Lauren Roscizewski, Pharm D, PGY-2 Ambulatory Care Pharmacy Resident, Palm Beach Atlantic University
Keri DePatis, PharmD, Assistant Professor of Pharmacy Practice, Palm Beach Atlantic University
With the start of the New Year, it is time to start working on resolutions. Two of the resolutions I set for myself this year are to learn how to set boundaries and how to say “no”, particularly when it comes to patient interactions. During one of my APPE rotations, a patient made an inappropriate remark on my appearance, and my preceptor, without missing a beat, looked at the patient and let it be known that the behavior would not be tolerated. My preceptor then took the 20 minutes following the visit to reflect with me how the situation made me feel and informed me I could ask him for help if another situation occurred in the future while I was on rotation. I am now two years past this rotation, unable to seek out his assistance as needed, and have been forced to discover how I can best navigate this on my own. Through conversations with mentors, peers, and friends, I have discovered this is something many people like me are struggling with so I thought I would share what I have found to get me started in achieving this resolution!
That time spent reflecting with my preceptor allowed me to recognize that this patient’s comment was considered sexual harassment. The US Equal Employment Opportunity Commission states that sexual harassment in the workplace includes unwanted sexual advances, requests for sexual favors, and hostile verbal or physical conduct that affects one’s work performance or employment and/or creates an inappropriate hostile work environment. More specifically sexual harassment can look like making suggestive stories or jokes, making sexist remarks about careers, staring or ogling, making propositions in addition to providing rewards for sexual cooperation or threatening against noncooperation.1
And it is not just me that was unable to recognize sexually harassing behavior. In a 1996 survey of Ohio pharmacists regarding sexual harassment experiences, at least 69% of male and 76% of female pharmacists had witnessed or experienced sexual harassment, but only 11% of males and 23% of females had felt they were sexually harassed demonstrating a large disconnect in identifying behaviors as sexual harassment. We can be hopeful in our thinking that much has changed in the last 25 years, however these responses from respondents seem familiar when it comes from patients specifically. Respondents in the survey stated, “In retail pharmacy chain stores, some male customers demand an inordinate ‘explanation or lengthy’ discussion on the sale of condoms”, “I’ve been kissed, grabbed, threatened … all by male patients”, and “The main problem that I have had with harassment has been with patients. I have found it very difficult to deal with it because you want to keep the person as a customer, yet protect yourself.”2
So, what can we do in handling sexual harassment when the perpetrator is a patient? Unfortunately, there is no one right way to address this situation, but we can have strategies in our tool box to utilize in the moment. The Yale School of Medicine uses the acronym ERASE to achieve this, and it is one that I will be trying in the future.3
- Expect – It is likely that it will happen. Try to have others around to act as a witness if possible.
- Recognize – If something doesn’t feel right about the situation, say something.
- Address – Have phrases ready to use when it happens. Examples include, “I feel offended by that” or “Your comments are making me uncomfortable”, or “Your behavior is inappropriate and unacceptable”. It is important to set the boundaries early on to potentially avoid any escalation.
- Support – Reach out to colleagues when you witness harassment.
- Establish/Encourage – Approach institutions about developing materials to teach how to handle patient harassment.
When setting boundaries, I am resolving to be clear and set them early on. Learning how to say “no” is something most of us practiced as a 2-year-old to our parents, but as adults we tend to be reserved in using this word. When saying “no”, we need to be clear. Using the phrase is much stronger than saying “I already have plans” or “I have a partner.” The same can go for addressing dirty jokes. To fully address the situation, the statement “I don’t want to hear dirty jokes. They make me uncomfortable” will be more successful in stopping the behavior than uncomfortably laughing at it. Using this type of phrasing makes the stance on the situation very clear with no room for misinterpretation.4
While these strategies will not magically end harassment from patients overnight, we can feel more equipped and confident in our abilities to navigate such situations by having a few phrases prepared. Using the recommended language conveys to our patients that we will not tolerate their behavior and potentially avoid escalations if employed early. Combatting this is an individual and joint effort. It is not enough for us to be bystanders of sexual harassment, and we need to continue to engage in conversations surrounding sexual harassment in the same way I had this conversation with my preceptor years ago.
- S. Equal Employment Opportunity Commission. Sexual Harassment. Available at: https://www.eeoc.gov/sexual-harassment#:~:text=It%20is%20unlawful% 20to%20harass, harassment%20of%20a%20sexual%20nature. Accessed December 11, 2020.
- Broedel-Zaugg K, Shaffer V, Mawer M, Sullivan DL. Frequency and Severity of Sexual Harassment in Pharmacy Practice in Ohio. J Am Pharm Assoc. 1999;39:677-82.
- Paturel A. When the perpetrators are patients. AAMCNews. Available at: https://www.aamc.org/news-insights/when-perpetrators-are-patients. Accessed December 1, 2020.
- Ross S, Naumann P, 1Hinds-Jackson DV, Stokes L. Sexual Harassment in Nursing: Ethical Considerations and Recommendations. OJIN. 2019;24: Manuscript .