Half of the medical students in the United States are women, as are two-thirds of the health-care workers taking care of patients in hospitals, clinics and residential communities.

And the majority of the nurses on the frontlines of the COVID-19 pandemic? Women.

Yet gender bias and workplace harassment continue to plague women who have dedicated their careers to taking care of others.

A classic example given by Michelle Mello in a Perspective published in this week’s New England Journal of Medicine goes like this: A female attending physician and a male resident respond to a call to the emergency department. The ED staff direct questions about medical decisions to the man, addressing the logistics to the woman.

“The resident looks awkwardly at the attending but says nothing,” Mello writes. “Gesturing at the attending, the patient says he hopes `the hot new nurse is going to be mine.’ Everyone ignores the comment.”

Sexual harassment and gender bias remain highly prevalent in medicine, ranging from the banal comments by the patient in the scenario above to aggressive misconduct that can damage female health professionals’ well-being, careers and quality of care.

Healthcare organizations have formal processes in place to respond to complaints of workplace discrimination, but these processes “are insufficient to transform cultures,” writes Mello, a professor of medicine with Stanford Health Policy and a professor of law with Stanford Law, and her co-author Reshma Jagsi, director of the Center for Bioethics and Social Sciences at the University of Michigan.

Health-care professionals of both genders must speak up.

“We believe health professionals have a moral duty to practice `upstanding’ — intervening as bystanders — in response to sexual harassment and general bias and that this obligation should be described in codes of medical professional ethics and supported within institutional training,” the authors write.

For example, the male resident in the above scenario should have stopped and said something like, “I’m the resident, she is the attending, so please ask her your medical questions and I’ll handle the logistics.” And any of the staff involved in the incident could have told the patient, “She is your physician. And you can’t speak to members of your care team like that. We can take better care of you without the distraction of offensive comments.”

While many medical professional societies now mention sexual harassment in their ethical codes, these guidelines fall short in that they do not encourage professionals to respond to the behaviors and intervene when they become aware of discrimination or harassment. The only large specialty society whose guidelines contain “aspirational advice” to stop sexual harassment in its tracks is the American Association of Orthopaedic Surgeons.

The American Medical Association (AMA) Code of Ethics Opinion 9.1.3 requires only that physicians “promote and adhere to strict sexual harassment policies in medical workplaces.” Mello and Jagsi note a striking contrast to the AMA’s approach to physicians who appear to be impaired (for example, due to substance use or mental health problems): Opinion 9.3.2. requires that physicians “intervene in a timely manner” to ensure that impaired colleagues stop practicing and get help.

“Absent stronger exhortation from within the profession, the norm will continue to be that clinicians are lauded when they stand up to harassment or bias but do not feel obligated — and they are not trained and equipped — to do so,” the authors write.

They recommend formal training in bystander intervention and peer-to-peer coaching, using tip sheets describing various courses of action, like this one adapted from Mary Rowe, an adjunct professor of negotiation and management at MIT Sloan.