She was everything one could ask for in a medical resident. During the few weeks she had been shadowing in my office, I found her fund of knowledge to be exceptional. Her intuition was right more times than not. And she negotiated the fine line between detached clinician and caring advocate. My patients loved her.

Did I forget to mention that she was exceptionally attractive? I hope so. I really feel that such things have little relevance in medical training (or life in general). Sure, I could tell that she was careful about how she presented herself. She dressed over-conservatively in an attempt to deflect attention from her looks. I occasionally noticed a prolonged stare by a young patient or a twinkle in an elderly gentleman’s eye, but for the most part everything ran smoothly.

That is, until Roger, a 70-year-old veteran, came in for his quarterly visit. A long-time smoker, his voice was gruff and gravelly. He was usually curmudgeonly but polite. He had no qualms about deviating from the Queen’s English from time to time, but usually in a harmless and endearing manner.

On this particular visit, I noticed the change in his stature the minute I walked in with the resident. He quickly straightened his shoulders and puffed out his chest.  He greeted us with a large broad grin unlike anything I had ever seen on him before. Over the next few minutes, he succeeded in turning every statement into a sexual innuendo pointed directly at the poor resident standing beside me. To her credit, she held her ground without a flinch.

I tried to minimize his comments as effectively as possible, juggling our long-term relationship and his history of cerebrovascular disease that occasionally affected his behavior. Eventually, though, one of his comments clearly crossed the line. My embarrassment and overriding wish to protect the young doctor in training strengthened my resolve as I spoke.

“You can either stop, or get out of my exam room!”

The force of my voice surprised all 3 of us. We finished the rest of the visit uneventfully, and the resident and I returned to my office for a debriefing. I apologized profusely even though I had little control over my patient’s actions. In retrospect, I could have spoken up more quickly, but there is a fine line between tolerating a patient’s foibles (and pathology) and scolding them for being someone with whom you don’t agree.

Years later, I have learned from my female colleagues that such behavior is fairly common. We all face countless barriers in the exam room. Females, it turns out, have yet one more to overcome when dealing with male patients. 

This is both unfair and unfortunate.