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The controversial news that NYU Grossman School of Medicine of David Sabatini, PhD, shined a new light on sexual misconduct and harassment allegations in the workplace -- and the willingness of leaders to dismiss or overlook these behaviors. Some say Sabatini strategically maneuvered himself into the victim seat by denying the accusations, attacking the women he allegedly preyed upon, and reversing roles so he was seen as the sufferer. This narrative points to a specific harassment behavior called "DARVO."

First described in 1997, (deny, attack, and reverse victim and offender) may sound unfamiliar. Yet, many have witnessed or experienced it. Consider this vignette, which is a composite based on real accounts:

The patient was in cardiac arrest. When the resuscitation team paused to check for a pulse, the junior doctor pulled out the ultrasound probe to look for a heartbeat. Everyone knew that ultrasound visualizes the heart far better than fingers can feel the beat; however, the senior doctor screamed at the junior doctor. With his hands on her shoulders, he pushed her away from the bed. The incensed senior berated the junior for wasting time using "unproven technology." Everybody saw it, heard it, and knew that the clinical judgement of the junior doctor was sound and the senior doctor's behavior was not. Yet nobody said a word. The next day, the junior doctor reported the incident to human resources and administration. When the senior doctor found out, he denied the allegations and attacked the junior's medical knowledge and competency. He questioned her credibility and professionalism, and claimed that he himself was a victim of false accusations.

As illustrated, the senior doctor reframed himself as the victim. Instead of admitting error and apologizing or offering evidence that the junior doctor's accusations are false, the perpetrator responds with outrage that his power is being challenged and his character assailed. The modus operandi of perpetrators using DARVO is to deny the alleged actions and turn the attack on their victim, most often by undermining the victim's credibility. Then the perpetrator reverses roles, assuming that of the victim. The scenario represents the most common dyad -- a man using DARVO to denigrate and disempower a woman -- a situation all too common in the medical field.

DARVO Behavior Threatens Women Healthcare Workers and Patients

DARVO and harassment behaviors contribute to burnout and are a weighty factor in their careers in medicine. DARVO and harassment behaviors have downstream long term on victims, including of stress, anxiety, depression, strokes, diabetes, and heart attacks. Poor health compounded by toxic behaviors of aggression in the healthcare workplace encourage women to disengage, or worse, to leave. And studies show that when women leave, the benefits of the presence of women in medicine are lost. For example, patients have when treated by women internists as compared to men. Heart attack patients have when their emergency medicine doctor is a woman or the team is led by a woman. Furthermore, women are a necessary demographic in a workforce with dangerous shortages.

How DARVO Exists and Persists

The hierarchical structure of medicine perpetuates DARVO behavior. The perpetrators are often protected and promoted by the institution. This practice is also known as getting a "" card. For example, Yale University cardiologist received an endowed professorship despite his long and well-documented history of sexual harassment and misconduct. This protected his career while removing him from the setting of his bad behavior, thus passing the problem on to a new environment rather than addressing it.

Perpetrators use DARVO because it works. In researchers found that targets of DARVO were more likely to blame themselves. Self-blame is associated with self-silencing. In , researchers found that observers of DARVO tended to doubt the credibility of the true victim, believing the perpetrator instead.

There is not yet systematic data on what makes certain institutions and certain people more likely to DARVO. Yet, there appear to be relevant characteristics associated with other types of harassment, and the field of medicine checks all the boxes: high prestige, , hierarchical leadership structures, inadequate safeguards for employees and trainees, and a climate which harassment.

Resistance to Calling Out DARVO

People are motivated to trust workplaces and leaders; thus, they often remain . Betrayal blindness is a concept describing the tendency to stay attached to a person or institution on which one depends. Just as an abusive marriage can entrap a financially dependent partner, victims of workplace harassment and abuse find it difficult to confront the institution because of the high risks of personal repercussions or professional damage. Victims also will hesitate to come forward if they feel unsafe and if there's an institutional pattern of protecting perpetrators.

Stopping DARVO Behavior

The time is now to make workplaces safer for healthcare workers and patients. The time is now to stop DARVO behavior. We recommend these four solution-based actions for organizations and individuals:

Research, document, and share data

Organizations should have a mechanism for reporting and tracking DARVO behaviors. Encourage witnesses to document the chain of events. Perpetrators who resort to DARVO are successful because they deny their actions. Denial of accusations becomes more difficult when records and eye-witness accounts can be established and archived.

Listen, respect, and validate when an individual reports

Too often the individual with the courage to report an incident experiences dismissal or minimization -- types of , a form of manipulation where an individual is made to question their story or perceptions. So instead, listen, respect, and thank them for coming forward. Look for other examples of DARVO behavior, prior incidents, or other signs from the accused. Then take appropriate action to hold the perpetrator accountable.

Educate and remove ignorance

Talk about DARVO behaviors with your teams. Include education about DARVO in both new and ongoing employee and trainee education and in leadership development curricula. Education is a key step in identifying these behaviors, and then confidently addressing them in real time.

Disrupt and confront in the moment

Individuals can play an important role in disrupting DARVO before it begins. Recall the opening vignette: everyone in the room knew it was inappropriate behavior, yet no one said or did anything. Bystander paralysis is a psychological phenomenon that prevents people from acting as , who to support an individual being bullied or attacked. Being an upstander can be as simple as saying, "We don't do that here" or in the vignette, "Let's see what the echo shows." Disrupting in the moment calls out the offender's behavior, tells others where you stand, validates what others were perceiving, and gives observers the courage to voice their own concerns and to act similarly in the future.

DARVO behavior in the healthcare workplace is toxic to women and to patients. The culture of healthcare has historically protected men who DARVO and allowed them to thrive. Now is the time to educate, recognize, call out, and put a stop to DARVO behavior in healthcare.

is a professor of emergency medicine and radiology at Thomas Jefferson University. is an associate professor in the Johns Hopkins Carey Business School. is an assistant professor of internal medicine at the University of Illinois Chicago. is a professor of psychology in the Department of Leadership, Ethics, and Law at the U.S. Naval Academy. is an emeritus professor of psychology at the University of Oregon, and founder and president of the Center for Institutional Courage.

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