Here’s another subject I thought I’d touch on which the outside world would seldom have an insight into.
Bullying is rampant in the medical field, right from medical school, through to junior doctor hospital work, to specialty training to being a consultant. Why?
That’s what we’re here to explore.
Firstly, here are the phases of medical training in Australia:
Medical student –> Intern –> Resident Medical Officer (RMO) –> Registrar –> Fellow –> Consultant.
Let us now focus on some of the authorities who have an influence over virtually every doctor’s practice:
- Employer (e.g. medical practice, hospital, local health district etc, private company etc.)
- AHPRA (Australian Health Practitioner Regulation Agency)
- Medical Boards
- Specialty training colleges
- Department of Health (State and Federal)
- HCCC (Health Care Complaints Commission)
- Medical Indemnity/ Defence Organisations
- Professional associations
Each of the above entities has an organisation structure (or food chain) and separate complaint handling processes, policies and procedures.
Who can bully doctors?
- Other doctors (often those who are more senior or have been established longer)
- Other staff (e.g nurses, senior hospital administration, practice managers)
- Specialty training providers
- Regulatory bodies
- Patients and the public
Below, we’re going to focus on bullying by other doctors:
Some bullying strategies I’ve witnessed or experienced:
- From seniors:
- “Raise an issue, and I’ll make sure YOU are flagged as the issue”. The senior will immediately flag the junior to all senior staff, and possibly to governing or regulatory bodies. Management takes the side of those who are higher up the food chain (who act as a buffer for issues, and have a greater influence on their job stability)
- “I might break the rules, but still, do as I say and hush up..or else, I’ll make sure my examiner friends fail you, and/or will make sure you won’t be employable by telling my kangaroo club about you”
- “I don’t like you, so i’m going to”:
- Raise concerns about your performance and show how you lack competence or are a danger to the public. Subsequently, “monitor” you closely under the microscope, micromanage you, and put you on a performance review plan.
- Destroy your reputation amongst other staff e.g. if you’re taking over the shift, say something down the lines of “oooo, I’m not sure how things are going to go with him/her on…I’ll have to come back in the morning and make sure everyone’s safe”
- Overload you with work and responsibility to the point you know you can’t cope and will either voluntarily leave, or, will give management a reason to comment on your poor performance. Potentially report you to regulatory bodies, and recommend imposing restrictions and conditions on your registration.
- Humiliate you during meetings or in front of others by asking you questions you don’t know the answer to, or reminding you of cases that went bad under your care.
- Use feedback forms with a vengeance. I will be vindictive by providing negative feedback about you, knowing that these feedback forms will be visited in the future throughout your training, and can be used as evidence against you. This may impact on your career progression.
- Give a bad reference about you.
- Question you on every decision, and ask you to justify every action, regardless of how insignificant it appears.
- “I don’t know you but I’ll reverberate the negative comments others made about you because I don’t want to stand out”.
- Equals :
- Will make vexatious complaints about you to management to tarnish your reputation and get ahead
- Will badmouth you to other equals, so as to ensure you receive minimal support and cooperation.
- Complain about something that will attract media attention e.g. sexual harassment (no disrespect to genuine cases, but many are vexatious, aimed at destroying your career)
- Encourage patients to complain to management.
If senior bullies make a complaint about you, management often choose to conduct an urgent ambush meeting – this is poor form where they often give you last minute notice, do not reveal the meeting agenda, do not allow you to have a support person, and they make it clear once you’re in the room that it’s serious, that there is another person who will be taking the minutes of meeting. They do not give you an opportunity to prepare, but afford themselves the chance to brush up on everything they need to know about you, to direct the meeting towards their pre-set agenda. They will go through your entire career history, sifting through all your feedback, complaints, term assessments, and will bring to light anything negative. They will not provide you specifics, but would rather, just remind you that a number of “concerns” have been raised about you, and encourage you to ask yourself if you are the problem, or if you feel you should take responsibility. They are not often prepared for you to question them, which will often cause them to become aggravated and wishing to brush your concerns aside, so they wrap up the meeting – which usually goes back to their underlying agenda for the meeting – often to punish you in some way, whether it is recommending you take leave, seeking counselling, going on a performance management plan or a multi-source feedback survey, or withdrawing from the program or employment. Behind your back, they will notify other senior staff or organisations and flag you with them. They will never support you over their buffer zone, so don’t bother explaining your concerns about them. Whatever they put in writing about you will be there forever, regardless of how reasonable or untrue it is. They will use this information in future meetings or reviews to form a case or evidence against you, with no regards to your perspective on the individual negative feedback from the past.
As the victim, you may feel extremely isolated. You know very well that telling anyone about your problems may do more harm than good:
- There is no such thing as confidentiality amongst medical staff or in the medical field. Once you have opened your mouth, your words are no longer a secret, and may be used against you.
- Telling colleagues may mean that you are damaging your own reputation. Your colleagues may fear retribution merely by associating with you. People talk! Can you imagine…if, as a male doctor, you told a colleague that a nurse made a false allegation that you sexually harassed her..what sort of impression is that going to leave about you? You are guilty until proven innocent. If word reaches the wrong people, and you have more such frivolous accusations against you, guess who’s career will be ending?
- You may be encouraged to speak to your boss or training coordinators of your difficulties. Now just stop and think for a while. At the end of the day, as part of the complaint handling procedure, they’re really just there to tick the boxes and cover themselves. They are going to conduct a mediation process – hear both sides of the story, ask the parties involved to shake hands, then document it and file it away. Tick. Notify all relevant parties (e.g. training organisation, junior medical staff unit, medical board, AHPRA etc.). Tick. Recommend you get counselling. Tick. Now..as for loyalty aspect – are they going to take your side, or the side of someone who has been there longer or will be there longer? Or is more useful? e.g. nurses looking after your ward full of patients may be considered more important to have better long standing relations with than a transient intern or registrar in training. Your training’s Director will need the support of their subordinates to act as a buffer and to support their position of power. They will need the support of training facilities in order to be a viable training institute. What I am trying to say is, as a trainee, you are at the bottom of the food chain. If you are the domestic cat complaining about the leopard to the lion, the lion and the leopard will gang up and the two of them will destroy you. As opposed to just the leopard alone trying to destroy you and running out of steam. If you raise an issue, they will make sure that you become the issue.
- If you lose faith and decide to report your case externally (e.g. to the Department of Health, the media etc.), you will be marked as the whistleblower. You will be seen as the troublemaker who can’t accept responsibility for their own actions and puts the blame on others. People who respond by boycotting you. The longer you remain unemployed, the tougher the questions will get for you and the more difficult it becomes for other health staff or the public to have faith in you. There goes your career.
Sure the above possibilities may paint a very pessimistic view for the victim. But that’s my job. I’m not here to highlight the few cases where issues are successfully handled, everyone shakes hands, gives each other flashing feedback and they all live happily ever after. I’m here to raise an awareness of the unspoken reality that doctors suffer.
Complaints should be handled with the hope of reaching an understanding for all parties, and not be used as vindictive weapons. Feedback should be constructive, so that a doctor can appreciate their strengths and weaknesses. Feedback should not used to inflict punitive damages on doctors down the track. Doctors should not be inhibited from speaking out about their pain and suffering for fear of retribution or a lack of confidence in complaint handling by management.
There is no need for the field to foster such rampant bullying. Doctors have one of the highest suicide rates. Bullying is not only a risk to doctors, but their patients too. Enough is enough!