Beyond zero tolerance: what it will take to end sexual harassment in medicine

“[Sexual harassment] may be illegal,” said one survivor, “but so is rape, and law has been ineffective preventing that for centuries.”

Sexual harassment is common within hierarchical cultures, and medicine is not unique in struggling to manage the problem. However, medicine has its own challenges and capacities – from trauma psychiatry to public health – that mean the community can analyse, understand and respond to the problem in unique ways.

Medical culture is influenced by all the organisations and individuals that engage with it and influence it. Simplified ‘solutions’ don’t work, and we know that legal sanctions alone have never been enough to prevent sexual harm.

“Zero tolerance” is an aspiration, not a policy.

Managing harms

During my team’s work on the book Sexual Harassment Between Doctors: Healing Medical Cultures Around the World, we found plenty of laws and institutions willing to help, but a bewildering, intersecting maze of options for the survivor.

A medical student, for example, can report to police, medical regulators, their university, the hospital they are in, or several informal support networks. We found it almost impossible to find out what was behind those “doors”, so people wanting to report an incident couldn’t easily locate the critical information they needed to decide how to proceed. Simply put, they wanted to know how much it would cost, how long it would take, what the risks of harm were, whether their name could be kept confidential, what would happen to the perpetrator, and what the process would involve.

Reporting is not the simple action it’s often portrayed to be – it’s a long, arduous, lonely process that can become a full-time job. It’s no wonder that reporting is comparatively rare.

Sexual harassment and its management across the world

Every representative we spoke to, from Austria to Zambia, had stories of sexual harassment shaped by gendered bias in their context. Targets of sexual harassment are of all genders, but perpetrators are commonly male, and we found that those with intersectional disprivilege – including international medical graduates – were at higher risk of being targeted.

Consciously or unconsciously, predators choose professions with deep hierarchies, gendered workplaces and masculine cultures. Medicine, like law, politics and education, is attractive to those who seek to dominate others. Despite the best efforts of educators, managers and regulators, entrenched organisational and cultural barriers to change remain. Many of them surprised us.

A young surgeon from the UK described reporting her sexual abuse to the medical regulator, but after months of stressful evidence tried to withdraw due to her declining mental health.

“I was told I was under mandatory reporting obligations to report my abuser,” she said. “The alternative was to stop practicing until I recovered.”

One of our contacts in Egypt said harassment was less common there “because medicine is predominantly a profession for women, you are more likely to find perpetrators in other areas, like business.” A contact in Iran shared similar findings.

Every country had, in some way, addressed the breadth of prevention needed, but there were gaps.

Medical training and professional identity formation

While junior doctors’ professional identities are still forming, we found that they are vulnerable. Medicine, by its nature, involves structured breakdowns in personal boundaries which medical students usually find challenging. It’s understandable that junior doctors, still adapting to this new social environment, can find it hard to distinguish occupational discomfort or a disinhibited, unwell patient from intentional harm.

Doctors are human too, subject to the same cognitive biases as anyone else. Despite being trained to recognise trauma in their patients, many fail to recognise it in themselves – dismissing their own experience because it doesn’t fit the stereotype. “My story is not the right story,” said one survivor, “it didn’t happen in a dark alley.”

All this means that while workplaces are meant to be safe, the reality of working within medicine’s often challenging interactions means it can be harder to tell where clinical discomfort ends and harm begins.

Trustworthy institutions

In a way, institutions echo transportation planning, where there are formal paths through a system, and also “desire paths”, the convenient shortcuts that emerge when a more deliberately constructed path takes a longer or more circuitous route, has gaps, or doesn’t exist at all. This is often known as “the way we really do things around here”.

Institutions have their own personalities, expectations and rules, but there’s often a gap between stated and enacted policy, what educators call the “hidden curriculum”. The wider that gap, the less trust health workers have in institutional frameworks, and without trust they are unlikely to feel safe reporting inappropriate conduct.

“Zero tolerance” can be another aspirational bumper sticker from an untrustworthy source.

Where to from here?

It is time to stop performative policy – things like awareness campaigns, aspirational statements and compulsory modules that offer simple solutions to complex problems. Medicine should tackle this within its own culture, the way it tackled medical error: creating safe spaces to honestly deconstruct the problem, setting aside defensiveness and blame, and drawing on expertise from law, social science, therapy and management.

Real progress means mapping existing policies, creating space for junior doctors to debrief, monitoring hotspots, and giving survivors independent advice.

As a profession, medicine has done its best work when it has provided moral and cultural leadership. Facing this problem frankly and openly is part of that leadership.

Sexual trauma should never be the price a doctor pays to work in the medical profession.

Resources

Sexual Harassment between Doctors: Healing Medical Cultures Around the World (Cambridge University Press, March 2026), edited by Louise Stone, Rosalind H. Searle, Elizabeth Waldron, Christine Phillips and Kirsty Douglas (open access, ANU-funded).

If this article has raised issues for you, you can contact 1800RESPECT on 1800 737 732, or Lifeline on 13 11 14.