I'm Stepping Back From Medicine Because Of Bullying. But The Problem Is Bigger Than My Case

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  1. Dr.Scorpiowoman

    Dr.Scorpiowoman Golden Member

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    After eight years as a doctor, Kate Johnson is taking a break from medicine.

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    After eight years as a doctor, I have taken a break from the profession I love. I am too emotionally exhausted to continue my training.

    This is not about the pressures of working amid COVID-19, but more on that later.

    Instead, for some time now, I have felt voiceless and powerless due to an insidious culture of bullying and harassment within our hospitals, and though I have tried to fight it, it has taken a toll.

    I am far from alone. As junior doctors, we are often taught it is easier to grit our teeth and move on to the next job than to challenge perpetrators and face the consequences.

    But there comes a point in time where simply "toughing it out" isn't an option anymore.

    I could have let it go

    I tried to organise a meeting once but arranged it for the wrong date. A senior doctor wrote to me and copied a colleague into the email to demonstrate what an idiot I had been: "How many times do we have to tell you what date the meeting is on? I will let you figure out when the meeting is."

    An understandable lapse of temper, perhaps — if it hadn't occurred following complaints from the department that I was distracted, disinterested and, apparently, they just didn't like me.

    I replied to the email saying, "This is not an appropriate way to speak to someone."

    I received an apology, but suddenly I was no longer welcome to observe clinics each week, and other members of the department ignored me in the corridors when they had not done so before.

    Australian Health Practitioner Regulation Agency's (AHPRA) survey of 10,000 trainee doctors found that 33 per cent had experienced or witnessed toxic behaviour at work in the previous 12 months. Only a third of victims reported the toxic behaviour and, of those, just half had their reports followed up. That means less than 10 per cent of incidents are actually acted upon.

    Recently the Australian Medical Association NSW released results of the 2020 Hospital Health Check, a survey of 1,332 doctors-in-training, which found similar rates of bullying.

    Most hospitals showed significant improvements in their scores for rostering, leave and education compared to previous years, but these were not matched by improvements in wellbeing, with most hospitals across NSW scoring C or D, and two hospitals receiving an F.

    This suggests that deeper cultural issues persist, which will not improve rapidly with simple administrative or protocol changes.

    Cultures of bullying often operate in a hierarchical and autocratic fashion, where junior staff do not have a voice and tolerating bad behaviour may be seen as a tradition.

    Despite the widespread adoption of zero-tolerance policies by hospitals and training colleges, and despite the knowledge that bullying cultures are unsafe for patients and staff, it is as pervasive as ever.

    People don't feel empowered to report

    The problem is, policy doesn't change culture.

    'Bullied and broken' trainees'A final-year medical student recounts his experience with bullying, stress and fear in the profession.
    In response to several high profile cases, the Royal College of Surgeons has pioneered the program, Operate with Respect, in collaboration with Monash University.

    This program hopes to educate fellows and trainees on bullying, harassment and what they can do about it.

    The other colleges must follow suit.

    Moreover, medicine should take lessons from other industries, like business, where — in ideal workplaces — supervisors are accountable for the quality of their supervision, and leaders, regardless of seniority, are provided with mentorship, with positive examples of how to lead and relate to their staff.

    We need to ask, 'Are you OK?'

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    There is an insidious culture of bullying and harassment within our hospitals.

    When my friend and colleague, Chloe Abbott, was reported to AHPRA in 2016, the documentation referring to her case said she appeared distracted and intoxicated and that she was emotionally erratic.

    This means that the agency which certifies doctors would be investigating her capacity to practise safely. Most doctors, even when mentally well and under investigation for unsubstantiated complaints, find this process invasive and extremely stressful.

    When Chloe investigated the evidence behind this, she found that she was described as emotionally erratic because a colleague found her a little blunt one day, while she seemed normal the next.
    There was no evidence of intoxication and no complaints suggesting she was a risk to patient safety.

    Chloe died by suicide on January 9, 2017.

    Ostensibly, staff members were not inappropriate or abusive, but had they responded more empathically and supportively, would Chloe be here today?

    Anyone with a modicum of experience of mental illness knows that Chloe must have felt hounded and judged, that she would never be good enough and that her reputation was irrevocably tarnished.

    Staff could have asked: "Why are you distracted? Are you OK? Is there anything we can do to support you?"

    In an ideal universe, she could have reported, "I feel overwhelmed by stress and fatigue," as she later documented.

    Theoretically, she could have gone onto part-time duties, been given more
    time to pass the RACP exams and been linked up to supportive mentors.

    Similarly, my own "distractedness and disinterest" would have benefited from a more empathic approach.

    Cultural change in medicine is very patchy. It is very much dependent on individual hospitals and departments, particularly their senior staff, and their desire to "be the change".

    Wagga Wagga, for instance, got an overall score of A in the hospital health check and serves as a positive example. Other hospitals, however, are still proud of a culture where teaching sessions are referred to as a "bear pit".

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    The culture of bullying cannot be tackled by policy change alone.

    The stories from COVID-19 are yet to be told

    South of the border, my colleagues in Victoria have been isolated from their families while working overtime during the second wave of the coronavirus pandemic.

    No doubt we will be hearing tales, good and bad, of how the Victorian system held up under strain and incidents where colleagues supported one another (and didn't).

    The true mental health burden of the pandemic is yet to be revealed.

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    The true burden of COVID-19 on the mental health of medical workers is yet to be revealed.

    Meanwhile, medical experts know this is not going to be the last pandemic. This makes positive cultural change all the more imperative, as it help to build resilience into the medical community.

    This culture cannot be tackled by policy change alone. The powerful need to be given positive examples of better leadership. Supervisors need to be held accountable for bad behaviour. We need diversity in leadership.

    Most importantly, junior and senior doctors alike need to respond to one another with empathy.

    If we don't, it is only a matter of time until the next doctor suicide.

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