Bullying in medicine: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
reformatted refs and stripped before running citation bot
Line 2: Line 2:
[[Bullying]] in the [[medical profession]] is common, particularly of student or trainee doctors. It is thought that this is at least in part an outcome of conservative traditional [[Hierarchical organization|hierarchical structures]] and [[teaching methods]] in the medical profession which may result in a bullying cycle.
[[Bullying]] in the [[medical profession]] is common, particularly of student or trainee doctors. It is thought that this is at least in part an outcome of conservative traditional [[Hierarchical organization|hierarchical structures]] and [[teaching methods]] in the medical profession which may result in a bullying cycle.


According to [[Tim Field|Field]], bullies are attracted to the caring professions, such as medicine, by the opportunities to exercise power over [[Vulnerability|vulnerable]] clients and over vulnerable employees.<ref name=Field>Field T [http://www.bmj.com/content/324/7340/786.2.extract Bullying in medicine: Those who can, do; those who can't, bully - BMJ: British Medical Journal, 2002 324, 786]</ref>
According to [[Tim Field|Field]], bullies are attracted to the caring professions, such as medicine, by the opportunities to exercise power over [[Vulnerability|vulnerable]] clients and over vulnerable employees.<ref name=Field>{{cite journal |doi=10.1136/bmj.324.7340.786/a}}</ref>


==Impact==
==Impact==
Bullying can significantly decrease [[job satisfaction]] and increase job-induced stress; it also leads to low [[self confidence]], [[depression]], [[anxiety]] and a desire to leave employment.<ref name=Field/><ref>Bjoerkqvist K (2001) Social defeat as a stressor in humans. Physiology and Behaviour, 73, 435 -442</ref><ref>Quine L (2001) Workplace bullying in nurses. Journal of Health Psychology, 6, 73-84</ref> Bullying contributes to high rates of [[Turnover (employment)|staff turnover]], high rates of sickness absence, impaired performance, lower [[productivity]], poor [[team spirit]] and loss of trained staff.<ref name=Field/> This has implications for the [[recruitment]] and retention of medical staff.
Bullying can significantly decrease [[job satisfaction]] and increase job-induced stress; it also leads to low [[self confidence]], [[depression]], [[anxiety]] and a desire to leave employment.<ref name=Field/><ref>{{cite journal |pages=435-42 |doi=10.1016/S0031-9384(01)00490-5}}</ref> Bullying contributes to high rates of [[Turnover (employment)|staff turnover]], high rates of sickness absence, impaired performance, lower [[productivity]], poor [[team spirit]] and loss of trained staff.<ref name=Field/> This has implications for the [[recruitment]] and retention of medical staff.


==Bullying of medical students==
==Bullying of medical students==
{{Main|Bullying in academia}}
{{Main|Bullying in academia}}
[[Medical students]], perhaps being vulnerable because of their relatively low status in health care settings, commonly experience [[verbal abuse]], [[humiliation]] and [[harassment]] (nonsexual or sexual). [[Discrimination]] based on gender and race are less common.<ref name=Coverdale>Coverdale JH, Balon R, Roberts LW [http://ap.psychiatryonline.org/cgi/reprint/33/4/269 Mistreatment of Trainees: Verbal Abuse and Other Bullying Behaviors Academic Psychiatry 33: Pages 269-273, July-August 2009]</ref>
[[Medical students]], perhaps being vulnerable because of their relatively low status in health care settings, commonly experience [[verbal abuse]], [[humiliation]] and [[harassment]] (nonsexual or sexual). [[Discrimination]] based on gender and race are less common.<ref name=Coverdale>{{cite journal |pages=269-73 |doi=10.1176/appi.ap.33.4.269}}</ref>


In one study, around 35% of medical students reported having been bullied. Around one in four of the 1,000 students questioned said they had been bullied by a doctor, while one in six had been bullied by a nurse. Manifestations of bullying include:<ref>Curtis P [http://www.guardian.co.uk/education/2005/may/04/highereducation.science Medical students complain of bullying] [[The Guardian]] 4 May 2005</ref>
In one study, around 35% of medical students reported having been bullied. Around one in four of the 1,000 students questioned said they had been bullied by a doctor, while one in six had been bullied by a nurse. Manifestations of bullying include:<ref>Curtis P [http://www.guardian.co.uk/education/2005/may/04/highereducation.science Medical students complain of bullying] [[The Guardian]] 4 May 2005</ref>
Line 16: Line 16:
* being put under pressure to carry out a procedure without supervision.
* being put under pressure to carry out a procedure without supervision.


