Sexual assault, crude banter — what it’s like to be a female surgeon

It never crossed her mind that anyone would ever think that, because she was a girl, she might be less able than her older brother. But over the 12 years that she has been training as a trauma and orthopaedics surgeon she has experienced misogyny, discrimination and sexual harassment. “There’s a boys’ club mentality in surgery,” she says. “At the start, people often underestimated me. They’d look at me and say, ‘You’re not one of us.’ I decided I’d have to turn it into an advantage. If their expectations were low, then I’d have to try to blow them away.”

Mehdian-Staffell, 37, is part of a new generation of female surgeons who are challenging the male-dominated culture in the profession. With two boys aged three and four, her north London home is overflowing with toys as well as piled high with the books that she is studying every evening for her next set of exams. It is clear that she loves her job. “My aim is not just to be a surgeon – it is to be a damn good one. I didn’t go into it to be average,” she says as she pours tea. But she is also exhausted and demoralised. “The sexism comes from patients as well as other members of staff. People will assume you’re a nurse. I’ve previously worked in departments where the guys all went off to golf and men were prioritised for opportunities over women. Sometimes, as female surgeons, we feel as if we have to work twice as hard.”

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She says many of her more recent male colleagues have been supportive, but there is a systemic problem. Even the surgical instruments are made for male hands. Traditionally, surgeons are known as “Mr” rather than “Dr”, but women often get called by their first name. Once, when Mehdian-Staffell told a consultant that she wanted to be an orthopaedic surgeon, he looked her up and down and said, “What’s your plan B?”

“I suppose I didn’t look like your average orthopaedic wannabe. I dress quite nicely, my hair was perfectly done and I had my make-up on, but that doesn’t mean I can’t be a great surgeon,” she says. “It was so patronising. I said, ‘I don’t need a plan B,’ and walked off.” Another male doctor suggested to her that full-time surgery was “not an appropriate career choice for mothers”.

There have been darker moments. “I’ve been sexually harassed lots of times,” she says. “One surgeon in medical school made me feel extremely uncomfortable. He kept calling me to his office under this guise of having philosophical conversations. He’d say things like, ‘I can read everyone but I can’t read you.’ He’d insist I should go in his car to a satellite clinic, then put his hand on my thigh. It was really creepy. I remember on my last day there I got a message from him saying, ‘I want to say goodbye before you go. I’m coming to your accommodation.’ I was so terrified that I threw everything into a bag and ran out. I had nightmares about it for years.”

That was not an isolated incident. During her time as a junior doctor, she says, “I’ve had people come into the sluice room [where waste is disposed of] and stand behind me and grind themselves on me. There was one time when someone walked in and said, ‘You’ve got your short trousers on – make sure you always wear them because your ankles are really sexy.’ I know so many people who have had similar experiences.”

There is a systemic problem in surgery: the instruments are made for men’s hands and while male surgeons are known as “Mr”, women often get called by their first name

GETTY IMAGES

Mehdian-Staffell has persuaded the surgical instrument manufacturers to review their equipment to make it more female-friendly and, as chairwoman of the Healthcare Workers’ Foundation, is working for better conditions for NHS staff. There is, however, a long way to go. More than half of medical students are women, but only 15 per cent of consultant surgeons in England are female and in some specialisms the percentage is much lower. Fewer than 8 per cent of orthopaedic surgeons are women. “We’re known in medicine as the jocks or the meatheads. Historically it was the big rugby players who went into orthopaedics,” Mehdian-Staffell says. “I’d never met any female orthopaedic surgeons with families when I started my career, so I said, ‘If no one’s done it, then I will be the first.’ That’s been my motto throughout. I’m going to do it my way.”

She has paid a price. Surgical training involves long hours and unpredictability. At one point, Mehdian-Staffell was paying more than £4,000 a month on childcare. “I was basically working for nothing. My husband and I said we just had to see it as an investment.” Now she spends four hours a day travelling to and from her hospital, leaving before 6am and often not getting home until 8pm. “Surgery is horrific for working mothers,” she says. “There is a saying, ‘Knife before wife’, and the whole profession was designed around the idea that a surgeon is a man with a wife at home to look after the family. I don’t feel that the system has changed much.”

