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The effect of sexual harassment and abuse on female GPs

The effect of sexual harassment and abuse on female GPs

Female GPs are facing sexist comments, harassment and even abuse at work from patients and colleagues. In a major Pulse investigation, Eliza Parr looks at the scale of the problem

Last year, a report by researchers and the Working Party on Sexual Misconduct in Surgery detailed harrowing allegations made by female surgeons. There were reports of sexual harassment, abuse and even rape. Some of the allegations were very particular to surgery: male surgeons (normally senior) rubbing erections against (normally younger) female surgeons while performing in the operating theatre.

A major Pulse investigation has looked into the prevalence of sexual harassment and abuse of female GPs in the practice, and issues around terms and conditions of service. It differs in nature to the allegations in surgery, in part due to the difference in the way the professions practise.

In general practice, the nature of the work involves more intense relationships with patients, and longer-term professional relationships with colleagues. Pulse’s investigation – centred on a survey answered by just under 700 female and marginalised gender GPs – has revealed stories of female GPs being stalked by patients, misogyny from colleagues, comments around their medical abilities, lower pay and career progression being hampered due to their gender.  

In this first part of a four-part series, we look into the everyday sexism, harassment and abuse faced by female GPs.

Harassment and abuse from colleagues

For female GPs – often younger, or more junior – facing harassment from older male colleagues can make their jobs untenable, and affect every facet of their lives.

According to Pulse’s survey, a disturbingly high proportion – over a fifth – of female and marginalised gender GPs have experienced sexual abuse or harassment from their colleagues at least once.

Dr A, a portfolio GP, describes years of repeated harassment at the hands of a more senior male colleague, which had a profound impact on both her career and her emotional wellbeing. She was introduced to the male GP partner when she was a medical student, and the pattern of abuse began at a New Years’ Eve party she attended at his house.

‘I ended up in a corridor with him, and he very quickly pushed me against a wall and kissed me. I was so stunned. I thought “what the hell just happened?”. It almost wasn’t frightening. You’re so taken aback. You kind of question reality. No speech, no nothing. Just pushed up against a wall that you can’t move away from and kissed, certainly without consent. And then everything just carries on as normal, like it didn’t happen.’

She later ended up working at his practice as a salaried GP, where the ‘harassment got worse over time’. She says that he became supportive over the years. He was also ‘very influential locally, well-known at a national level and very entrepreneurial and charismatic… untouchable in many ways’. The way he behaved as if nothing had happened, which ‘made me question the reality of that first event’.

However, Dr A adds: ‘When the more serious harassment started very shortly after, I thought “if I told anyone, who would believe me?”’

‘He would come into my room and lock the door behind him, and would be quite physical with me. It escalated over time, and eventually I said to him “you’ve got to stop doing this”. He then withheld my pay for the next pay month. He just stopped my pay. Of course, it’s not legal. I had to leave.’

Even though the BMA was helpful, the process took so long that by the time anything could be done to resolve the dispute, Dr A had moved on to another practice – ‘you just want to get away’.

And the emotional toll of an experience like this is huge: ‘It stays with you. I don’t think it goes away. I can still remember what it was like, it was horrible. When I go to events, I want to make sure he’s not attending. It sounds really silly, but I don’t want to run into him in a corridor or have him walking or standing behind me in a queue. It’s that sort of thing that really affects you.’

On top of the damage caused by abuse or discrimination, some female GPs fear further consequences if they speak up. Dr B, a locum GP in Yorkshire, says her most recent salaried role was at a practice with a ‘very traditional culture’, where there were four male partners, two female partners and three salaried GPs.

‘The senior partner was larger than life, quite arrogant. He was basically the leader and made all the decisions. At meetings, the female partners never said anything. He was often derogatory towards women, and it always seemed to be female patients or female local leaders that he found “difficult”.’

Dr B tried to speak up about this sexist language sometimes, but says she felt this was ‘frowned on’, certainly wouldn’t make any difference, and would end up making her unpopular.

‘I felt I would never get a partnership there. They’d prefer someone who was meek, and just did what they were told.’

Harassment and abuse from patients

New stories of abuse at a GP practice seem to emerge almost weekly, and a Pulse investigation last year revealed that crimes involving violence at surgeries rose by 16% between 2019 and 2022. For female GPs, the stakes are higher. At the time, former chair of the BMA GP Committee England Dr Farah Jameel told Pulse that she had carried a rape alarm with her ever since an incident with a threatening patient in 2018.

Alarmingly, Pulse’s survey revealed more than two-fifths (44%) of female GPs reported having experienced sexual abuse or harassment from patients – 18% said they had experienced this once, while a quarter said it has happened more than once.

Dr C, a locum GP who wishes to remain anonymous, says she was stalked by a patient over a six-year period. ‘I lived where I worked. I saw him a lot, he would walk around a lot. I didn’t think much of it. In fact, I laughed it off at first. He would walk past my mum’s house, my exercise class, and my flat.’

She says he ‘got to know [her] routine’ and she would ‘always’ see him. Eventually, the issue was raised by a partner at his practice and the police had an ‘informal word’ with him. Dr C says: ‘I dealt with it by being angry. But I used to look around whenever I got out of my car.’

‘When you’re a GP, you’re in an intimate situation with someone. You talk about their personal issues – their health and their personal lives. And while training, we weren’t really taught about boundaries, and how to be aware of potential danger, and what to look for. People do sometimes mistake kindness for something else.’

Dr Susan Bowie, a GP in Shetland islands, describes an experience with a patient when she was a ‘lot younger’ in the 1980s. She says the patient ‘came onto’ her in the consulting room a couple of times. ‘He undressed himself in front of me, he was wearing no pants. I have a no tolerance policy towards behaviour like that. But at the time it was a bit scary.’