One study showed that the medical faculty was the faculty in with the students were most commonly mistreated.<ref>Rautio A, Sunnari V, Nautinen M, Laitala M. [http://www.biomedcentral.com/1472-6920/5/36 Mistreatment of university students most common during medical studies. BMC Med Educ 2005; 5:36.]</ref>
One study showed that the medical faculty was the faculty in with the students were most commonly mistreated.<ref>{{cite journal |doi=10.1186/1472-6920-5-36}}</ref>


===Bullying of postgraduate students===
===Bullying of postgraduate students===
Bullying extends to [[postgraduate]] students.<ref>{{cite journal |pages=93-6 |doi=10.1136/pmj.2003.009001}}</ref><ref>{{cite journal |pages=87-90 |doi=10.4103/0022-3859.32206}}</ref>
Bullying extends to [[postgraduate]] students.<ref>Stebbing J, Mandalia S, Portsmouth S, et al. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742926/pdf/v080p00093.pdf A questionnaire survey of stress and bullying in doctors undertaking research. Journal of Postgraduate Medicine 2004; 80: Pages 93-6.]</ref><ref>Bairy KL, Thirumalaikolundusubramanian P, Sivagnanam G, et al. Bullying among trainee doctors in Southern India: a questionnaire study. Journal of Postgraduate Medicine 2007; 53: Pages 87-91A</ref>


==Bullying of junior (trainee) doctors==
==Bullying of junior (trainee) doctors==
In a UK study, 37% of [[junior doctors]] reported being bullied in the previous year and 84% had experienced at least one bullying behaviour. Black and Asian doctors were more likely to be bullied than other doctors. Women were more likely to be bullied than men.<ref>Quine L [http://www.bmj.com/content/324/7342/878.full Workplace bullying in junior doctors: questionnaire survey. British Medical Journal 2002; 324: Pages 878-9.]</ref>
In a UK study, 37% of [[junior doctors]] reported being bullied in the previous year and 84% had experienced at least one bullying behaviour. Black and Asian doctors were more likely to be bullied than other doctors. Women were more likely to be bullied than men.<ref>{{cite journal |pages=878-9 |doi=10.1136/bmj.324.7342.878}}</ref>


Trainee doctors who feel threatened in the clinical workplace develop less effectively and are less likely to ask for advice or help when they need it.<ref>Hicks B. [http://www.ncbi.nlm.nih.gov/pubmed/10962661 Time to stop bullying and intimidation. British Journal of Hospital Medicine 2000; 61: Pages 428-31.]</ref> Persistent destructive [[criticism]], [[sarcastic]] comments and [[humiliation]] in front of colleagues
Trainee doctors who feel threatened in the clinical workplace develop less effectively and are less likely to ask for advice or help when they need it.<ref>{{cite journal |pmid=1096266}}</ref> Persistent destructive [[criticism]], [[sarcastic]] comments and [[humiliation]] in front of colleagues
will cause all but the most resilient of trainees to lose [[Self-confidence|confidence]] in themselves.<ref name=Paice>Paice E, Smith D. [http://www.londondeanery.ac.uk/files/publications/traineewelfare.pdf Bullying of trainee doctors is a patient safety issue. The Clinical Teacher 2009; 6:13-7.]</ref>
will cause all but the most resilient of trainees to lose [[Self-confidence|confidence]] in themselves.<ref name=Paice>Paice E, Smith D. [http://www.londondeanery.ac.uk/files/publications/traineewelfare.pdf Bullying of trainee doctors is a patient safety issue. The Clinical Teacher 2009; 6:13-7.]</ref>


