The Field Guide › Paper
Siad and Rabi's viewpoint argues that harassment is endemic in medicine and that it operates as a cultural barrier to psychological safety, not a separate problem sitting alongside it. Their throughline is structural: the steep hierarchies and power gradients that define medical training and practice both enable harassment and suppress the safety to speak up, and the two feed each other. Where advancement depends almost entirely on those above you and status is scarce, people compete for the favour of the powerful and cannot afford to challenge them, so harassment goes unnamed and voice is chilled by the same gradient. The authors foreground gender inequality as a driver rather than a footnote: women face barriers to promotion, leadership and research opportunity while men disproportionately hold the senior, decision-making roles, and that asymmetry is the terrain on which both harassment and silence grow. For a corpus about psychological safety this is the healthcare-and-power instance of a point the map makes repeatedly, that psychological safety is not only an interpersonal climate to be cultivated but a product of structural hierarchy and equity, and that harassment is in a real sense what the absence of psychological safety looks like at the sharp end of a steep gradient. Its limits are those of the form: it is a short viewpoint in a cardiology journal, making its case by argument and illustration rather than new data, and its remedies are directional rather than tested. (Text drawn from the 2021 CJC Open viewpoint.)