The NHS pays more attention to how doctors make toast than to stamping out sexism – and this has to change. That’s the view of BMA representative body chair Latifa Patel, who wants to see a commitment to reform at every level in every health organisation across the UK.

‘You go into the NHS and you’re taught not to leave a toaster on or you’ll set off a fire alarm, but you’re not taught the policy on sexism,’ she says.

‘And we know there’s more sexism in the NHS than there are toaster fires. But we’ve just had 50,000 junior doctors rotating and they’ve all been told about fire safety as it’s compulsory in induction, but no doctor is being told that sexism isn’t right.’

Last month The Doctor reported on what some have called surgery’s ‘me too’ moment. This followed a paper published in the Royal College of Surgeons of England’s Bulletin, outlining the specialty’s problem with sexism ranging from ‘jokes’ and ‘banter’ to serious sexual assault, including rape.

The paper, by surgeons Becky Fisher and Simon Fleming, prompted many other doctors to describe their own – often harrowing – experiences. Many organisations and individuals, including England’s health secretary Sajid Javid, expressed concern about what the doctors, mostly women, shared.

For Dr Patel, expressing concern isn’t enough. ‘We need a commitment at every level of every organisation, from the leaders at the top right to the bottom,’ she says, adding that individuals have responsibilities too.

‘The poorest behaviours you walk by and accept is probably the behaviour that’s going to flourish in that environment. We’re saying you have to call it out, you have to have clear policies, you have to make sure people know about them, and you have to implement them.’

Although The Bulletin paper – and some of the experiences subsequently revealed, mostly through social media – focused on serious sexual assault, it was also clear that so-called lower-level sexism, such as jokes, was also a major issue.

Again, Dr Patel says that this should not be deemed as an acceptable part of an organisation’s culture – and just because the perpetrator didn’t mean any harm, doesn’t mean it isn’t harmful.

‘At the end of the day, it’s not just how it’s seen or perceived by the person who’s doing it, it’s how it’s perceived. To the person who’s doing it, it might just be one joke they’ve done and moved on, but to the person receiving, it might be the tenth.’

This rings true for Professor Claire Hopkins. An ENT consultant at Guy’s and St Thomas’ NHS Foundation Trust and professor of rhinology at King’s College, London, she describes how, as a trainee in surgery, she felt she had to ‘laugh along’ with sexist jokes if she wanted to fit in and progress in her career.

‘I was the only female and most junior doctor in the department – it was a typically male environment,’ she says.

‘There was constant sexist banter; it was very light-hearted but it was the norm. Some of the experiences talked about now were everyday occurrences, and it didn’t occur to me at the time that the behaviour was inappropriate.’

She recalls the behaviour of one senior male colleague.

‘At the end of operating, the consultant surgeon I was working for would slap me on the bottom and say, “now I’ve serviced my patient, I’m going home to service my wife”.’

There was another occasion when Prof Hopkins – who initially intended to specialise in orthopaedics – was attending a Friday meeting of trauma surgeons.

‘I was shown an X-ray of a pelvic fracture displayed on a screen and asked in front of the entire room to talk through what sexual position I’d used to cause that fracture.

‘It’s only now when I look back on it that I think, “Oh my god, that was actually terrible”. But it was the norm of where I was working and if you didn’t get on with it, you didn’t fit in.’

She knows of female doctors who decided against a career in surgery because of the way women were treated – including one who said she had left because she couldn’t stand the toxic sexist environment in a department that Prof Hopkins had actually found quite supportive at the time.

‘I just saw it as normal behaviour,’ she says. ‘At the time we just thought it was part of the life of being a surgeon. I’m not saying that’s a good thing, because although I was able to grow a thicker skin and somehow laugh it off, it turned women against surgery.’

She began a group called WENTS (Women in ENT Surgery) which aims to inspire, support and empower women at all stages of their careers – and she makes the point that things are getting better in some surgical specialties, including ENT.

‘One of the reasons I chose to go into ENT was that I think generally that [sexist behaviour] is less prevalent than it is in a specialty such as orthopaedics, for example.’

Even with her level of seniority, however, she is still subjected to microaggressions – such as being called by her first name when male colleagues are called Mr or Professor. ‘It’s still hard to be a woman in surgery, and we need that support to help encourage women to come through it.’

It’s also important to raise awareness, she adds. ‘I think our male colleagues in general are supportive and are allies – they just don’t realise that it happens on a regular basis. I don’t think anything is going to change overnight, but it’s important to try and make people more mindful. Even if just a few people notice when these things happen, and correct it themselves, or stand up for the junior who is being treated unfairly, then over time, things will change.’

Dr Patel is also determined this issue will not be swept under the carpet.

‘My dream would be for it to be talked about all the time,’ she says.

‘It should be talked about whenever a member of staff goes to a new department, at every induction. Because we know it’s so prevalent, so rife, and it’s only when it becomes part of routine induction and discussion that people feel they can call it out.’ 

Read the BMA's Sexism in Medicine report