TRANSCRIPT
"And that's when I experienced the episode of what I could only call the most humiliating, intimidating time I had with him. It destroyed... he destroyed me."
"I've experienced bullying and harassment. I've been spoken over, I've been interrupted. Ideas have been misappropriated in meetings."
We've heard stories of gaslighting, dismissal and coercion from women in our health system and from the LGBTIQ+ community.
But what about misogyny and discrimination directed against health workers?
Those working tirelessly on the frontlines to care for people in some of their most vulnerable times?
Experiences of sexism and discrimination can range from the more insidious exclusions to instances of outright bullying.
In this final episode of 'Hysterical'... we hear from health professionals about what it's like to work in a system which many argue is designed by men for men.
And what changes need to occur to make the space safer and more inclusive for female and trans health practitioners?
Jennifer has worked as a nurse for more than 30 years, and her decades-long career was nearly ended by what she describes as an experience of bullying by a male nurse.
He was brought in from a different children's hospital in Sydney in 2018 as the two hospitals were becoming a network.
"And one of the staff members was a male nurse who kept coming over to our hospital, and he made everyone feel uncomfortable with his presence. And we didn't know why he was coming over, but he was creepy, and he would just come in and want to know certain information, and I was uncomfortable around him as other nurses were."
Jennifer says he worked his way up to become a relieving clinical educator or operational manager, which is when things really turned for the worse.
She made an appointment to see him about an opportunity to be appointed into a director's position, which she had already been performing in for a year.
"And I could tell at the beginning of the meeting and the way he was reacting to me that I had no chance. But it was the way he did it, I experienced a physical meltdown because I knew what he was doing and I could feel... He's saying things that aren't true, and he just made me feel horrible and I broke down and he was making comments like, 'look, you can't even speak properly'. And it was just so humiliating that it actually destroyed me. And I had to walk away after a 30 year career because of the way that he made me feel. It destroyed, he destroyed me."
Jennifer says she suffered post-traumatic stress due to the incident, which occurred in 2018, not long after the death of her husband.
"It was the worst experience. It was worse than losing my husband because I'd been absolutely humiliated by him, and the way he made me feel was the most horrible experience I've ever felt. And it's still very traumatic talking about it. I was a good nurse. I was disciplined. I turned up for work every day. I looked after my staff, my nurses, and I looked after the patients. And to be treated like this, I had to walk away. "
Nursing continues to be a female-dominated profession in Australia.
Just over 88 per cent of nurses identify as female, compared to nearly 12 per cent as male, in a 2022-2023 annual summary by Australia's Nursing and Midwifery Board.
But a 2022 report by Western Sydney University projected a shortfall of up to 85,000 nurses by 2025, and up to 123,000 by 2030.
It explored the experiences of workplace gender discrimination from the perspective of nurses across 12 countries including Australia, and found that although men are a minority in nursing they do not suffer the same consequences as other minority groups in regard to career success.
In fact, it found that whilst women experience a 'glass ceiling' of career progression in male-dominated fields, men in nursing in fact experience a 'glass escalator' to career success.
It suggested that workplaces should work to ensure women aren't discriminated against to improve job satisfaction and the retention of experienced nurses, particularly as the world confronts a critical shortage of nurses.
Jennifer feels that in her experience, her colleague was able to get away with treating her poorly because he was a man.
"I think I was treated this way because he was a male nurse, and he obviously struggled as a male nurse, and he struggled with his own identity in nursing. And I think I was treated that way because he didn't want me in a position that I deserved and that I had performed in for over a year. But, you know, if something's not right, I will speak up and usually I will speak up. I won't walk past something that's not right. I will always speak up for safety and for nurses, probably because I do speak up for nursing, and, you know, he didn't want that."
She echoed concerns around a declining cohort of nurses, and says the issue needs to be dealt with immediately.
"In 2030, we are going to lose all our nurses. There's going to be a lot of nurses retiring, and there's nurses coming in, but they're not staying. They're walking away after a year. They can't deal with the amount of stress and workload. We need to look after our nurses. We need to look after their health, and they're recognised for their hard work. I know that New South Wales Health are doing everything they can, but it's not enough. It's hard enough without bullying coming into it and bullying, it can be subtle, but it can really destroy people."
Female doctors also confront this discrimination, despite women now making up just under half of the country's GPs, according to Australian government Department of Health 2022-23 workforce data.
Professor Ada Cheung is a research fellow and clinician scientist at the University of Melbourne, as well as a practicing endocrinologist.
