Me Too Hospital: “78% of female doctors say they have experienced VSS in their career” (Interview)

It all started with an interview given to the magazine by infectious disease specialist Karine Lacombe Paris match Mid-April. The latter accused emergency doctor Patrick Pelloux of “sexual and moral harassment”. In his wake, hundreds of testimonies poured into social networks. United under the hashtag #MeTooHopital, they all denounce a climate of sexism and sexual violence ferociously established in the medical environment.

Decryption with Coraline Hingray, university professor of psychiatry at the CHRU in Nancy and member of the association Donate Elles to healthwho has been working since 2020 for gender equality and the feminization of positions of responsibility in the healthcare sector.

Karine Lacombe’s speech and the testimonies that followed helped shine a spotlight on the taboo topic of sexist and sexual violence in the medical environment. Was this a situation that had been known for some time within healthcare facilities?

Coraline Hingray. This is no surprise. We were waiting to have media coverage to allow real freedom of speech and finally make things happen. With Give themsince 2020 we have carried out an annual barometer on this topic, interviewing hospital doctors, women and men. 78% of the women interviewed say they have been victims of sexual and gender-based violence during their career, and it has been a perfectly stable figure for years. In 30% of cases it involves gestures, touching or even sexual violence. So, as we know, this is something extremely common. It is also interesting to note this 78% of the men interviewed said they had already witnessed these acts.

Before #MeToo, we were really on a form of institutional violence with daily sexist comments, thoughts about outfits, about cleavage, about a woman bending down to pick up a pen, about rubbing… Observations like this “Are you completely naked under your blouse? » OR “Don’t act so stupid! » they are common. But we need to stay positive: things have evolved a bit since Me Too and we are seeing beginnings of awareness with changes.

How can we explain that this ubiquitous climate can thrive so much in a hospital environment?

Coraline Hingray. For me there are two big levers. There is that of “explanations” which is not specific to the medical world. We’ll say it’s just humor, it’s for fun, that we need to relax, to decompress, that it’s seduction… We’ll talk about a “from men to women”, “still charming”. All of this is a trivialization of these behaviors. Furthermore, in our barometer we see that up to 30% of women have been victims of sexist comments, or even inappropriate gestures, and that they were not aware of it.

The second lever is the context of the rifle. Initially the medical field was predominantly male, while the paramedic field was predominantly female. There were once frescoes in all the colleges of France, which depicted scantily clad doctors or nurses performing sexual acts on surgical garments. We too have a relationship with the body and nudity which in medicine is very different, with a sort of proximity. Added to this is a relationship with tragedy, stress and death which is used to justify the fact that some form of release is necessary. We also have this kind of idea If you are a good doctor, you cannot be fundamentally bad. That cannot be a good doctor and a good aggressor, since the doctor is the one who takes care, he is the empathetic one. This dichotomy, for example, does not exist in the film industry.

Finally, the medical environment is very crowded, with an overrepresentation of men in positions of responsibility in hospitals, which activate dynamics of explanation and acceptance in the face of sexist and sexual violence.

Does the hierarchical organization of the hospital also play a role?

Coraline Hingray. This, in fact, fuels a certain fear of the consequences for the victims who would be forced to speak. Breaking the silence means risking being taken for cowardice, of being accused of having done something big. But it also means risking your career, especially when the person involved is a superior. What we see in our barometer last year is that, among women who experienced this type of violence, only 3% told their supervisors or the reporting unit about it.

A certain impunity remains. The victim has a triple penalty: she suffers an assault, she faces several obstacles when speaking (if she can speak), and it is up to her to walk away while procedures are put in place (procedures that very often fail). Since speaking openly means jeopardizing one’s professional and specialty choices, remaining silent unfortunately still remains the only solution for many.

How are healthcare facilities handling VSS issues?

Coraline Hingray. There has been a real backlash from institutions in recent years, probably thanks to Me Too. Thanks to the work of Come on ELLES, we have 100 factories that have committed to implementing an active policy against VSS. Legally, all institutions were supposed to have a reporting unit as well as equality and treatment of VSS representatives (although, in practice, some have so far escaped control).

For my part, I teach all medical students at different points in their course, in the first year before the integration weekend, before their internship, when they become clinic directors. On the one hand, so that they can report very quickly and break the systems if they become victims of this violence. And, on the other, to prevent them from being authors and reproducing models that they could see.

And on the sanctions front, are any measures being taken?

Coraline Hingray. For me the perpetrators are not sufficiently punished and only a minority are. However, we cannot demand free speech until we have much more explicit and effective sanctions.

If the perpetrator is not a doctor, but is a nurse or a manager for example, there will be two sanctions levers. There will be the judiciary (and the victim will still have to be able to file a complaint, which is not always easy: less than 10% of victims file a complaint and less than 20% of perpetrators of sexual violence are convicted). And there is the internal disciplinary lever. In the case of non-medical people there are sanctions because these people depend directly on the hospital. So, generally, we have examples of sanctions being adopted quite quickly and victims being protected.

The difficulty when dealing with doctors is that the process is much more complex and that the hierarchy of the public hospital doctor does not depend on the hospital director, but on a national organization (the CNG). The journey to get there, the necessary investigations, the back and forth, the eventual disciplinary council, are much more complex to implement and can lead to situations that are ultimately not dealt with, or which are dealt with extremely slowly. Or we’ll hear arguments like “we will do according to what justice does”, except that the time of justice is measured in years. As a result, the victim spoke and the attacker remains there.

The third lever for doctors is the medical order. Some decisions have been made, but once again, at times, it remains complicated to obtain ordinal sanctions because we clash with this interpersonal relationship and this male overrepresentation.

How does “Giving ELLEs to Health” intervene on these issues?

Coraline Hingray. First of all, we have the annual barometer which allows us to photograph the evolution over time.

We are also working to sign a Charter, with hospitals, groups of hospital companies, the ARS, the CNG, the General Directorate of Health Care and ministries. The papers are accompanied by works on the commitments of the institutions, on measures for the representation of women, etc.

We have organized training seminars for HR managers and doctors on how to set up a reporting system, how to follow up on a sexist and sexual violence case, what are the possibilities, what are the rights, what are the steps to follow? It’s a very educational process.

We also have a process of raising awareness among students and doctors, we speak at various congresses, we have integrated a multitude of scientific medical societies to work on the issue of VSS and the necessarily related issue of women’s representation.

And here our axis and our desire is to be able to go further on the issue of sanctions and put in place clear mechanisms to allow quicker and clearer sanctions for the perpetrators.

What do you recommend to combat this climate of violence and environmental sexism?

Coraline Hingray. Greater awareness of the workforce on these issues is needed. The Me Too Hospital movement will help us because this freedom of speech accelerates awareness. It must be said: a number of SGBV perpetrators in hospitals are not even aware that they are SGBV perpetrators since it is so anchored in morality.

The other axis is to work on very clear guidance and facilitate the reporting and investigation process in case of VSS in hospital, work to explain the sanctions suffered at disciplinary level and at ordinal level in case of SGBV, also guarantee indicators of protection of victims to ensure that if the victim speaks out, there is monitoring and that he does not suffer the consequences. So that the victim does not find herself changing services against her will, make sure that she can, if she is a student, choose the specialty she wants. There is real work to be done, which is already well underway, but which is still too slow to make a profound difference.

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