Line 33: Line 33:


==Bullying in psychiatry==
==Bullying in psychiatry==
Intuitively, the [[psychiatric]] profession might be expected to be particularly sensitive to bullying and its consequences. However psychiatric trainees are in no way exempt with rates of bullying at least as high as other medical students. In a survey of psychiatric trainees in the West Midlands, 47 per cent had experienced bullying within the last year with even higher percentages amongst ethnic minorities and females. Ironically qualified psychiatrists are not themselves required to be psychiatrically tested.<ref>Hoosen IA, Callaghan R. [http://pb.rcpsych.org/cgi/content/full/28/6/225 A survey of workplace bullying of psychiatric trainees in the West Midlands. Psychiatric Bulletin 2004; 28: Pages 225-7.]</ref><ref>Gadit AA [http://findarticles.com/p/articles/mi_hb4345/is_5_35/ai_n29350486/ Bullying in psychiatry must stop - Clinical Psychiatry News, May, 2007]</ref>
Intuitively, the [[psychiatric]] profession might be expected to be particularly sensitive to bullying and its consequences. However psychiatric trainees are in no way exempt with rates of bullying at least as high as other medical students. In a survey of psychiatric trainees in the West Midlands, 47 per cent had experienced bullying within the last year with even higher percentages amongst ethnic minorities and females. Ironically qualified psychiatrists are not themselves required to be psychiatrically tested.<ref>{{cite journal |pages=225-7 |doi=10.1192/pb.28.6.225}}</ref><ref>Gadit AA [http://findarticles.com/p/articles/mi_hb4345/is_5_35/ai_n29350486/ Bullying in psychiatry must stop - Clinical Psychiatry News, May, 2007]</ref>


==Doctors bullying/abusing patients and nurses==
==Doctors bullying/abusing patients and nurses==
Line 45: Line 45:
==Bullying in nursing==
==Bullying in nursing==
{{Main|Bullying in nursing}}
{{Main|Bullying in nursing}}
The [[nursing]] organisation workplace has been identified as one in which workplace [[bullying]] occurs quite frequently.<ref name=Hutchinson>Hutchinson, M, Wilkes, L, Vickers, MH & Jackson, D 2008, The development and validation of a bullying inventory for the nursing workplace, Nurse Researcher, vol. 15, no. 2 Pages 19-29</ref><ref name=Scott>Porter-O'Grady T Transforming work environments. Interview by Diane E Scott and Amanda Rosenkranz. Am Nurse 40(2):7 (2008)</ref> It is thought that [[relational aggression]] (psychological aspects of bullying such as [[gossipping]] and [[intimidation]]) are relevant. Relational aggression has been studied amongst girls but not so much amongst adult women.<ref>Richards A, Edwards SL A Nurse's Survival Guide to the Ward (2008)</ref><ref>Dellasega, C Bullying Among Nurses AJN, American Journal of Nursing: January 2009 - Volume 109 Issue 1 Pages 52-58</ref>
The [[nursing]] organisation workplace has been identified as one in which workplace [[bullying]] occurs quite frequently.<ref name=Hutchinson>Hutchinson, M, Wilkes, L, Vickers, MH & Jackson, D 2008, The development and validation of a bullying inventory for the nursing workplace, Nurse Researcher, vol. 15, no. 2 Pages 19-29</ref><ref name=Scott>Porter-O'Grady T Transforming work environments. Interview by Diane E Scott and Amanda Rosenkranz. Am Nurse 40(2):7 (2008)</ref> It is thought that [[relational aggression]] (psychological aspects of bullying such as [[gossipping]] and [[intimidation]]) are relevant. Relational aggression has been studied amongst girls but not so much amongst adult women.<ref>Richards A, Edwards SL A Nurse's Survival Guide to the Ward (2008){{pn}}</ref><ref>{{cite journal |pages=52-8 |doi=10.1097/01.NAJ.0000344039.11651.08}}</ref>


