008;337:a949 )

Participants in this study include six doctors who have experienced sexual abuse from other doctors. Participants have been recruited through organisations (eg AMA email circular, College publications), mainstream media and social media. Initial screening excluded participants who experienced violence as medical students, or earlier, and participants who were currently acutely mentally unwell. Data included interview transcripts, legal transcripts and judgements, media reports, social media commentary and institutional policies. Interview data was collected during 90-150 minute interviews and analysed using narrative methodology techniques and a critical theory framework

Early findings

Analysis is complete and early findings have been presented as a poster at ANU in 2017 and another poster (beyondzerotolerance) in 2018. We have also presented the work at several conferences, including AMEE, the Society for Academic Primary Care in the UK, the Australian Doctors’ Health Conference And GPDU. You can see the video of the GPDU conference presentation here.

Outcomes and significance

This research program is the first of its type internationally. The studies will inform the development of a set of guidelines on clinical care for doctors that have experienced sexual assault from other health professionals, especially doctors. It will also inform policy change in relevant organisations, such a hospitals, through consultation. Consultation will occur through a series of workshops at professional conferences and through work with individual workplaces and professional bodies.

This work will trigger a raft of further work: on prevalence, treatment of victims and perpetrators, preventive strategies and organisational culture. The focus on the lived experience of participants will provide a rich a powerful story, based on empirical evidence. This story has been disseminated through a series of articles, presentations at relevant conferences, one page circulars and technology mediated communication, such as social media.

Sexual abuse should not be tolerated within the medical workplace. Studies like this are necessary to expose, question and correct toxic cultural practices, and creating a safe working environments for all doctors in the future.