The traditionalists argue, “Don’t be so impatient. Change is coming.” Deborah Eastwood, 65, the president of the British Orthopaedic Association, was one of only a handful of women in the speciality when she qualified in 1980. “There’s been a slow but steady increase,” she says. She points out that a fifth of orthopaedic consultant appointments went to women last year, but she admits that there is still a long way to go. “We have to change the culture.”

To qualify as a surgeon takes a minimum of 15 years, including at least 6 years in speciality training when the hours are irregular. Trainees rotate around different hospitals every year to build up expertise and often have little control over where they are posted. Flexible working is frowned upon and sometimes impossible; going part-time means it takes even longer to qualify. Many doctors delay having children so that they will be taken seriously at work and then struggle to conceive. “Female surgeons have fewer children,” Mehdian-Staffell says. “There’s a higher miscarriage rate, higher pre-term labour and higher infertility. I am sure it’s the stress and physicality of the job – the whole idea of a 12-hour shift or a night shift when you’re pregnant, the stamina needed to do 72-hour weekends on call. I was 37 weeks pregnant and doing hip replacements.”

One recent study found that female surgeons typically have better outcomes than men, particularly with female patients. But the attrition rate among women who apply to become surgeons is astonishingly high. At the start of the process, around 42 per cent of trainees are female, but almost half of them drop out during the two-year foundation programme, and only 22 per cent of registrars are female. There are even fewer fully qualified consultants. “Women are lost at every stage,” Mehdian-Staffell says. “I’ve got so many friends who have left. When I told my mum that I was pregnant for the second time, she burst into tears – and not in a good way. She knew it would be incredibly difficult and she was right.”

She reads me messages on her WhatsApp group for female surgeons. There are dozens of women who are saving lives every day but finding it almost impossible to cope with the amount of juggling that is required. One says, “At every stage there is double jeopardy as a female trainee. Work harder, earn less and the physical anguish of babies and attempted babies… I love my job but I do feel the job has not loved me.” Another describes a “low-grade toxic unconscious bias throughout training”.

The Royal College of Surgeons of England knows there is a problem. One recent poll by the Nuffield Trust for the governing body found that 61 per cent of all surgeons regretted the sacrifices they had made for the sake of their career. In 2021 the Royal College commissioned the human rights lawyer Helena Kennedy to do a review of diversity and inclusion in surgery. “The evidence I had from women was that the culture was very male and the chat in and around the operating theatre for surgeons was often inappropriate. It’s really not a very conducive environment for women.” She made a raft of recommendations to improve the situation and tells me she is “disappointed” at how slowly they are being implemented.

Fiona Myint, the vice-president of the Royal College and a consultant at the Royal Free Hospital in London, tells me that “more than 50 per cent” of female surgeons have experienced harassment or abuse.

A 2021 article in the Royal College’s Bulletin raised the “uncomfortable truth” that, “Surgery and surgical training have a problem with sexual harassment, sexual assault and rape.” Philippa Jackson, a consultant plastic surgeon in Bristol, shocked the medical establishment by writing a letter in reply detailing the sexual assault she had suffered outside an operating theatre. Her account prompted a flurry of other claims in what was described as surgery’s #MeToo moment, but she fears that nothing has changed.

Consultant plastic surgeon Philippa Jackson, whose letter detailing the sexual assault she had suffered outside an operating theatre prompted a flurry of other claims

COURTESY OF PHILIPPA JACKSON

I speak to Jackson on the phone. She calmly describes her experience at the hands of a male colleague. They were discussing the patient who was about to arrive for surgery when he moved in to give her a hug. “He made some noises and rubbed himself against me. And then, as he backed away, he said, ‘You probably felt my erection then,’ and he also told me he could see down my top.” The encounter seemed so at odds with the sterile, clinical setting of the hospital that she wondered whether she had somehow misunderstood. “I didn’t make a fuss because we were about to go into theatre and I don’t think I had properly registered what had happened. I think as women we spend a lot of the time giving people the benefit of the doubt and assuming we’ve made a mistake in the way we’ve interpreted things. I thought, ‘That’s creepy,’ but it didn’t mean I couldn’t do my job. So I did what I had to do.”

