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Guest Post: Bullying in Medicine

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Written by Christopher Chew

Monash University

Today, the Royal Australasian College of Surgeons (RACS), the peak representative organization for the surgical profession in Australia, released the results of the Expert Advisory Group convened to investigate allegations of bullying, harassment, and sexual assault earlier this year.

Shockingly, of nearly half its members  who responded to a survey, including trainees and full members (fellows), a full 49 percent reported that they had been subjected to bullying, discrimination, or sexual harassment. The burden fell disproportionately on junior, female, and minority surgeons, with senior surgeons and consultants being reported as the main source of these issues.

As a graduating medical student and soon-to-be junior doctor, these – and other recent scandals  and revelations about both surgeons and the medical profession at large – fill me with a particularly personal apprehension for my future career.

My very first clinical placement in 2012 was at the Neurosurgery unit at Monash Medical Centre in Melbourne, Australia. It was here in 2006 that Dr. Caroline Tan alleges her senior supervising surgeon, Dr. Chris Xenos, sexually assaulted her, leading to her successful lawsuit and the subsequent comments that lifted the lid on this particular Pandora’s box. It was also here that Dr. Imogen Ibbett, the surgical registrar during my placement, alleges she experienced concerted bullying and mistreatment by another senior surgeon, Dr. Helen Maroulis during 2011-2013, as recounted during a scathing expose by the ABC, Australia’s national broadcaster.

I have not been, fortunately, the subject of anything that even remotely approaches the extreme conduct that has made headlines recently, and this would seem to be true of most of my peers. Yet each and every student sees their initial boundless enthusiasm withered around the edges by challenging experiences, to be replaced with a mixed bag of trepidation and resignation. Practices such as aggressive and relentless quizzing, teaching by humiliation, disproportionate verbal abuse, continual put-down, or even simply being ignored all take their toll. And this rumbling baseline of casual bullying continues and even worsens, my seniors have warned me, as a junior doctor, up and down the medical hierarchy, and across all occupations in public hospitals.

How is it that doctors, those empathetic caregivers, those respected healers, can at the same time behave so horrendously towards fellow professionals and other medical staff? Much ink has been spilled in the last few months identifying and dissecting contributing factors. An entrenched hierarchal power structure, poor mechanisms for complaints and redress, career progression dependent on senior staff and ‘tough love’ or ‘trial by fire’ traditions are among the many.

Yet rarely mentioned has been the very environment and nature of the job at hand. Medicine in the public hospital system, where most doctors and almost all trainees work, is largely under-resourced and overburdened, more badly in some places than others. Night shifts, sleep deprivation, emergency calls and skipped meals are the norm, rather than the exception, at least until the prized goal of seniority is achieved. More than a pale facsimile of a work-life balance, though emphasised throughout medical school, becomes all but unachievable for many who choose to specialise and remain in the hospital system. Add to all this, of course, the ever-present knowledge that any mistakes are not simply embarrassing, but potentially deadly, and you have a volatile cocktail for frustration and hostility.

Much of the more prevalent sorts of bullying, hostility, and general nastiness that is often present in public hospitals is the result of work pressures and frustration. The intern who attempts to transfer a patient to another ward, only to be shouted down and berated at length by a harried registrar who already has far too many sick persons under his care. The exhausted registrar coming off a consecutive week of night shifts who snaps at the medical student for wasting his time by asking too many questions. Indeed, Dr. Helen Maroulis, the senior surgeon accused by Dr. Imogen Ibbett of bullying and abuse, has herself filed a lawsuit against the healthcare network, alleging that she was overworked without compensation and passed over for promotion solely because of her gender. In such cases, both parties are the victim, seniority notwithstanding, and both see the other as the unprovoked aggressor.

Of course, the serious conduct currently making headlines – sexual assault, racial discrimination, physical – requires other, complex personality issues in their perpetrators. Yet it should be said that while some take genuine pleasure in exerting power or abusing others, these are in the vast minority, and some of the standard measures proposed should be of some help – a ramping up of zero-tolerance anti-bullying policies; external accountability for assessment and career progression; and more responsive systems for complaint handling and redress.

But these are less likely to be effective in curbing the far more pervasive undercurrent of more low-level conflict and bullying.  The David Geffen School of Medicine at the University of California, for example, instituted wide-ranging reforms in 1995 in an effort to combat abuse of medical students. In thirteen years, however, only a disappointingly slight drop in abuse was reported. When both sides are frustrated, angry, and see themselves as the wronged, it is difficult to sort the bully from the bullied, and policies that aim to label persons as such can be divisive and counterproductive.

What, then, should be done? In recent years there have been concerted efforts to eradicate inhumane shifts (previously up to a hundred consecutive hours), dangerous staff-to-patient ratios, and unsupervised junior doctors.  Yet doctors continue to report below-average mental health, higher suicide rates than any other profession, and sky-high rates of burnout, signs that perhaps more improvements are still needed.

More than this, however, perhaps what the profession requires is an image change. Doctors are humans, after all – flawed, conflicted, and with the same basic needs, no matter what some patients or indeed doctors themselves need to think. By facing these imperfections, adjusting expectations accordingly, and working to cultivate towards other medical professionals the same sense of empathy and tolerance accorded to patients, hopefully we can begin to take steps towards tacking the spectre of bullying and conflict in medicine. Although the current scandal has wrought significant damage to the reputation of the medical profession, perhaps by peeling away the oft-impenetrable façade it gives us the chance to re-examine ourselves and the way we practice medicine.


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2 Comment on this post

  1. What it seems is that an overhaul to the entire medical system is in order . In consent doctors are humans and should be expected to be as such . An average of 35-40 patients daily a GP alone sees . Its hard to personalise each appointment to cater everyone that enters with an issue .

    Something that doctors can use to as rails to follow such as a check list or revamped system to accommodate their needs too . I seriously believe us future to be doctors must be also the future of our predecessors no matter how emotionally disconnected we may be . By following simple but effective check list that has been exhausive in it’s implementations and implications in as many accounted scenarios doctors can relieve themselves of overthinking about the drama and do what they signed up for ; that’s heeling the injured both emotionally and physically with their own sanity intact .

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