Author: Sarah Russell

Entrenched sexism in surgery

For decades, the Royal Australasian College of Surgeons turned a blind eye to the entrenched sexist culture within surgery. After recent publicity, they have finally opened their eyes. They can no longer deny sexist surgeons operate within hospitals around Australia.

The college appointed a group of independent experts – Rob Knowles, Helen Szoke, Graeme Campbell, Cathy Ferguson, Joanna Flynn, Judith Potter and Ken Lay – to advise them on what should be done.

The first thing was to determine the extent of the problem. Was it just a few rogue sexist surgeons? Or is sexism pervasive within surgery?

The Expert Advisory Group found sexism is commonplace in surgery. A survey found 49% of fellows, trainees and international medical graduates were subjected to “discrimination, bullying or sexual harassment.”

The large number of victims comes as no surprise to those of us who have worked in a hospital. Hospitals operate on a hierarchical structure with surgeons positioned at the top of the pecking order. They call the shots.

Sexist surgeons do not leave their bullying behaviour at the operating theatre door. They bully other health care professionals and patients. They also take their bullying behaviour home.

Sexist surgeons have a strong sense of entitlement. They are in command, both at work and home. Not surprisingly, the expert committee found protagonists had a lack of insight about their bullying and sexist behaviour. This lack of insight into their internalised misogyny will make changing their behaviour difficult.

The expert committee noted that sexist behaviour has negative implications for patient care. I recently observed a senior surgeon disagree with a colleague about a female patient’s analgesia. The surgeon spoke very loudly whilst the patient lay quietly in her bed. Afterwards, the patient was very distressed. She asked me if the surgeon wanted “to euthanise me?”

I later asked the surgeon not to talk about the patient within her earshot. I explained how upset she was about the altercation at her bedside. He stormed off, shouting: “I will not listen to this.”

The Expert Advisory Group found “known bullies” are untouchable. Bullying among surgeons has become normalised as a culturally accepted behaviour. Perpetrators are more likely to be promoted than held to account.

Most surgical departments have at least a few bullies. It is likely that these bullies are well known to the hospital’s management. Yet, despite legal obligations to provide a safe workplace, hospital managers rarely reprimand surgeons for their sexist behaviour.

The demonstrable lack of consequences for perpetrators encourages some surgeons to continue to abuse their power. Hospital managers may be reluctant to take action on badly behaved surgeons for a range of reasons. They may fear the financial and reputational consequences. Hospitals fear both publicity and litigation.

There is an expectation among some senior surgeons that junior trainees should endure the same training circumstances as those in place when they trained. Trainee surgeons do not complain for fear of being seen as weak or unsuitable for surgery. They fear being black-balled.

Those who have the courage to complain risk career suicide. Sometimes a surgical career is over before it starts.

The expert committee also identified “bystander silence” as a serious problem. Within a culture of fear and reprisal, colleagues who witness bullying, discrimination and sexual harassment are rarely prepared to complain. They see no point in making a complaint.

Complaint processes protect the status quo. The person responsible for dealing with complaints is often a close colleague of the person who is being complained about. Not surprisingly, complaints often hit a brick wall.

The college has responded to the current toxic professional culture within surgery with a 21-page action plan. The document “Building Respect, Improving Patient Safety: RACS Action Plan on Discrimination, Bullying and Sexual harassment in the Practice of Surgery” claims to show “RACS’ commitment to dealing with unacceptable behaviours; strengthening surgical education and training; and reshaping the culture of surgery on foundations of collaboration and respect”.

The action plan is difficult to read, let alone understand. It is replete with weasel words. Phrases create an impression that a meaningful statement has been made, when only a vague or ambiguous claim has been communicated.

According to the current President of the Royal Australasian College of Surgeons: “We must make it safe for victims and bystanders to speak up. There must be clear consequences for those whose behaviour is unacceptable.” Unlike the action plan, his statement is clear.

The Royal Australasian College of Surgeons plans to provide education in countering discrimination, bullying and sexual harassment. Once again, the onus is on the victim to take action. However, with better complaints mechanisms, perhaps the victims will now get justice.