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Later that evening, she was back in theatre with the same colleague for an emergency operation. This time his behaviour was even more overt. “When you put on your gown you need somebody to tie it behind you. People will often do it automatically,” Jackson explains. “He came up behind me in the scrub room, which was just around the corner from the operating theatres so nobody could see us, and he said, ‘Can I tie you up?’ I said, ‘Yes,’ because, again, we needed to get on with the case. I couldn’t be fussy about who tied my gown. Then he said, ‘Now you’ve given me permission to tie you up under any circumstances,’ and he kissed me on my neck from behind. We were just going into an emergency operation, so I went and got on with that. An operating theatre is quite an intimidating environment anyway. What was I going to say – ‘He tied my gown and I didn’t like it’? You feel trapped in the circumstances. I don’t think any of us really wants to believe that we’re vulnerable. A few days later I was talking to the theatre nurse about what had happened and she said, ‘That’s not OK.’ ”

Eventually, Jackson wrote a letter to the hospital, detailing what had occurred. The person she had taken it to said, “ ‘Do you want me to have an informal chat with him? Or do you want this to go down the formal route?’ She inferred that the informal route might be more appropriate,” Jackson recalls. Fearful that if the man was not confronted about his behaviour he would do it again, she pushed for an inquiry, but nothing happened. “They did an investigation, which was quite superficial. The questions to me were very much focused on, ‘Did you say no? Did you push him away? Did anyone see it?’ You’re made to feel it’s your fault. In the end, they said, ‘Nobody saw it. We can’t prove that it happened therefore we can’t do anything about it.” The man was not suspended, and shortly after Jackson left the hospital for another job. “You survive, then move on to the next place and just hope it doesn’t happen again.”

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Looking back, the warning signs were there. “I think the person who assaulted me is probably predatory. When I look at his behaviour over the preceding months, he had been escalating in physical contact with me and I do wonder what would have happened next if I hadn’t spoken to someone about it, because he was getting bolder and bolder. His behaviour was known about and nobody chose to act.”

The personal long-term emotional impact has been enormous on Jackson. “It has stayed with me and it has affected the relationships I have with other members of staff,” she says. “I’m waiting for the next person to betray my trust. It makes you seem unwelcoming, unfriendly, unkind. There’s no faith in the system to stop it from happening or to fix it.”

She worries about the consequences for patients as well as staff. “It is absolutely devastating because people put their lives in our hands. They trust us at their most vulnerable moments and there are people out there taking advantage.” Of the man who assaulted her, she says, “How many times has he behaved like that in front of a patient or to a patient, either when nobody else has been watching or when they have and they’ve let it slide? I’ve been a patient and it frightens me now to think what’s happening when I’m unconscious, because not everybody is there with good intentions.” She has witnessed some shocking behaviour around patients under general anaesthetic. “I’ve been there when people have commented, ‘I don’t know why she wouldn’t have shaved for us,’ in reference to a woman’s pubic hair. There are a lot of inappropriate comments. Now I’m a consultant I’m much more protected and it’s easier for me to say, ‘OK, you can’t make those jokes. Those comments are not allowed.’ But it happens all the time.”

The film industry was jolted into action by the crimes of Harvey Weinstein, but Jackson thinks it is much harder for the health service to deal with sexual assault. “Everybody knows that it’s an issue but nobody wants to take ownership of it. They don’t want to admit they have a problem because if you say, ‘Yes, there are sexual predators among us,’ what happens to the public’s trust in the NHS? They are essentially admitting that they put patients at risk on a daily basis,” she says.

Only last month, James White, a doctor who repeatedly sent explicit photos of himself to fellow medical students, escaped being struck off. “There are so many stories but nothing changes,” Jackson says. “I feel like we’re in a holding pattern. We have to keep pushing. But I look at the review of the Metropolitan Police, which came as a result of someone being murdered by a police officer who was known to be a sexual predator, and I wonder what has to happen in the NHS for us to get a root-and-branch overhaul of the organisation? We’ve created a permissive environment that is tolerant of people who are predators. It’s like giving the wolf the sheep’s clothing – we’re effectively saying, you can walk among us and no one will know because we all wear the same clothes. And if they’re prepared to do this to colleagues, what do they do to patients?”

