A Culture of Silence Persists in Medicine Despite #MeToo

Jessica Singh, MD, and Joanne Wilkinson, MD, MSc
8 Min Read

Singh is a holistic coach for providers and a former emergency medicine physician. Wilkinson is an associate professor of family medicine.

Despite the strains the pandemic has placed on our healthcare system, including understaffing, an exodus of healthcare providers, and increased physician burnout, the number of medical school applicants continues to remain steady, with approximately 52,500 for the 2023-2024 academic year.

Per a national survey by U.S. News & World Report in 2021, the average medical school acceptance rate for 2020 was just 6.5%. With competition this fierce, every aspect of the application has to be top-notch. One application element that carries a lot of weight — and induces apprehension in students — is the personal comments essay. In it, prospective doctors must not only describe their reasons for wanting to pursue medicine and why they feel they’re suited for the profession, but they must also share who they are as people. This critical essay serves as a personal introduction to admissions committees, influencing which students they select for interviews from thousands of qualified applicants.

As physician-educators who have reviewed many student essays, we are regularly approached by applicants to provide feedback on their essay drafts. Popular topics evolve to reflect cultural trends, and many students are currently exploring subjects like advocacy for diverse patient populations or their volunteer experiences.

However, a hesitancy persists to broach one potential essay topic: personal experiences of sexual violence and trauma.

While advice to avoid this topic may have previously been well-meaning, in our post-#MeToo world, it sends a harmful message by devaluing these experiences and suggesting that our personal trauma is a black mark on our resumés and irrelevant to our profession as physicians. We need to do better.

From the beginning of our medical education and training, prospective and new doctors are pushed to perform at the highest, uniform standards academically and clinically — regardless of their individuality, communication styles, or beliefs. In learning to practice in a modern medical culture that prioritizes the financial bottom line, we become workers in a corporate assembly line. In order to succeed, we are forced to stifle our humanity, the very thing our patients relate to and connect with. We are taught to separate our personal and professional lives, with the implication that acknowledging our full life experiences would interfere with patient care.

This idea couldn’t be more off-base. A study published in PLOS One by David Greenberg, PhD, and colleagues found that “on average, adults who reported experiencing a traumatic event in childhood had elevated empathy levels compared to adults who did not experience a traumatic event. Further, the severity of trauma correlated positively with various components of empathy.” It stands to reason that physician and medical student survivors who feel that their lived experience is accepted and appreciated by their profession would be even more effective in offering empathetic care to their patients.

By sharing in the perception that these students should conceal these experiences on their application essays, we are perpetuating a culture of shame and going against the oath we take as physicians to advocate for healing and to embrace the human experience.

The implications are widespread. According to the National Violence Against Women Survey, one out of every six American women has been the victim of an attempted or completed rape in her lifetime (14.8% completed, 2.8% attempted). A qualitative study published in Women’s Health Issues (2016) that assessed interviews from 16 faculty physicians across five medical specialties found that physician barriers to caring for sexual assault survivors included not only system obstacles and barriers of physician-patient communication but also “internal barriers.” This includes discomfort with the topic of sexual assault, the emotional burden of managing sexual assault, and personal opinions providers have about sexual assault and sexual assault survivors.

Physician awareness of sexual violence issues and barriers to caring for sexual assault survivors is critical, but equally important, the one-in-six statistic means that medicine is already full of women physicians who are survivors of sexual violence. Considering that the majority of medical students in the U.S. are women and that the percentage of women in the physician workforce continues to rise steadily, increased education and advocacy around these issues is critical.

According to a 2023 study examining the role of blame and rape-related shame in depression among victims, “Self-blame and receiving victim-blaming messages upon disclosing the experience of rape are associated with higher levels of rape-related shame as well as general shame pertaining to personal characteristics, habits, and behavior. Higher levels of rape-related shame are associated with higher levels of posttraumatic stress disorder and depression.”

We, as physicians, have a duty to reduce shame to promote recovery in both our patients and in ourselves.

The skewed perspective that “vulnerability is weakness” is no longer serving us. We need to adopt an attitude and medical culture that acknowledges the strength and courage of vulnerability, and the power that comes from owning one’s traumatic experiences.

We must acknowledge this strength and courage not only in new applicants to medicine but also in the ranks of physicians already practicing, teaching, and mentoring others.

Just as we honor and respect our patients’ experiences, as physicians, we must do the same for ourselves and our colleagues. This starts at the very beginning of our journey as prospective doctors. The answer is not to encourage silence in our students on their medical applications. Instead, we should support them in writing about their full life experiences, trauma, and all.

Jessica Singh, MD, is a former emergency medicine physician, the founder & CEO of Sukhayu Wellness and the Center for Health and Wellness Coaches, a holistic coach, and a healthcare provider well-being consultant. She is also a Public Voices fellow on Advancing the Rights of Women and Girls with the OpEd Project and Equality Now. Joanne Wilkinson, MD, MSc, is an associate professor of family medicine at Brown University in Providence, Rhode Island. During her 25-year career in medical education, Wilkinson has advised medical school and residency applicants on their personal statements and has served on admissions committees at the medical school and residency level.

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