25 September 2023

An open letter to the medical profession in Wales

Doctors in hospital

Unfortunately, the problem is not confined to surgery or anaesthetics, and we commend our colleagues on the Working Party on Sexual Misconduct in Surgery (WPSMS) for being the most recent group to shine a light on this issue last week. Misogyny is still commonplace in medicine, and just because it's occasionally less obvious to those of us further along in our careers, that doesn't mean it doesn't exist.

We are proud of our colleagues in Swansea Bay University Health Board for the statement that they made this week. It takes guts to disagree publicly with a former colleague in the context of long-held professional loyalties, and to stand up and be counted on such an important issue. These views have no place in the Welsh NHS. They have no place in modern society, full stop.

The four of us have risen to senior leadership positions in our respective specialties. We work in cancer, general practice, psychiatry and HIV medicine. And every single one of us can think of experiences from our own career that at the time we ignored, brushed off, pretended not to hear or not to see – but we saw, we heard, and we still remember.

We remember the consultant who told one of us that we'd passed a professional exam simply because of the size of our breasts, and the senior NHS leader who displayed bullying behaviour when presented with legitimate patient safety concerns. We remember the colleague who suggested that instead of studying medicine, we should concentrate on making tea for our husbands, and the surgeon who called us ‘mumsy’ to our face. We remember being told that a talk on sexism in medicine simply wasn’t relevant to the men in the audience. We remember how they spoke to the nurses. We remember hearing the sexual innuendo, comments about a pregnant colleague’s body shape, the locker room ‘banter’.

We remember avoiding social situations with certain men – it was too risky. We remember the need to prove again and again that we were competent doctors, despite passing the same exams as our male colleagues, or the pressure to act as ‘one of the boys’ to fit in, to be part of ‘the club’. We remember being patronised, being told to leave our specialty for another more family-friendly option, feeling undermined and powerless. We remember feeling reluctant to speak out during meetings, practising self-censorship to avoid being thought the ‘difficult’ woman in the room. We remember wanting to give up medicine after being treated very badly by a female trainee who had herself been bullied by a consultant. Cruelty leads to cruelty; toxic cultures breed toxic behaviour.

Sexual harassment in medicine has been tolerated for too long. Forty years ago it was rife, it was blatant and it was upsetting. And it certainly hasn’t gone away.

Trainees, we stand with you. Medical students, we stand with you. Those starting out in your specialty career, or as a new consultant, or as a locally employed doctor, we stand with you. Colleagues from ethnically diverse or religious backgrounds, or those who come from more disadvantaged backgrounds, those whose voices so often go unheard, we stand with you.

We cannot afford to lose these talented, intelligent and brave young women who have chosen a career in medicine despite the relentless negativity in the press, the intensely hard work and the long hours. The medical students and trainee doctors who choose our profession have often given up a great deal to join us. The job is tough, yes, with regular job and house moves, years of intense night shifts, early starts and late finishes, and a rigorous and stressful exam, education and assessment regime. But the behaviour that we have heard about this week is not only unacceptable and offensive, it is illegal.

Medicine can be a challenging career choice, but that doesn't mean that we should abandon decency, civility and respect along the way.

If part of you agrees with those colleagues who believe that women should 'toughen up', ask yourself why. We can only ask you to reflect on whether you would have wanted to work with predatory senior doctors during your time in training. Would you have enjoyed knowing that your career progression was in part dependent on an older consultant who wanted to see you naked? You don't have to be a woman to feel the unfairness and injustice of that. You simply have to be human.

These are our people

These women were us, once upon a time. And just because things were, at times, awful for us, they absolutely should not be awful for our daughters, our nieces, our friends.

So do not pull up the ladder after you – extend a helping hand.

A lot has been said about cultures of openness, transparency, the freedom to speak up. Yet it doesn't matter how many reviews, policies or guidance documents we publish, we still can't seem to get it right. Why do our trainee colleagues still feel so unsafe? Or more accurately, why is the system still allowing them to be unsafe? For – lest we forget – putting the onus on others to change the world is draining, exhausting and ultimately futile.

It has been said before, and it will be said again. If you are not part of the solution, you are part of the problem. These attitudes fester and, worse, grow more pervasive when we turn a blind eye. Often we say ‘oh, just ignore them’, or ‘oh, don't let it bother you’. But it does bother us, and if we ignore the behaviour, it will happen to someone else.

After all, in a country where more than 99% of rapes reported to police do not end in a conviction, the system is failing us all.

Trainees and newly qualified consultant colleagues tell us that reporting systems are weak. Decisive action rarely follows a complaint, and the risk of career damage is too great for many to want to speak out. The very nature of medical training means that junior colleagues rotate through different hospitals and health boards, so where misconduct takes place, the trainee is moved on and the perpetrator is often unaffected.

There are often no real consequences for unacceptable behaviour, so it should be no surprise that so many instances of misconduct and assault go unreported. Instead, we endure, then we carry the guilt with us.

So call it out. If it makes you feel uncomfortable, there's probably a good reason. Say something. Challenge the hierarchies. Sometimes they are necessary, in a very specific time and place, but not often, and never always. You are all leaders. Know your power.

Our royal colleges have a role to play. So do Health Education and Improvement Wales and the health boards and trusts that employ us. The General Medical Council (GMC), the British Medical Association (BMA), the myriad of other organisations that have power over our lives as doctors.

So we stand with the authors of the excellent WPSMS report. Of course we support their call for urgent measures to support the prevention and ensure robust investigation of sexual misconduct in healthcare. Of course we support calls for a national implementation panel and the reform of reporting and investigation processes. We need more senior female mentors and role models, and we need safe spaces where colleagues can speak out. We need better, braver, more supportive leadership from our senior colleagues. It is all there in the GMC good medical practice principles: now we need to make it happen. 

We want to thank the colleagues who have spoken to us about their experiences, those who felt ready to talk, and those who still feel too vulnerable to share their memories. We are proud of you all. Our role as senior female leaders in the NHS is to be there for you, provide a safe space, and be the mentors you deserve. We promise to do that.

Enough with the surveys. Enough with the eye-opening reports and the heartbreaking stories and the abuse that comes with doing a job we love. It is time for change. In the past, we learned to put up and shut up, but this isn’t good enough anymore. In truth, it never was.

Dr Olwen E Williams OBE
Chair, Welsh Academy of Medical Royal Colleges
Immediate past vice president for Wales, Royal College of Physicians

Dr Hilary Williams
Vice president for Wales, Royal College of Physicians

Dr Rowena Christmas
Chair, RCGP Cymru Wales
Royal College of General Practitioners

Dr Maria Atkins
Chair, Royal College of Psychiatrists Wales
Vice president, Royal College of Psychiatrists

Supported by colleagues, including:

Dr Jeanette Dickson
Chair, Academy of Medical Royal Colleges

Dr Sarah Clarke
President, Royal College of Physicians

Professor Sam Abraham
Wales council chair, British Geriatrics Society

Dr Raghavendra Acharya
Welsh Academy SAS doctor representative  

Dr Llion Davies
Faculty of Public Health

Dr Simon Ford
Wales Chair, Royal College of Anaesthetists

Dr Alex Gorton
Faculty of Forensic and Legal Medicine

Dr Suresh Pillai
Vice president for Wales, Royal College of Emergency Medicine

Ms Rhianon Reynolds
Llywydd, Royal College of Ophthalmologists

Dr Phillip Wardle
Royal College of Radiologists

Dr John Watkins
Faculty of Public Health