==In popular culture==
==In popular culture==
Line 65: Line 65:


==Further reading==
==Further reading==
*{{cite journal |doi=10.1371/journal.pone.0003889}}
* Ahmer S, Yousafzai AW, Bhutto N, et al. [http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0003889 Bullying of medical students in Pakistan: a cross-sectional questionnaire survey. Public Library of Science PLoS One 2008; 3:e3889.]
*{{cite journal |pages=148-52 |doi=10.1192/pb.bp.105.008730}}
* Faruqui RA, Ikkos G. [http://pb.rcpsych.org/cgi/content/full/31/4/148 Poorly performing supervisors and trainers of trainee doctors. Psychiatric Bulletin 2007;31: Pages 148–152].
*{{cite journal |doi=10.1136/bmj.38924.722037.7C}}
* Frank E, Carrera JS, Stratton T, Bickel J, Nora LM [http://www.bmj.com/content/333/7570/682.full.pdf Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey - BMJ 2006]
*{{cite journal |pages=463-6 |doi=10.1136/jme.2007.021832}}

*{{cite journal |pmid=20730401 |url=http://smj.sma.org.sg/5107/5107a8.pdf}}
* Gadit AA, Mugford G. [http://www.ncbi.nlm.nih.gov/pubmed/18511621 A pilot study of bullying and harassment among medical professionals in Pakistan, focusing on psychiatry: need for a medical ombudsman. Journal of Medical Ethics 2008; 34: Pages 463-6]
*{{cite journal |pages=497-501 |doi=10.1080/01421590310001606317}}
* Imran N, Jawaid M, Haider I I, Masood Z [http://smj.sma.org.sg/5107/5107a8.pdf Bullying of junior doctors in Pakistan: a cross-sectional survey Singapore Medical Journal 2010; 51(7) : 592]
*{{cite journal |pmid=21205548}}
* Maida AM, Vasquez A, Herskovic V, et al. A report on student abuse during medical training. Medical Teacher 2003; 25: Pages 497-501.
*{{cite journal |pages=658-9 |doi=10.1136/bmj.38133.502569.AE}}
* Mukhtar F, Daud S, Manzoor I, Amjad I, Saeed K, Naeem M, Javed M [http://www.ncbi.nlm.nih.gov/pubmed/21205548 Bullying of medical students - Journal of the College of Physicians and Surgeons--Pakistan 2010 Dec;20(12): Pages 814-8]
* Paice E, Aitken M, Houghton A, Firth-Cozens J. [http://www.bmj.com/content/329/7467/658.full.pdf Bullying among doctors in training: cross sectional questionnaire survey. BMJ 2004; 329: Pages 658-9]
* Mistry M and Latoo J [http://www.bjmp.org/content/bullying-growing-workplace-menace Bullying: a growing workplace menace BJMP Mar 2009 Volume 2 Number 1]
* Mistry M and Latoo J [http://www.bjmp.org/content/bullying-growing-workplace-menace Bullying: a growing workplace menace BJMP Mar 2009 Volume 2 Number 1]
*{{cite journal |pmid=12689995}}
* Paice E, Firth-Cozens J. Who’s a bully then? BMJ 2003; 326 (suppl): S127.
*{{cite journal |first1=Lyn |last1=Quine |pmid=9915730}}
* Quine L [http://www.bmj.com/content/318/7178/228.full.pdf Workplace bullying in NHS community trust: staff questionnaire survey. BMJ 1999; 318: Pages 228-32.]
* Vanderstar ES [https://litigation-essentials.lexisnexis.com/webcd/app?action=DocumentDisplay&crawlid=1&doctype=cite&docid=8+Empl.+Rts.+%26+Employ.+Pol%27y+J.+455&srctype=smi&srcid=3B15&key=683372e259430a9405343f6df22703b5 Workplace Bullying in the Healthcare Professions 2004 8 Employee Rights and Employment Policy Journal 455]
* Vanderstar ES [https://litigation-essentials.lexisnexis.com/webcd/app?action=DocumentDisplay&crawlid=1&doctype=cite&docid=8+Empl.+Rts.+%26+Employ.+Pol%27y+J.+455&srctype=smi&srcid=3B15&key=683372e259430a9405343f6df22703b5 Workplace Bullying in the Healthcare Professions 2004 8 Employee Rights and Employment Policy Journal 455]
*{{cite journal |pages=664–5 |doi=10.1136/bmj.38954.568148.BE}}
* Wood DF [http://www.bmj.com/content/333/7570/664.short Bullying and harassment in medical schools] BMJ 2006
* Wood DF [http://archive.student.bmj.com/issues/06/10/editorials/357.php Bullying in medical schools] Student BMJ October 2006
* Wood DF [http://archive.student.bmj.com/issues/06/10/editorials/357.php Bullying in medical schools] Student BMJ October 2006