So I started off in medicine with a bit of a naive perspective. Even when I went through medical school back in 1997, 1998, female medical students outnumbered males. I went into medicine with really rose-coloured glasses that it would be equitable, that everyone would have equal opportunity to make a difference and improve the health and well-being of the community. And what I perhaps wasn't prepared for is that hospitals are really hierarchical, patriarchal institutions. There's a long history of that. They're institutions built by men for men. Often, it's older senior white men who hold many of these senior leadership roles and control performance reviews. There's a power imbalance."
This power imbalance is something Professor Cheung has suffered.
I've experienced bullying and harassment. I've been spoken over, I've been interrupted. Ideas have been misappropriated in meetings. They're not heard if the ideas are not repeated by a male doctor. I've been yelled at. You know, there's like very behaviours that when I first went into medicine were accepted as just the way it was, the way the system is. Like it's not uncommon for junior medical staff to be yelled at with a raised voice, it's not uncommon for junior medical staff to be completely belittled by senior medical staff. And this still happens, like in 2024 this behaviour still happens."
Even in her role representing all doctors across Australia, President of the Royal Australian College of General Practitioners Dr Nicole Higgins isn't immune to the sexist remarks many female health practitioners confront.
"So here am I. I'm president of the College of GPs. I represent 40,000 doctors, and I'm a health leader, and yet not uncommonly, I'm asked, oh, where are kids? Who's looking after your children? Inferring that I'm a bad mother because I may be in Canberra doing something, and it's like, this is not a conversation that you would be having with a male colleague. So it is just these little microaggressions that really impact women health practitioners, but making judgements on your ability to perform your work because of gender, it's not acceptable."
This bias is despite the fact female GPs actually spend longer with their patients on average than male GPs.
The Royal Australian College of General Practitioners' 2023 Health of the Nation report found female GPs spend 20 minutes on average with their patients, compared to the 16.8 minutes male GPs spend with their patients.
As Dr Higgins explains, this is because female GPs are more likely to see appointments related to complex health needs, such as mental health or antenatal care for instance.
This creates a system whereby female GPs are typically not being remunerated as much as their male counterparts despite spending longer with their patients.
"There is a significant gender pay gap within general practice and medicine. Because of the way that the system is set up, the system is set up to firstly reward medicine or procedures, and it doesn't reflect the type of practice that female GPs do. We know that female GPs see patients for longer who are more complex. What we're then finding is that the rebate that is back from Medicare, really the gap is widening between our male and female GPs. So unfortunately for female GPs, the longer that you spend with a patient, you're penalised."
Dr Higgins says this means female GPs have a lower income but are often working harder than male GPs... making it less attractive as a career at a time when our health system is desperate to attract a workforce.
She says one key issue their peak body has tried to raise with the government is guaranteeing paid parental leave for GPs, like in the hospital system, so female doctors aren't further discouraged from the profession.
"Doctors who want to train as a GP, and as I said before two thirds of those are women, lose parental leave, they lose entitlements that have been accrued through the hospital system. So there's not the pay parity in general practice compared to our hospital colleagues. So we are currently working with the government on what that would look like. And when we tried to get this up before the government said, 'we can't do that, it's too difficult, it costs too much'. But what happens is this creates such a barrier and disincentive for doctors, and female doctors, to train as GPs."
Unlike GPs, surgery continues to be a male-dominated field, with women still only comprising 15 per cent of the workforce.
This makes it unsurprising to hear of Associate Professor Rhea Liang's experiences of sexual harassment and bias.
Associate Professor Liang is a general and breast surgeon on the Gold Coast and Clinical Sub Dean for the Bond University Medical School.
She says her own experiences are sadly consistent with data from the Royal Australasian College of Surgeons, which found in 2021 that 30 per cent of female trainees had experienced sexual harassment.
"And so it's not surprising when I say as I was coming through training in the late 1990s and early 2000s, that was taken as something that we would meet almost for granted. That if you wanted to play with the boys, as they used to say, that you had to take some of the heat in the kitchen, by which they meant that we would have to take a fair bit of tease banter. Some of us experienced physical sexual harassment. People would touch you or be physically affectionate in uncomfortable ways. And of course, some of us actually experienced sexual assault. Some women we know this have been asked for sexual favours to progress in their surgical training. What's changed since that time, I think, is that it's become much, much more clearly unacceptable."
Professor Liang says she and her female colleagues were often left powerless.
"It makes you feel horrible. You have to be incredibly strong to be a surgeon and you pride yourself as being a strong woman because we were very, very much in the minority. And you pride yourself on being a strong woman. But in those moments, you understood quite often that you couldn't say or do anything because the power was not on your side. You had to complete your training, they would be writing your training assessments. They controlled my progression through surgical training. So generally speaking, none of that was reported."
