DISCLOSURE by Michael Crichton, Alfred A Knopf, Inc, 1993, Ballantine Books Edition, 497 pages, October 1994. Random House, AudioTape, four tapes.

Review by Del Meyer, MD

Michael Crichton, who received his MD from Harvard, treats the subject of sexual harassment in this number one best seller which has now been on the movie screens for over a month. Although only 20% of harassment claims are by men, Dr. Crichton felt he had to use this "reverse" scenario to more objectively treat the sensitive but controversial issues involved. Crichton essentially takes a common situation, shuffles a couple of the factors to force the reader to view the scene anew, and then allows the universal truths to rise from the well-crafted story, including a strategic Freudian slip.

Crichton takes us on a high tech ride from DigiCom in Seattle to their Malaysian production line in Kuala Lumpur where the new Twinkle drive, the worlds fastest CD ROM drive, is having unexplained problems. This is critical since an important merger with Conley-White, a publishing conglomerate in New York, is in the final stages. Tom Sanders, the division manager for 12 years in Seattle, is planning on becoming rich with the spinoff of the Applied Products Division after the merger is consummated.

Garvin, the CEO, brings in Meredith Johnson, an old flame of Tom Sanders as his boss. Johnson invites Sanders to come to her office after work for a glass of wine "for old time's sake." As she pours the Pahlmeyer Chardonnay (which turns out to be unavailable within 50 miles of Seattle, and thus had to have been brought in with her from Cupertino) she sits on her desk in a provocative manner, and then attempts to seduce him on her office couch. Sanders tries to explain that he is now married and has two children. "Things have changed," he tells her. "You're my boss now." Meredith unzips his fly and continues. Sanders resistance diminishes. When she copulates him orally, he changes from resistance to being proactive and begins to remove her lingerie, noting that she had already removed her pantyhose since the business meeting a few hours earlier. Just before intromission, Meredith coughs, which brings Sanders to his senses realizing that this is not passion, (Crichton is forever the physiologist) but a calculated job. He gets up, zips up, buckles up, flips up his motorola, and strides out. The vitriolic language that Meredith unleashes as Sanders leaves Meredith's office causes the cleaning lady to look aghast.

The next morning Sanders is greeted stiffly by his secretary Cindy and doesn't understand what's going on until the in-house attorney offers him a lateral transfer in order to get him out of a sexual harassment claim. Sanders states that it was he who was sexually harassed, not Meredith. He becomes the target of hatred in the division as all of his trustworthy coworkers are called into Garvin's office to be reminded of their financial stake in the pending merger which is being subverted by Sanders NOT admitting to his attempted sexual conquest and NOT taking the assignment in Texas. Sanders gets advice on his E-Mail but he is unable to respond since his access code has been deleted. He tries to retrieve his office files, only to find them gone. It is through his legal counsel, Louise Fernandez, Esq, that one of Crichton's main messages is sounded: sexual harassment is primarily about power, not sex. The book explores the power struggle between Meredith and Tom, but it is an undisclosed "A Friend" on E-mail who encourages Sanders to "solve the problem."

Fernandez stated that the problem of sexual harassment would play itself out as women obtain equal employment which she defines as half of all positions. However, she also points out that women in high positions use sexual harassment in about the same ratio as men. As currently interpreted, a woman can say "no" anytime up to the event and the man has to stop. In one hearing, Johnson admits that Sanders did say "no" to her advances, but men can't stop at any moment like women can. In a man saying "no" is a hostile act, she concludes. Since a turgid phallus has no morals, a man, if he's in a compromising position, even if requested to attend an after-hours meeting with a female boss, will be assumed to be guilty whether he does or whether he doesn't. And the employer may also have to pay. Have you noticed the marked decrease in holiday office parties?

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The tape of this book gives a good account of the book in four hours what takes all day to read if you read 12-15,000 words per hour. John Lithgow (Tony award for The Changing Room on broadway and an Oscar for Terms of Endearment) does an excellent job of vocalizing the different characters. The dialogue on tape actually brings out the important issues, whereas the restraints of the movie version, with Michael Douglas and Demi Moore, leaves some latitude for improvement. The book, tape, and movie all give a convincing look at the inside of a high-tech company; the virtual reality sequence is particularly state-of-the-art. Michael Douglas does portray fear and stepping up to the plate well.

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That sexual harassment has little to do with sex and more to do with power is not unlike what authors in this journal (Kime; Waite; Nov 94, Galie, Jan 95) have pointed out that physician review has little to do with quality of care and is mostly an economic or power issue. The medical board in their expose' of doctors in the Sacramento Bee stated that over 95% of physicians are practicing good medicine. That would suggest that there is less need for physician quality review than in any other profession. The Medical Board of California admits that they targeted the chief of SPN for a sting operation. It cost this prominent physician over $40,000 to defend himself. As this physician was being treated like a drug dealer or legislator, did the rest of us, as Kime stated, act "like gazelles grazing peacefully across the plain unconcerned about the intense life-and-death struggle going on about us?"

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The book, tape, and the film are all worthwhile vehicles to cause us to think about how power can be abused. We need to understand this since a new law in January 1995 brings sexual harassment into the consultation room in addition to the work place. As physicians, who must do a detailed examination of the sex organs of the opposite sex, we will now have one set of attorneys that will be looking over our shoulders to see if we do a detailed enough examination and another set of attorneys who will be looking over our shoulder to make sure we don't look too much. The BEE article mentioned above noted a large malpractice award of $1.1 million for not detecting cancer in a sex organ soon enough. Another physician notes that the MBC investigated him for raising the left breast longer than it would take to listen to the mitral valve and so was probably looking at a mammoplasty scar. We could conceivably have a law suit on our hands by both sets of attorneys in the same patient by looking too long or examining too much and still missing or delaying the diagnosis too long. Did we point out to the legislators that the net effect of that law was to decrease appropriate patient care? Doesn't that also amount to physician harassment? Shouldn't organized medicine get attorneys further removed from our practice instead of more involved? Yes we do have the issues to unite all doctors in private practice, whether in solo practice, Permanente, MedClinic, or other large groups. Let's use the E-mail message that Sanders got when he was down and out, "Solve the Problem."

Del Meyer, MD
delmeyer@healthcarecom.net