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INCIDENT REPORT A Joke as Cover for Sexism and Violence The response below was written by Elizabeth Miller, HMS instructor in pediatrics and in social medicine at Massachusetts General Hospital. Incident as reported by a student: I was the only woman on the medical team. Everyone knows how important it is for a team to "bond," often through a shared sense of humor. Unfortunately, I found this humor frequently involved oohing and aahing at attractive nurses. These jokes made me feel alienated from my team, especially when one intern jokingly commented that he wanted to take one nurse into the back room and "slap her around some." Response: Gender-based discrimination pervades the practice of medicine in insidious ways. It is insidious because on the surface, dramatic changes have occurred for women in medicine. Twenty years ago, women made up less than a third of incoming students; HMS had no formal sexual harassment policy; women's health as an area for research and practice was barely recognized; and only a small proportion of senior faculty were women. While times have changed, our students continue to report multiple examples of sexism. Humor is a characteristic way of reproducing relationships of power, and because it is "a joke," calling attention to its inappropriateness often further alienates. In this incident, the student struggles to be part of the medical team. The joking leaves her out and marks her as inconsequential, as if she were not even there. The presentation of nurses as sexual objects continues to perpetuate the power and gender differentials between doctors and nurses. Despite changing demographics in medicine with greater diversity among nurses as well as physicians, these relationships of power persist. Respect for nurses and other care providers is a first step toward creating the teamwork necessary to deliver the highest quality care to all of our patients. Finally, this joking normalizes sexual violence. Confronting sexual violence with the care and thoughtfulness that our patients hope to receive from us remains a grave challenge for medicine, when as professionals, some do not even take such violence seriously. Jokes are meant to be funny; this one is not.