Bullying in medicine
- 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. The rampant problem of medical student mistreatment and bullying was systematically studied and reported in a 1990 JAMA study by pediatrician Henry K. Silver which found that 46.4 percent of students at one medical school had been abused at some point during medical school; by the time they were seniors, that number was 80.6 percent.
While the stereotype of a “victim” as a weak inadequate person who somehow deserves to be bullied is salient, there is growing evidence that bullies, who are often driven by jealousy and envy, pick on the highest performing and most skilled staff or students, whose mere presence is sufficient to make the bully feel insecure. Threats (of exposure of inadequacy) must be ruthlessly controlled and subjugated. Psychological models such as transference and projection have been proposed to explain such behaviors, wherein the bully's sense of personal inadequacy is projected or transferred to a victim; through making others feel inadequate and subordinate, the bully thus vindicates their own sense of inferiority.
Beyond its ramifications for victims, disrespect and bullying in medicine is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices.
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. 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. This has implications for the recruitment and retention of medical staff.
Chronic and current bullying are associated with substantially worse health, according to research by Laura M. Bogart, associate professor of pediatrics at Harvard Medical School.
Bullying of medical students
Medical students, perhaps being vulnerable because of their relatively low status in health care settings, may experience verbal abuse, humiliation and harassment (nonsexual or sexual). Discrimination based on gender and race are less common.
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. Furthermore, bullying has been known to occur among medical students. Manifestations of bullying include:
- being humiliated by teachers in front of patients or peers
- been victimised for not having come from a "medical family" (often people who enter medicine have an older sibling pursuing the same degree or share ties with other individuals in the profession with whom familial relationship confers some degree of protectsia or special influence - especially within academic settings.) Such practices extend to admissions procedures, which are regularly influenced by factors far afield of candidates' intrinsic merits, such as being related to faculty members or well-known medical luminaries.
- being put under pressure to carry out a procedure without supervision.
- being ostracized by other medical students for asking questions (due to the medical content being confusing for some students) through social media networks (Facebook bullying), phone, or in person.
One study showed that the medical faculty was the faculty in which students were most commonly mistreated.
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 physicians were more likely to be bullied than other physicians. Women were more likely to be bullied than men.
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. 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.
Bullying of Doctors and Consultants is rampant in the UK NHS - eight documented cases of victimized NHS staff five doctors and three consultants see http://www.ajustnhs.com/ See also Bullying Report by Central London Community NHS Trust http://www.scribd.com/doc/100218887/Bullying-Report-in-Central-London-Community-Healthcare-NHS-Trust The recent farewell interview from Sir Ian Kennedy (Chair of the HealthcareCommission) caused significant media interest following his statement that ‘Bullying’is a ‘corrosive’ problem that the NHS must address.
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.
Physician Jonathan Belsey relates in an emblematic narrative published in AMA Virtual Mentor entitled Teaching By Humiliation that "however well you presented the case, somewhere along the line you would trip up and give the predatory professor his opportunity to expose your inadequacies. Sometimes it would be your lack of medical knowledge; sometimes the question that you failed to ask the patient that would have revealed the root of the problem, or sometimes your ineptitude at eliciting the required clinical signs. On one memorable occasion, when I had appeared to cover all the bases clinically, the professor turned to me and berated me for attending his ward round wearing a plaid shirt that was clearly inappropriate for an aspiring doctor."
Bullying in psychiatry
The psychiatric profession might be expected to be particularly sensitive to bullying and its consequences. However psychiatric trainees experience rates of bullying at least as high as other medical students. In a survey of psychiatric trainees in the West Midlands, 47% had experienced bullying within the last year with even higher percentages amongst ethnic minorities and females. Qualified psychiatrists are not themselves required to be psychiatrically tested.
Doctors bullying/abusing patients and nurses
|This section requires expansion. (April 2011)|
Speaking of many doctor's predilection of bullying nurses, Teresa Brown writes:
- "...the most damaging bullying is not flagrant and does not fit the stereotype of a surgeon having a tantrum in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults."
Bullying in nursing
Nurses experience bullying quite frequently. It is thought that relational aggression (psychological aspects of bullying such as gossipping and intimidation) are commonplace. Relational aggression has been studied among girls but not so much among adult women.
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. The film series also demonstrates bullying of student doctors by other doctors and the nursing matron.
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- The cost of bullying to the NHS
- The Bullying Culture of Medical School
- News stories
- Bullying on the NHS BBC News January 22, 1999
- Bullying 'ruining NHS workers' lives' BBC News 6 December 2000
- Many junior doctors bullied BBC News 11 April 2002
- One in four junior doctors bullied BBC News 26 September 2002
- Dunne R 'My fellow doctors bullied me' BBC News 9 June 2003
- NHS anti-bullying culture ordered BBC News 12 January 2006
- Targets' triggering NHS bullying BBC News 18 May 2006
- Surgery team 'unsafe' - and at times 'dangerous' Staffordshire Newsletter 10 March 2011