They were often forced to find other ways to avoid inappropriate behaviour and sexual harassment.
"We talked about it amongst ourselves. So we talk about the secret handover, we would have the standard handover, the one that goes alright, in room three we've got Mrs, so-and-so she's 28, she's had this operation, she's day three, very, very technical handovers. And then at the end almost, I mean online meetings weren't a thing back then, but almost like you'd turned off the zoom recording once the formal part of the meeting was over, everyone would go, by the way, Dr. so-and-So make sure you're not in a room by yourself with 'Dr. So-and-so he'll call you these names, but actually his bark is worse than bite. So just ignore all the noise."
She says only last year did the Royal College of Surgeons commit to a breastfeeding policy she had advocated for since her son was born - he is now 19 years old.
These kinds of barriers were also raised by Dr Nisha Khot - the Vice President of the Royal Australian New Zealand College of Obstetricians and Gynaecologists - who you might recall from an earlier episode.
Dr Khot said she'd also like to see men shoulder more of that parental leave so women are given more opportunity to progress in their careers.
"So in a medical career where it is important to be present and get the experience and the hands-on experience, if we take time out to have babies and pregnancies, it means that disadvantages us. And actually that shouldn't be true at all. We have had more than 50 per cent medical school entry of women for a long time. We have specialties which are almost 50 per cent. Some like Obs and Gyn is now 80 per cent women. And so we really need to have a health system and a health training system that takes into account the fact that women will need to have maternity leave, will need to take time off."
Professor Liang does admit things have improved, but says while it's less overt, sexism prevails in her profession.
"I see it all the time still, but what's changed is that it's not overt or intentional, it's unintentional. We've moved from the macroaggressions into the microaggressions and that's actually a slightly more difficult problem to address. So it used to be that we literally had surgeons who were happy to stand up in meetings with the microphone and declare that women were not suited to surgery and they personally would not take women trainees and so on. And while there might be quite a few people in the room who would disagree with them, the point is they felt able to say those things in a public setting. Nowadays that would be completely unacceptable. The chair would probably take the microphone off them and tell them to sit down, but we still have a lot of microaggressions. It's still quite common for women doctors to be mistaken for something other than a woman doctor to be given tasks that relate specifically to a woman's gender stereotype. So 'this is a difficult conversation. Women are better at communication. Can you take it on?'"
Trans health workers also confront bias and discrimination in the health system - often of a different kind.
Vic is the trans and gender diverse health lead at Thorne Harbour Health Clinic in Victoria - an LGBTIQ+ community-controlled health organisation.
But prior to working at Thorne Harbour, Vic says they certainly experienced bias and discrimination as a nurse - with misgendering a recurring experience.
"Having to constantly remind people of what your pronouns are, it gets exhausting. And so you sort of end up not doing it. After a while, you sort of give up and it becomes a problem when it's happening in front of patients. When we're with a patient and my colleague uses the wrong pronouns, it's a really awkward interaction. The patient is looking at me trying to figure out what's going on. It also, other ways that I've experienced that is when I would be assigned patients who had specifically requested female nurses and unbeknownst to me until I get to the patient, and then while my voice sounds quite feminine, I present quite masculine. And so they've asked for a female nurse and that's not what they've been given."
Vic says that left them in the difficult scenario of either potentially compromising their own safety by disclosing to the patient that they are trans, or going back to their colleague to arrange a swap.
This can be particularly challenging when, as Vic describes, trans health workers are often battling unfair stereotypes from their colleagues.
"There's also an experience that many of us have had where healthcare workers still see trans people as the patient, where I might be the first trans person that somebody has ever worked with, and they're used to only having trans people as patients. And so we then have to be exposed to and navigate listening to our colleagues, talk about trans people and talk about trans patients as if we're not there because they're used to talking about trans people as just the patient and not as an equal, as a colleague. And that's something that we experience a lot."
Unfortunately, harassment and bullying has also been part of Vic's experience - in this instance, from the very people they are caring for.
"I've definitely experienced harassment from patients being called it or being told that they don't want me as their nurse or implying that I might do something inappropriate with them and things like that. And then having to raise that with my colleagues or talk about it with my colleagues. It's really difficult, especially when the only trans person and the person that you're trying to talk to, your manager or whoever it is, just aren't able to comprehend how damaging and how hurtful that can be, especially when you're trying to just care for somebody."
And another common scenario almost any minority group would be familiar with is the expectation to become the expert on your community.
"I've also experienced something that I know a lot of my trans peers, trans health workers experience, where you kind of unwillingly become the trans expert. Often we might be the only trans or gender diverse person in the team or in a clinic. And so you kind of end up becoming the go-to person, which on the surface sounds like a good idea, but when that's not the role you've signed up for, it becomes an additional burden. It's an additional sort of thing that you have to carry and hold in your work instead of staff members or the rest of the team doing the work to make their practice and the whole practice safe and inclusive for trans people."