The college also plans to change the way surgeons are trained. Current surgical training arrangements provide disincentives for doctors seeking work-life balance to join the surgical profession. The current arrangements favour those without family commitments or with partners who have less demanding careers.

They aim to embrace diversity and foster gender equity. However, simply bringing females into the surgical boys club will not change this culture. Changing the toxic culture among surgeons requires structural change.

Respect living wills

Letter, The Age

I arrived at an aged care facility recently to find a fire truck, 2 Mobile Intensive Care Unit Ambulances (MICA), a paramedic motorcycle and an ordinary ambulance. The flashing lights heralded the death of a 94-year-old resident. The nurse in charge had dialled 000 despite explicit written instructions that the resident not be resuscitated. Residents of aged care facilities are encouraged to make living wills. These advance directives allow residents and their families to state their wishes for end-of-life medical care. These living wills are meaningless unless health care professionals respect our wishes.

Sarah Russell, Northcote

Too quick to prescribe

pills

Letter, The Age

I am the medical power of attorney of my 91-year-old mother, who lives in an aged-care facility. She was recently reviewed by a psychogeriatrician, who prescribed a new drug to slow down the progression of Mum’s dementia, despite the fact her dementia is progressing slowly without this drug. Instead, I prescribed lifestyle intervention, such as outings and conversation, to improve Mum’s quality of life.

Another doctor was concerned my mother was taking a diuretic without a potassium supplement. I explained that she ate several bananas a week, because they are her favourite fruit. Surely, this is preferable to taking a drug.

Last Saturday, my mother had a fall. The doctor was sure she had not fractured her ribs, but still ordered an X-ray. The only treatment for a fractured rib is rest and analgesia. I cancelled the X-ray and instead prescribed trips to the park in a wheelchair and The Age crossword. With burgeoning healthcare costs, I call on all medical doctors to ask: is that drug or medical test really necessary?

Sarah Russell, Northcote

Greedy son syndrome

Letter, The Age

Financial elder abuse is family violence. Senior Law suggests the contributing factor is ageism rather than gender (Domestic violence victims not just women). However, research shows that women over the age of 80 are most at risk of financial elder abuse, with adult sons being the most common perpetrators.

Some children assume that older women, particularly those who have not been the family’s breadwinner, are unable to manage their own finances. After the father dies, they encourage their mother to appoint a financial power of attorney, often a son. In some cases, the mother is declared legally incapable.

Children with ‘Early Inheritance Syndrome’ feel a sense of entitlement to their mothers’ assets. These impatient children will actively seek ways for their mothers to give them money. They claim: “Mum doesn’t need money, and it’s going to be mine anyway.”

Some greedy children keep their eyes peeled on the Bank of Mum. They curtail her expenses, such as money she spends on holidays, carers and Kingston biscuits. They protect what they see as their entitlement.

The financial abuse of older women is on a continuum of violence towards women. It should be a criminal offence.

Sarah Russell, Northcote

 

 

 

Keeping an eye on the bank of Mum

Australians are living longer and living richer than at any time in our history. The Intergenerational Report predicts that 40,000 people will celebrate their 100th birthday in 2055. Some older women will enjoy their wealth – travelling the world, with their luggage broadcasting that they are ‘spending their children’s inheritance’. Others will live in an aged care facility while their children keep their eyes peeled on the ‘Bank of Mum’.

State Trustees Victoria report ‘For Love or Money: intergenerational management of older Victorians’ assets’ shows that women over the age of 80 are most at risk of financial elder abuse. This research found that adult sons are the most common perpetrators.

Financial elder abuse involves taking or misusing an older person’s money, property or assets. Studies confirm that financial abuse is the fastest-growing type of abuse of older women. So much so that Senior Rights Victoria suggested the terms of reference for the Royal Commission into Family Violence should include elder abuse.

