Harassment The goal of medicine is excellence in the care of patients and, often, research and education that will advance the practice of medicine. Everyone involved in the process should be able to pursue the common goal on equal footing and without harassment that interferes with employees’, learners’, or colleagues’ ability to work or be promoted equally in that environment. Every office and institution should have an assessment strategy to ensure that the work environment is conducive to focusing on work and learning and not hostile to individuals.
Every office and institution must have written policies on discrimination and sexual harassment that detail inappropriate behavior and state specific steps to be taken to correct an inappropriate situation and make sure they are widely accessible and available. The goal is to ensure appropriate reporting and procedures for taking appropriate action and protecting victims, educating or rehabilitating an offender, and preventing the reoccurrence of the behavior.
The legal sanction for this right is encoded in both statutory law through the Civil Rights Act of 1964 [42 U.S.C.A. at 2000e–2000e–17 (West 1981 and Supp. 1988)] and reinforced with judicial action (case or precedent law) by state and U.S. Supreme Court decisions. Charges of sexual harassment can be raised as a result of unwelcome sexual conduct or a hostile workplace.
Employees are not the only ones to experience sexual or other harassment, learners such as medical students or nursing students can experience it and have a high reported prevalence of it (43). Sexual or other harassment for students can interfere with the educational process and trigger federal discrimination liability, including loss of federal funds encoded in Title IX protections (44).
Stress Management There is little doubt that the day-to-day stress of practicing medicine is significant. Besides the acknowledged stress of the time pressures and responsibility of medicine, the current health care environment has a detrimental effect on physicians’ job security, with concurrent health risks (45). Stress takes a toll on cardiac function and on the practice of medicine and life outside of medicine (46,47).
Responding to stress through drug or alcohol abuse increases overall health and marital problems and decreases effectiveness in practice. In a long-term prospective study of medical students, individuals with high-risk (e.g., volatile, argumentative, aggressive) temperaments were shown to have a high rate of premature death (particularly before 55 years of age) (48). Adequate sleep, reasonable working hours, exercise, and nutritional balance are directly related to decreases in psychological distress (49). Simple relaxation training is shown to decrease gastroesophageal reﬂux in response to stress (50).
The pace that physicians maintain has a seductive quality that can easily mask the need for stress reduction by means of good health practices, exercise, and relaxation training. The answer to increased stress is not to work harder and extract the time for this from the relaxing and enjoyable pursuits that exist outside medicine. The outcome of that strategy (in terms of optimal psychological and physical functioning) is in neither the physician’s nor the patient’s best interest. Both the welfare of the patient and the welfare of the physician are enhanced by a planned strategy of good health practices and relaxation. This strategy is important to all members of the health care team. By providing such leadership, physicians can contribute to a better work and health care environment for everyone.
Justice Some of the ethical and legal problems in the practice of gynecology relate to the fair and equitable distribution of burdens and benefits. How benefits are distributed is a matter of great debate. There are various methods of proposed distribution:
Equal shares (everyone has the same number of health care dollars per year)
Need (only those people who need health care get the dollars)
Queuing (the first in line for a transplant gets it)
Merit (those with more serious illnesses receive special benefits)
Each of these principles could be appropriate as a measure of just allocation of health care dollars, but each will affect individual patients in different ways. Just distribution has become a major issue in health care. The principles of justice apply only when the resource is desired or beneficial and to some extent scarce (51).