Ronan Farrow’s most recent article alleging decades of sexual assault by an extremely powerful Hollywood man feels less than shocking in this #MeToo era. The well-researched chronology of patterned harassment and abuse, the second one on CBS’ Les Moonves, resulted in the CEO losing his job.

Embedded in the allegations against Moonves was a smaller yet illustrative story. Shortly after Farrow’s expose was printed, a Vanity Fair piece connected Moonves to a May 2018 article from the Annals of Internal Medicine. In that piece, Dr. Anne L. Peters, now a professor of medicine at the University of Southern California, reflected on her #MeToo experiences, first with an anonymous patient and then with a colleague at a conference. Moonves, it turns out, was the anonymous patient that she described here:

I am a bit different from the others who have come forward in the #MeToo movement because, as a physician, I am legally unable to name the patient who harassed me. It happened many years ago in an examination room where I’d been asked to see a VIP patient early in the morning before regular business hours. … He grabbed me as I stepped forward. He pulled himself against me and tried to force himself on me. He did this twice; when I rebuffed him, he stood beside the examination table and satisfied himself.

Somehow it still needs to be said: Sexual harassment is not about sex. It is about power.

Moonves has confirmed being a patient of Dr. Peters, and he admits to attempting to kiss her, though he denies the other allegations in the article. Dr. Peters also notes that she reported the incident to the administration at the hospital system she worked for at the time, UCLA. Specifically, she hoped that “a note [would be] placed in his chart warning other women never to be alone with him.” She claims that when she reported it, the person she spoke with warned against bringing the incident forward because “the patient had ‘more money for lawyers’ ” than did UCLA and cautioned her to “refrain” from reporting to the police “because I would lose in court.”

The allegation of a patient sexually harassing his doctor seemed shocking to many, but as women in medicine, we were not surprised. A recent National Academies of Science, Engineering, and Medicine report on women working in academic sciences found that sexual harassment is common across scientific fields. Across the STEM fields, harassment of women is most prevalent in medicine, where harassers may be not just colleagues, supervisors, and staff but also patients. As many as 50 percent of female medical students report experiencing sexual harassment. Our recent New England Journal of Medicine article describes the culture of harassment in medicine and the long-term implications for the profession. It does not address the question raised by this particular Moonves anecdote: How can doctors respond when the perpetrator is also the patient?

Somehow it still needs to be said: Sexual harassment is not about sex. It is about power—specifically, the power the harasser exerts over the victim. Environments in which individuals have unequal power are fertile ground for harassment, sexual or otherwise. To be a technical expert with authority and decision-making power over a patient’s physical and, at times, mental condition is a formidable responsibility, and one that nearly every physician appreciates and honors. But some don’t; as we saw in the Larry Nassar case at Michigan State University, some physicians can unfortunately and disturbingly abuse that power.

From the first day of medical school, we are taught to respect and manage the asymmetrical power balance between physicians and patients. Patients come to us hurt and vulnerable. For some, it is the worst day of their lives. It is our job to listen, diagnose, treat, and care for them. If a patient is noncompliant, one of our first instincts is to reflect back on ourselves and ask questions like, “Could I have communicated those instructions better?” In the end, we often feel fundamentally responsible for our interactions with patients, for their health outcomes, for their ability to be healed.

But this is not to say that all physicians, especially all female physicians, receive an automatic presumption of authority. Gender-based bias affects females in medicine at all levels of training and often undermines their ability to be authoritative with their patients, colleagues, or staff. This lack of respect is more prevalent for female physicians of color, who are afforded neither the protection of gender (like male physicians of color) nor that of race (like white female physicians).

A patient engaging in sexually inappropriate behavior toward a physician distorts the structure of power and authority that is an essential component of this relationship. This baffling inversion of power often changes how the person who is harassed understands the experience. Does the physician blame herself? How and why did it happen? For many female physicians, there is no context or common vernacular to describe the effects of a patient sexualizing a medical encounter. In a culture where victims of assault or harassment are often second-guessed for their language, their dress, or their actions, is it any wonder that female physicians’ first instinct would be to doubt themselves? And, in a profession in which physicians are assumed to be in control, how do we admit—to anyone—that the clinical situation devolved and the patient crossed a line?

A 1993 study in the New England Journal of Medicine demonstrated that 77 percent of female physicians had experienced sexual harassment by a patient in their careers, with frequency ranging from less than once a year to more than once a month. As expected, emergency departments had the highest incidence, with grabbing, fondling, requests for genital exams, and breast touching being the most common complaints. Nineteen percent of women who experienced harassment told no one, while 53 percent told a female colleague only, and more than half continued to care for the patient after the incident. Lastly, a recent survey conducted by Medscape found that 40 percent of physicians (and 70 percent of nurses) reported they had been sexually harassed by a patient.

Given that now over half of matriculating medical students are female, to imagine that half will face some form of harassment in their practice can be a bit overwhelming. How should we respond? Do we commence medical student orientation with noble words about the Hippocratic oath, the sacrifices of years for technical training, the solemnity of the white coat, only to follow with the disclaimer, “Beware, many of you will be harassed, threatened, and paid significantly less than your male colleagues, but welcome to the halls of medicine”?

In most health care organizations and academic medical centers, there are safety officers and reporting mechanisms. There are guidelines and policies, though few describe what to do in this particular circumstance. Those who experience it describe a sense of isolation and even self-blame. Many feel resigned to a system that asserts, and at times champions, the idea that “it’s just part of the job.” But we, and our institutions, would be wise to improve the care offered to all victims of sexual harassment, including those holding the stethoscope. They need our trust, advocacy, and transparency in a reporting structure and a zero tolerance policy—in reality and not just on paper, because in medicine, as in the rest of the world, time is up.