When a father dies, some adult children assume what was once ‘Mum and Dad’s money’ is now their money, not their mothers’. They are not willing to wait for their inheritance until after their mothers die. Children with ‘Early Inheritance Syndrome’ feel a sense of entitlement to their mothers’ assets.

These impatient children will actively seek ways for their mothers to ‘gift’ them money, or will interfere in the management of their parents’ assets to protect what they see as their entitlement. They will keep a close eye on their mother’s assets and curtail her expenses, such as money she spends on holidays and carers.

According to the Office of the Public Advocate, older women are also more likely to be declared legally incapable than older men. This may be due to the fact that women live longer than men. Some children assume that older women, particularly those who have not been the family’s breadwinner, are unable to manage their own finances. After the father dies, they encourage their mother to appoint a financial power of attorney, often a son.

Children with ‘Early Inheritance Syndrome’ make assumptions that devalue the rights of older women.

  1. “Mum doesn’t need money, and it’s going to be mine anyway.”

In cases of financial elder abuse, this is the most common justification given for taking a mother’s money whilst she is alive.

  1. “Mum finds talking about her finances stressful.”

Some children believe that their mother finds discussions about financial issues complex and stressful. This is not only patronising but it also disempowers older women to make choices about how their money is spent.

  1. “Having a large amount of money does not improve Mum’s quality of life.

Most of us take comfort in the security of having savings in the bank. Why are older women different?

  1. “Mum will be no worse off after gifting her money to her children”.

This statement is absurd. By gifting money to their children, the children are better off at the expense of their mother. The less money an elderly woman has, the less money she will be able to spend on herself. 

  1. “Reducing Mum’s income will reduce her fees at the aged care facility”.

Lower fees at the aged care facility means more money for the beneficiaries of the will (i.e. the children). However, many older women may appreciate the care that they receive in an aged care facility, and are happy to pay higher fees for receiving good care.

  1. “Reducing Mum’s income will reduce the amount of tax she needs to pay”

Gifting money to children will result in Mum paying less tax. This may be a good thing for the children, but certainly not for society.

  1. “Mum’s current will cannot be changed”.

Most people change their wills throughout their lives as their circumstances change. Why are older women different? Spending years in an aged care facility may change an older woman’s ideas about how the money is distributed after she dies. She may prefer to give some money to Doctors without Borders, The Lost Dogs Home, or even a kind nurse at the aged care facility. This is her decision, not her children’s.

  1. “By gifting money to the children, this gift reduces their children’s loans and interest payments on these loans.” 

Should middle-age professional people expect their elderly mother to assist them to manage their ‘lifestyle choices’?

Financial elder abuse may begin with the best intentions – with an elderly woman asking a child to act as her financial power of attorney. This can quickly progress to a sense of entitlement, particularly when adult children have mortgages or debts.

There is little reliable data on the extent of financial elder abuse. It is often a silent crime – unreported and unacknowledged. Although the banking industry has introduced initiatives to help prevent this silent crime, financial elder abuse remains difficult to police.

Published in Online Opinion

Good bloke or smug thug

The Human Rights Commission’s report The Forgotten Children: National Inquiry into Children in Immigration Detention was tabled in parliament two months ago. The 315-page report provided compelling first-hand evidence of the negative impact that prolonged immigration detention has on children’s mental and physical health. The report also made 16 recommendations.

Since the report was tabled, there has been no substantive discussion in parliament about the report or its recommendations. Our Prime Minister has used all-too-common techniques to stifle debate – attack, shoot the messenger and then ignore the message. These silencing techniques have been effective – they have taken the focus away from an important issue that reflects on Australia’s standing in the world community: children in detention and our obligations under international law.

Tony Abbott’s aggressive behaviour towards the President of the Australian Human Rights Commission, Professor Gillian Triggs, has been named for what it was: bullying.  No doubt, like me, other women have experienced this type of silencing behaviour. In response, Gillian Triggs remained composed and dignified. She is a role model for all of us at the receiving end of such attacks in both public and domestic places.