Line 87: Line 86:
* [http://www.jml-training.com/The_cost_of_bullying_to_the_NHS.htm The cost of bullying to the NHS]
* [http://www.jml-training.com/The_cost_of_bullying_to_the_NHS.htm The cost of bullying to the NHS]


'''News stories'''
;News stories
* [http://news.bbc.co.uk/1/hi/health/260061.stm Bullying on the NHS] [[BBC News]] January 22 1999
* [http://news.bbc.co.uk/1/hi/health/260061.stm Bullying on the NHS] [[BBC News]] January 22 1999
* [http://news.bbc.co.uk/1/hi/health/1057410.stm Bullying 'ruining NHS workers' lives'] BBC News 6 December 2000
* [http://news.bbc.co.uk/1/hi/health/1057410.stm Bullying 'ruining NHS workers' lives'] BBC News 6 December 2000

Revision as of 12:21, 24 April 2011

This article primarily concerns bullying involving doctors. For bullying involving nurses see Bullying in nursing.

Bullying in the medical profession is common, particularly of student or trainee doctors. It is thought that this is at least in part an outcome of conservative traditional hierarchical structures and teaching methods in the medical profession which may result in a bullying cycle.

According to Field, bullies are attracted to the caring professions, such as medicine, by the opportunities to exercise power over vulnerable clients and over vulnerable employees.[1]

Impact

Bullying can significantly decrease job satisfaction and increase job-induced stress; it also leads to low self confidence, depression, anxiety and a desire to leave employment.[1][2] Bullying contributes to high rates of staff turnover, high rates of sickness absence, impaired performance, lower productivity, poor team spirit and loss of trained staff.[1] This has implications for the recruitment and retention of medical staff.

Bullying of medical students

Main article: Bullying in academia

Medical students, perhaps being vulnerable because of their relatively low status in health care settings, commonly experience verbal abuse, humiliation and harassment (nonsexual or sexual). Discrimination based on gender and race are less common.[3]

In one study, around 35% of medical students reported having been bullied. Around one in four of the 1,000 students questioned said they had been bullied by a doctor, while one in six had been bullied by a nurse. Manifestations of bullying include:[4]

  • being humiliated by teachers in front of patients
  • been victimised for not having come from a "medical family"
  • being put under pressure to carry out a procedure without supervision.

One study showed that the medical faculty was the faculty in with the students were most commonly mistreated.[5]

Bullying of postgraduate students

Bullying extends to postgraduate students.[6][7]

Bullying of junior (trainee) doctors

In a UK study, 37% of junior doctors reported being bullied in the previous year and 84% had experienced at least one bullying behaviour. Black and Asian doctors were more likely to be bullied than other doctors. Women were more likely to be bullied than men.[8]

Trainee doctors who feel threatened in the clinical workplace develop less effectively and are less likely to ask for advice or help when they need it.[9] Persistent destructive criticism, sarcastic comments and humiliation in front of colleagues will cause all but the most resilient of trainees to lose confidence in themselves.[10]