I TALK TO VICTORIA PEGNA while she is driving from Brighton to Guildford on the three-hour round trip she does every day to complete her training as a colorectal surgeon. “I work what they call part-time. I do between 50 and 65 hours a week and I’m paid for 32, but it means I have Wednesdays off so I can see my children on that day,” says the 42-year-old mother of three. “I guess I’m pretty burnt out, but there isn’t really a way round it.” Her husband is a medic too and also works a four-day week to help look after their kids, who are six, four and two, but she says that is unusual in their profession. “Culturally, within surgery, you’re not an alpha male if you give equal priority to your kids.”

Pegna is about to qualify as a consultant and is one of the few women on the governing body of the Royal College of Surgeons of England. There is, she suggests, a complacency about the scale of the problem in a profession that is the most “old-fashioned” in medicine. “Men largely wrote off surgery as being male-dominated because women couldn’t hack the long and unpredictable hours, but I don’t believe that’s what it is,” she says. “Midwifery and obstetrics are female-dominated and they’re horrific hours. I absolutely believe it’s the culture. What happens is, you’re in an orthopaedic theatre and you are a Muslim hijab-wearing female junior doctor and someone goes to you, ‘Oh, the terrorist just walked in.’ Or they say, ‘Hello crumpet, looking hot.’ Or you walk in and no one acknowledges you. They ignore you and they carry on talking about their sexual encounters. Those are real examples. It still goes on.”

Recently, she met one of the UK’s most famous surgeons. “He said, ‘You’re the type of woman I really want to know intimately. You’re not one to miss.’ He went on and on. It was awful but I don’t know what to do with it. I can’t piss him off because he’s powerful.”

Her way of coping as a trainee surgeon was, she says, to be “one of the lads”. “I play rugby. I’m really sporty. I like banter. I thought that was the way to get through this without being offended. I have reached the end of my training now, but listening to other people, I feel like I’ve done a disservice to other women being that way, because all I’ve done is go, ‘Yeah, if you’re tough enough, you can weather this. I’m not bothered by it. I know what a joke is.’ And actually, it’s really bad. Women shouldn’t walk into theatre and feel, ‘As long as I can put up with the sexism and the racism, it will be OK.’ ” She thinks it is no coincidence that so many women are leaving the profession. “Surgery is tough. You need to be tough. But we’re losing really amazing people who would stay if we were just a bit more welcoming.”

Consultant orthopaedic surgeon Joanna Maggs: “We need to understand why many talented doctors are leaving surgery when they have already invested so much”

COURTESY OF JOANNA MAGGS

Joanna Maggs, 45, a consultant orthopaedic surgeon in Devon, is running a study interviewing surgeons who have left in the past ten years. “We need to understand why many talented doctors are deciding against pursuing careers in surgery and leaving when they have already invested so much,” she says. As a mother of two girls, she has found juggling her career with family life “very expensive and exhausting”. Although she qualified as a doctor in 2003, she has only been a consultant for two years because of the length of time it takes to train. “We need to consider different ways of working and training,” she says, “but surgery is a hierarchical profession and it can be difficult to challenge the status quo.”

Like Mehdian-Staffell, Maggs says one of the problems is that much of the equipment in orthopaedics is designed for men. “The operating table height doesn’t go down quite low enough for me, so during some parts of an operation I have to balance on a stool, which, when you’re using big power tools, can feel quite precarious,” she says. “If you’ve got long hair then you have to wear an elasticated ‘nurse’s cap’. ‘Operating caps’ are reserved for those with short hair. During the pandemic the hospital I was working in had no PPE that fit me properly, so I couldn’t operate for months.”

Correspondence and manuals are all written on the assumption that surgeons are male. “I’ve got letters addressed to me as Mr Joanna Maggs and a job offer that says, ‘The appointee accepts that he will…’ As soon as you submit a paper, it’s ‘Dear Sir…’ The men’s changing room is ‘the consultants’ changing room’.”

The majority of surgeons have no idea what it is like for their female colleagues. “If they aren’t a target or a perpetrator, they just never see it.” Most women in surgery, however, have plenty of examples of inappropriate behaviour. “When we share stories nobody ever goes, ‘Gosh, I can’t believe it.’ We are all just, ‘Yeah, obviously that happened.’ ”
Rachel Sylvester is chairwoman of the Times Health Commission.
The Times investigates the crisis facing the health and social care system in England. Find out more about The Times Health Commission