When Tony Abbott was accused of bullying Gillian Triggs, several colleagues defended him. They described him as a “good bloke”. I don’t know Tony Abbott but I know Tony Abbott Types (TATs). TATs are often described as “good blokes”.  They are men who attended an exclusive private boys’ school. After school, they studied at a sandstone university, lived at an exclusive college and did the ‘right’ courses – law, commerce and medicine. Although many men get over their privileged upbringing, TATs do not.

TATs are men whose sheltered lives as white, private school-educated, professional heterosexuals make them blind to their privilege. They form a network by surrounding themselves with others who share their worldview. They have a toxic sense of entitlement and often say that feminism has “gone too far”.

The upper end of town is filled with TATs. These men huddle together at exclusive clubs where their networking sustains their network. When they attend social functions, they often reminisce about their school and university days – a cricket game or a rowing regatta. The old school tie matters at the MCG’s Long Room.

They do not respond respectfully to alternate views. Instead, they react aggressively. They see disagreement as combat they must win. They either attack people who disagree with them, or ignore them. Either way, they ruthlessly shut down dissent. TATs perceive those who disagree with them as enemies who must be silenced.

They use a range of tactics to quell opposition. They will interrupt, talk loudly and mock. They jeer and insult. They blame others. Recently our Prime Minister described the Opposition Leader as an “arsonist” and “the Dr Goebbels of economic policy”. They dismiss alternate views by describing them as “offensive” and “ridiculous”. All these tactics are used to avoid negotiation and compromise.

They shoot the messenger rather than listen to the message. Personal attacks are common not only in parliament but also in the Australian media. In The Australian’s ‘Cut and Paste’ section and The Saturday Paper’s ‘Gadfly’, ‘argumentum ad hominem’ replaces reasoned arguments.

TATs do not substantiate their views. They don’t need to because they know they are right. They use rhetoric, slogans and dog whistles rather than evidence to support their views. The proposed government-funded ‘stop the boats’ telemovie has been described as “propaganda”. How can propaganda further informed debate?

If the evidence does not fit with their worldview, they will simply ignore the evidence. Statements such as “climate change is crap” and “coal is good for humanity” deny decades of academic research.

TATs do not apologise when they offend others – perhaps because they do not have the insight to know how offensive they can be. Scott Morrison refused to apologise to the Save the Children staff for besmirching their reputations. Instead, he brazenly attempted to justify his actions.

They are also vindictive. Cross a TAT and you will be punished.  Soon after the recent failed spill motion, an outspoken supporter of Tony Abbott, Scott Buchholz, replaced Philip Ruddock as party whip. Philip Ruddock went quietly. Not so Gillian Triggs. Professor Triggs refused to resign. She continues to speak about the plight of children in detention.

I call on all of us who are victims or witnesses of bullying to similarly take a firm stand. The next time our views are attacked, dismissed or ridiculed, we should stay put and stay on message.

A TAT recently told me to “shut up” before abruptly leaving the room and slamming the door. He told me that my views are “offensive”. When I later received a hurtful email, I was told that the email was “only factual and honest”.

The next time I am on the receiving end of a TAT attack, I will ask him to “settle down”. When he responds aggressively to my views, I will substantiate my views. If he treats me dismissively, or attributes malicious motives, I will name his behaviour for what it is: a technique to negate my views.

Now that the tantrum towards Gillian Triggs has passed, it is time for our government to provide a substantive response to the Human Rights Commission’s report and its recommendations.  If the issue of children in detention and Australia’s obligations under international law continue to be ignored, it will be at our peril.

Elderly women deserve their age of respect

Something remarkable is afoot. The Victorian Chief Commissioner of Police, Ken Lay, and the Chief of the Australian Army, Lieutenant General David Morrison, are talking publicly about male attitudes towards women. On the Victorian Police website, Ken Lay suggests that “our culture is filled with men who hold an indecent sense of entitlement towards women”.

Ken Lay and David Morrison are both middle-aged men in charge of organisations with masculine cultures. They are not your typical feminists. Although many men treat women respectfully, these men go one step further by viewing social issues through ‘gender goggles’. It is a giant step.