This lack of representation is particularly evident in leadership positions.
Professor Teede - who spoke on the misdiagnosis and under-diagnosis of PCOS in a previous episode - also helped develop a program to promote women in leadership roles in the health system.
She said she recalls early in her career that all of her mentors were male and struggled to find role models to relate to.
"And so we started a leadership development program that's been going for about nine years and have really gone back and evaluated that and shown that with brief three day programs, we can change careers because we change hearts and minds where women realise that this is not them, it's all out there. And when they see it for what it is, they can push through it and move forward and really make a difference. And so I still do that and absolutely love it. Our women in leadership program is probably one of the most fun things I do."
Alongside Professor Teede's work with the 'Advancing Women in Healthcare Leadership' project, there's also a commitment to changing the system and ensuring the burden isn't placed on individuals.
She says the project receives funding from federal and state governments, and has also brought together colleges, employers, health services and unions to address the lack of female representation in positions of leadership.
Professor Teede says women make up 75 per cent of Australia's health care workers, but this isn't reflected in leadership roles.
"We train them. We have the most educated women in the world in Australia, and if we don't harness that in the workforce, we're really missing out. But there is really good evidence that women are as good if not better doctors, they are as good if not better leaders in healthcare because when you put them in healthcare leadership roles, they have more equity, they drive more equitable policies. There are studies that have shown they have better vaccination and public health, they have less marginalisation, they have more services for under-serviced populations. So it would be unfortunate to have a system where all leaders were women or all leaders were Caucasian or all leaders were men. But that's what we've had."
Proper representation is something Vic also advocates for.
They now work at an LGBTIQ+ community-controlled health organisation in Victoria - Thorne Harbour - working in a safe environment among other trans and gender diverse people.
"One of the things that we do well at Thorne Harbour is seeing trans people as human beings and not just as trans people. We look at their skills and their experiences, and if they fit the job they get the job. Having trans people in all levels of an organisation I think is really important. I think also the culture of a workplace is so important. If you know that when you use the wrong pronouns for somebody that your colleague will gently correct you, not in a blame way, but in a way that we want to make sure we're all doing this the right way. It can really make a difference because it changes the culture of an organisation."
Professor Cheung says she's tried to raise issues of sexism and exclusion in her hospital unit in Victoria, but to little avail.
"And in the last 12 months within my unit, I've highlighted that misogyny is a major medical issue. And I've tried to ensure that I've tried to push the hospital to recognise that misogyny is an issue and that gender equity, diversity, inclusion needs appropriate resourcing. Despite writing this article, it's been difficult to have this heard and have this actioned. I think there is, every hospital in Victoria at least have to publish gender equity workforce reports for the government. And the amount of resourcing that's put towards gender equity, diversity and inclusion work is minuscule compared to the size of the organisations that we're talking about in corporate, this would not fly."
She says we can't address issues of misogyny for female and gender diverse patients, without first looking within our system.
"If we want to improve the health and wellbeing of the wider community, women in our community, transgender diverse community, we need to make sure that the female staff and the transgender diverse staff in our healthcare settings and hospitals are safe, healthy, and well. And we need to make sure that, first of all, we need to look within and reduce the discrimination and misogyny that's within our own healthcare settings before we can most effectively improve the health and wellbeing of the wider community."
Professor Liang is hopeful that things are changing.
"So the top down stuff is the policy work. It really helps when you sign off a breastfeeding policy or an equity policy or a job selection policy that makes transparent exactly what the criteria are, who gets access to it, what happens if they don't. It just gives you the ammunition you need sometimes to fight for what you need. Along with that, it has to be bottom up. So you've got to educate the people that will affect. So one of the things I've been doing is trying to improve the awareness that we now have a breastfeeding policy, because there are still a lot of trainees who will be needing that sort of support. So it's that bottom up education dissemination, making sure everyone's aware sort of approach."
Vic hopes that the safe space created in their current workplace can carry into the mainstream health system.
"When there's less trans people in healthcare, patients aren't able to see themselves represented, they're not able to see that this is a trans safe service, while trans people shouldn't have to be the ones always advocating for safe trans healthcare at the moment, that is often how it is. And so having more trans people in health services as health workers means that there's more of us who are able to advocate for that trans-affirming care and create change in that way."
I'm Catriona Stirrat and you've been listening to 'Hysterical' - a podcast series by SBS News.
You can catch the full series on SBS News, Spotify, Apple or wherever you listen.