Consultants who feel burnt out and alienated may take their disaffection out on junior colleagues.[10]

Bullying cycle

Medical training usually takes place in institutions that have a highly-structured hierarchical system, and has traditionally involved teaching by intimidation and humiliation. Such practices may foster a culture of bullying and the setting up of a cycle of bullying, analogous to other cycles of abuse in which those who experience it go on to abuse others when they become more senior. Doctors are increasingly reporting to the British Medical Association that they are being bullied, often by older and more senior colleagues, many of whom were badly treated themselves when more junior.[11]

Bullying in psychiatry

Intuitively, the psychiatric profession might be expected to be particularly sensitive to bullying and its consequences. However psychiatric trainees are in no way exempt with rates of bullying at least as high as other medical students. In a survey of psychiatric trainees in the West Midlands, 47 per cent had experienced bullying within the last year with even higher percentages amongst ethnic minorities and females. Ironically qualified psychiatrists are not themselves required to be psychiatrically tested.[12][13]

Doctors bullying/abusing patients and nurses

Main articles: Patient abuse and Bullying in nursing

There have been quite a few proven cases of doctors bullying and/or sexually harassing patients and nurses.[14][15]

Patients and nurses bullying/abusing doctors

Bullying in nursing

Main article: Bullying in nursing

The nursing organisation workplace has been identified as one in which workplace bullying occurs quite frequently.[16][17] It is thought that relational aggression (psychological aspects of bullying such as gossipping and intimidation) are relevant. Relational aggression has been studied amongst girls but not so much amongst adult women.[18][19]

In popular culture

Sir Lancelot Spratt, a character played by actor James Robertson Justice in the film series Doctor in the House, is often referenced as the archetypal arrogant bullying doctor ruling by fear.

See also

2

References

  1. ^ a b c . doi:10.1136/bmj.324.7340.786/a. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  2. ^ : 435–42. doi:10.1016/S0031-9384(01)00490-5. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  3. ^ : 269–73. doi:10.1176/appi.ap.33.4.269. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  4. ^ Curtis P Medical students complain of bullying The Guardian 4 May 2005
  5. ^ . doi:10.1186/1472-6920-5-36. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)CS1 maint: unflagged free DOI (link)
  6. ^ : 93–6. doi:10.1136/pmj.2003.009001. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  7. ^ : 87–90. doi:10.4103/0022-3859.32206. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)CS1 maint: unflagged free DOI (link)
  8. ^ : 878–9. doi:10.1136/bmj.324.7342.878. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  9. ^ . PMID 1096266. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  10. ^ a b Paice E, Smith D. Bullying of trainee doctors is a patient safety issue. The Clinical Teacher 2009; 6:13-7.
  11. ^ Williams K (1998) Stress linked to bullying. BMA News Review, April 18
  12. ^ : 225–7. doi:10.1192/pb.28.6.225. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  13. ^ Gadit AA Bullying in psychiatry must stop - Clinical Psychiatry News, May, 2007
  14. ^ Doctor faces court-martial in patient abuse case Stars and Stripes January 16 2010
  15. ^ 'Groping' surgeon found guilty BBC News 28 July 2002
  16. ^ Hutchinson, M, Wilkes, L, Vickers, MH & Jackson, D 2008, The development and validation of a bullying inventory for the nursing workplace, Nurse Researcher, vol. 15, no. 2 Pages 19-29
  17. ^ Porter-O'Grady T Transforming work environments. Interview by Diane E Scott and Amanda Rosenkranz. Am Nurse 40(2):7 (2008)
  18. ^ Richards A, Edwards SL A Nurse's Survival Guide to the Ward (2008)[page needed]
  19. ^ : 52–8. doi:10.1097/01.NAJ.0000344039.11651.08. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)

Further reading

External links

News stories
Retrieved from "https://en.wikipedia.org/w/index.php?title=Bullying_in_medicine&oldid=425652193"