Gender goggles are illuminating. They bring into clear focus the fact that a person’s gender influences attitudes and behaviours towards them. Gender goggles highlight issues for women such as discrimination, human rights abuses, domestic violence, rape, glass ceilings, inadequate childcare, political underrepresentation, catcalling, bullying and financial disadvantage such as unfair pay and unequal superannuation.

Unlike rose coloured glasses and beer goggles that provide optimistic perceptions, gender goggles are not a frivolous fashion accessory. Ken Lay’s gender goggles enable him to see that some people perceive women as “less valuable than men”. This perception applies to women of all ages, including older women.

When gender goggles are applied to older women, particularly women who have not been the family’s breadwinner, they may show the humiliation of financial elder abuse. Studies confirm that financial abuse is the most common, and fastest-growing, type of abuse of older women.

Research shows that women over the age of 80 are most at risk of financial elder abuse. This research found that adult sons are the most common perpetrators. Some adult sons assume that money that was once ‘Mum and Dad’s money’ is now their money, even though their mothers are alive and well. They make assumptions that devalue the rights of their mothers.

There have been several high profile trust fund disputes in which sons have sued their mothers. A former pupil of a private boys school in Sydney sued his mother after the family estate was left to his mother rather than to him. This ‘old boy’ was castigated by Justice Michael Pembroke for having a ”highly developed and unhealthy sense of entitlement”.

According to the Office of the Public Advocate, older women are more likely to be declared legally incapable than older men. This may be due to the fact that women live longer than men. It may also suggest that older men are revered whilst older women are infantilised. This was certainly the case in Julie’s family.

Julie is a middle-aged woman with five older brothers. With unseemly haste, a few days after her father’s death, a GP was asked to declare Julie’s elderly mother legally incapable. That she was bewildered, grieving and in the first weeks of widowhood after 50 years of marriage did not seem to have been taken into account.

After Julie’s mother was declared legally incapable, the youngest son became her financial power of attorney. Tony’s job was to manage his mother’s estate in her best interest. Determining what was in his mother’s best interest was contested. Was it in their mother’s best interest to keep money in the bank and continue to pay tax? Or should the children receive an early inheritance? Questions such as these divided Julie’s siblings.

The eldest son, Christopher, organised frequent financial family planning meetings. Christopher was planning his own retirement and unashamedly cast his eyes towards the Bank of Mum rather than towards his own financial planning. Julie questioned why these meetings were not convened prior to her father’s death, particularly when their father’s cognitive status was diminishing. Her question fell on deaf ears.

Tony prepared a financial spreadsheet describing ‘Mum’s assets’, sharing this spreadsheet amongst his siblings. Would a financial spreadsheet with “Dad’s assets” have been shared in the same way if their mother had died first? Of course not.

Then came the zinger. Julie was told that her mother’s monthly expenses were excessive. Julie’s sister-in-law explained to her: “Your brothers are worried about their inheritance. What’s wrong with that?” Gob-smacking stuff.

Julie went into full feminist flight to show her brothers, their wives and anyone else who would listen exactly what was wrong. She defended her mother’s right to spend her own money. Julie argued that their father would have wanted his wife to have as much lemon squash, cheddar cheese, milk chocolate and shortbread biscuits as she wants.

Two brothers supported her; the other three bunkered down, ensconced in their men’s club with others who share their views. These brothers refused to engage with Julie. They simply dismissed Julie’s views as offensive, describing her as mad and bad, as powerful men often do.

Julie’s gender goggles gave her clarity. On every issue, she asked her brothers a simple question: “Would you have treated our father like this?” However, her three older brothers had stopped listening years ago.

Perhaps Julie’s brothers will listen to The Victorian Chief Commissioner of Police and the Chief of the Australian Army talking about men’s sense of entitlement. Men with gender goggles may be easier on their ears.

Kathleen Brasher and Sarah Russell*

Published in The Age

(*Sarah was not named as an author because she did not want to embarrass her family)

 

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