#MeToo and the medical profession


All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Can adian Medical Association or its subsidiaries.

E972 CMAJ  |  AUGUST 20, 2018  |  VOLUME 190  |  ISSUE 33 © 2018 Joule Inc. or its licensors

I n the era of #MeToo, it is time for physicians to acknow­ledge that the medical profession is not immune to bully­ing, harassment and discrimination, and act to abolish 
these behaviours. Harassment and discrimination of female 
medical staff and trainees are well documented.1,2 So why, 
with the MeToo movement, has there been no complaint 
against a prominent male physician? Could the current cul­
ture of incivility and disrespect that is common in medicine be 
the reason?

Unprofessional behaviour in medicine affects not only 
women,1 but also goes beyond the individual to cultural and 
organizational issues that enable these inappropriate behav­
iours. Organizational factors that lead to unprofessional behav­
iour in medicine include poor leadership, power imbalances 
and a culture of silence.3 Implicit (or unconscious) biases within 
us all, stemming from dominant stereotypes linked to various 
groups, also play a role.

A diverse and collegial work environment contributes to 
improved quality and innovation.2 In contrast, a work climate 
that enables bullying, harassment, discrimination and micro­
aggressions can negatively affect a person’s health and career 
pathway, as well as limit their ability to be productive and 
advance, or even remain, within medicine.2 Moreover, unprofes­
sionalism in medicine affects patient care.

Medicine is a stressful career, and physician wellness is often 
neglected within the culture of medicine.4 The lines between health 
and professionalism can blur: unhealthy physicians find it difficult 
to be professional. Although beyond the scope of this editorial, 
harassment can be a criminal offense and, as such, there must be 
zero tolerance and improved accountability.2

Some Canadian medical schools and health care organiza­
tions have begun to promote respect in the workplace. The 
involvement of deans and chairs in the areas of professionalism, 
equity, diversity, wellness and mentorship within several Canad­
ian medical schools is a welcome first step. Local and national 
awards related to professionalism and equity are also to be 
applauded. However, real change will require changes to current 
structures and procedures.5

A respectful workplace is one that is healthy, safe and sup­
portive, and values diversity and equity. Interventions such as 
online and in­person education modules addressing respect in 
the workplace, which target the individual and attempt to 
address unprofessional behaviour, show promise.6 However, 

few studies have looked at interventions addressing organiza­
tional structures and procedures. Despite this lack of evidence, 
steps should be taken to address organizational barriers to a 
respectful workplace.

Unconscious bias can contribute to power imbalance within 
the workplace and should be addressed in medicine.7 This should 
include training on unconscious bias for all medical leaders and 
for members of grant review, promotion and hiring committees. 
Additionally, formal job descriptions, as well as standardized and 
objective hiring processes, are essential for all recruitment, includ­
ing medical leadership positions. Job descriptions must avoid 
gender­specific terms, and broad searches should be undertaken 
to identify and encourage all eligible candidates to apply. Evalua­
tion criteria for hiring and promotion should also be defined 
clearly and applied universally to avoid discrimination and inequi­
ties. Simply said, basic human resource standards that exist in 
many industries must be applied in medicine.

Professionalism is a required competency for physicians and 
codes of conduct exist, including the Canadian Medical Associa­
tion Code of Ethics. As a profession, we need to stop excusing 
unprofessional behaviour toward colleagues just because phys­
icians are accomplished in clinical care or academia. Periodic 
review and promotion processes should have measures related 
to professionalism.

In medicine, it is important to encourage healthy debate 
and the expression of dissenting opinion. However, silently 
observing unprofessional put­downs and verbal b ul l yi n g 
directed toward colleagues sends the message that this kind 
of behaviour is acceptable. Rather, allies need to be empow­
ered to speak up. As such, medical workplaces need safe and 
transparent processes for reporting unprofessional behav­
iour and for investigations that are fair to all concerned, as 
well as adequate mechanisms to support those who experi­
ence bullying, harassment or discrimination. Finally, strate­
g i e s  t o  a d d r e s s  t h e  u n p r o f e s s i o n a l  b e h a v i o u r ,  i n c l u d i n g 
remediation and changes to the work environment, should 
be available.

It is time that all Canadian medical schools and health care 
institutions implement and evaluate initiatives aimed at 
achieving a culture of respect within medicine. The medical 
profession — and ultimately patient care — will improve for all 
when we treat each other with respect, regardless of gender, 
age, race or stage of career. 

EDITORIAL

#MeToo and the medical profession
Jayna M. Holroyd­Leduc MD, Sharon E. Straus MD MSc

n Cite as: CMAJ 2018 August 20;190:E972­3. doi: 10.1503/cmaj.181037



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References
1. Fnais N, Soobiah C, Chen MH, et al. Harassment and discrimination in medical 

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2018. doi: 10.17226/24994.

3. Pattani R, Ginsburg S, Mascarenhas Johnson A, et al. Organizational factors contrib­
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4. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indica­
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5. Pattani R, Marquez C, Dinyarian C, et al. The perceived organizational impact of the 
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6. Tricco AC, Rios P, Zarin W, et al. Prevention and management of unprofessional 
behaviour among adults in the workplace: a scoping review. PLoS One 
2018;13:e0201187.

7. Carnes M, Devine P, Manwell LB, et al. Breaking the bias habit: a workshop to pro-
mote gender equity. Madison (WI): WISELI — University of Wisconsin­Madison; 2015.

Competing interests: See www.cmaj.ca/site/misc/cmaj_staff.
xhtml for Jayna Holroyd­Leduc. No other competing interests 
were declared. 

Affiliations: Departments of Medicine and Community Health Sci­
ences (Holroyd­Leduc), University of Calgary, Calgary, Alta.; 
Department of Medicine (Straus), University of Toronto; Li Ka 
Shing Knowledge Institute of St. Michael’s (Straus), Toronto, Ont. 

Correspondence to: Jayna Holroyd­Leduc, 
Jayna.Holroyd­Leduc@albertahealthservices.ca