More recently, around 2014, a patient ‘tried to kiss’ Dr Jameel during a consultation. ‘I was shocked, felt shaken, and couldn’t quite comprehend what had just happened – you just don’t expect it.’ She was quick to act, immediately leaving the room and coming back with a chaperone. Dr Jameel says her practice leadership team ‘moved very swiftly’ and ‘addressed the incident robustly’.

Female GPs who said they had experienced sexual abuse or harassment in Pulse’s survey described patients who put a hand on their knee, ‘tried to masturbate’ during an examination, or proposed they ‘go out’ together.

While experiences similar to these are not limited to GPs, there may be something about the GP/patient relationship which increases the chance of potentially dangerous situations.

As one GP put it, some patients can be ‘difficult’ and display ‘aggression…It can feel very intimidating when you’re a female GP, especially if you’re working late. You can feel very vulnerable.’

Everyday’ comments

Thankfully, such examples are rare. But the examples of ‘everyday’ sexism are far more frequent, from patients and colleagues.

A third of female GPs experience sexist comments from patients on a regular basis, while more than one in 10 experience the same from their colleagues at their GP practice.

One GP partner, Dr D from London, says she had a patient who would write inappropriate notes on his prescription requests which were addressed to her. ‘He would put a bunch of sexual jokes at the bottom, full of innuendo. He probably thought they were funny jokes, but I didn’t ask for it. And he used quite crude language.’

Many female GPs say they are frequently called ‘that lady’, ‘nurse’, ‘lady doctor’ or ‘the girls’. In fact, over 90% of female GPs said in Pulse’s survey that patients or other NHS staff make assumptions about their role based on their gender. While seemingly innocuous, the cumulative impact of these sexist attitudes can have a huge emotional toll.

One GP in the South East, Dr E, says she is called a nurse ‘repeatedly’, and that it’s ‘frustrating’ even if it seems harmless. One occasion that sticks out in her mind was with a patient who was deaf and required an interpreter. ‘I introduced myself as the GP, and I had my name on the door. I’d spent half an hour with this person, gathering the symptoms, examination, saying my diagnosis, the treatment plan. Then at the end, the patient said “and am I going to see the doctor today?”. The translator said “I’m so sorry, I did say you’re a GP”.’

Dr E says these mistakes are particularly frustrating in general practice, compared with working in hospitals where it is very common. ‘I think if you’re walking down a corridor in the hospital and you’re wearing scrubs and someone says “nurse”, you get it. You’re a female in a hospital in scrubs, and that’s just what people are used to seeing in media and for the last 100 years – that’s fine. But it’s when you’ve been talking to them for a long time, and then you are called a nurse – that’s frustrating.’

At Dr D’s practice in London, even through the whole staff is female, aside from some male locums, there is ‘often the perception that you must be junior’ and that the male staff ‘must be your boss’.

There are also issues around how this intersects with ethnicity. Dr D says: ‘As Asian female GPs, there’s also the perception that we are not going to stand up for ourselves. We get comments about being female, but also about not being white. Sometimes we have people from other ethnicities who are more aggressive with us because we are female and Asian.’

‘Unacceptable sexism’

RCGP chair Professor Kamila Hawthorne says ‘no one should have to experience sexual harassment or face sexist attitudes in their workplace’ and that it is ‘critical that all branches of our health service’ safeguard against this.

‘Clearly sexist attitudes and behaviour exist in general practice and action is needed to address this. […] The RCGP has signed up to the Sexual Safety in Healthcare Charter, and we provide support and information for women through our online equalities’ hub, including exhibits, podcasts and videos.’

While practices and GP leaders can’t be held responsible for wider societal attitudes towards women, perhaps the focus should be on creating cultures where women feel empowered to speak up. Dr A, who suffered years of abuse from her male colleague, says she is ‘certainly not the only one’ and knows that other women have had similar responses when they’ve raised concerns.

‘There’s not been any support. We’ve been told: “be careful, because you’ll be investigated” or “we can’t support one doctor against another doctor, we’ve got to be impartial”.’

Chair of the BMA’s GP Committee England Dr Katie Bramall-Stainer says Pulse’s survey results indicate the ‘unacceptable fact that sexism exists in general practice’. Back in 2019, Dr Bramall-Stainer spoke up about the ‘sexist culture’ at the heart of the union, and a scathing review later that year came to similar conclusions. Across general practice more widely, she urges all staff to work towards a safer workplace culture for women.

‘Doctors who abuse their positions to carry out sexual abuse, assault or make sexist comments have no place in the medical profession and healthcare settings. All who are involved in the provision of general practice need to think very carefully about what more needs to be done to create a safer environment for patients to receive care and for healthcare professionals to provide that care, free from sexist abuse,’ the GPC chair says.

Dr Bramall-Stainer also encourages anyone who experiences sexism of any kind to seek BMA support. And to create that ‘safer environment’, practice leadership teams, LMCs and ICBs must take decisive action when female GPs speak up.

Pseudonyms have been used throughout this article to protect anonymity

Pulse survey information

Pulse’s special sexism survey was open between 8 and 16 January 2024, collating responses using the SurveyMonkey tool. A total of 693 female and marginalised gender GPs from across the UK responded to these questions. For the purposes of this piece, we have removed ‘don’t know’ answers from our results. For the questions specifically on childcare and maternity pay, 554 female GPs with children responded. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £150 John Lewis voucher as an incentive to complete the survey. The survey is unweighted, and we do not claim this to be scientific – only a snapshot of the female GP population.