The healthcare system’s time-honoured response to bullying is to ignore the bullied and cover for the perpetrator There is still a propensity to treat bullying of doctors as some kind of an aberration rather than what it really is, a deep-rooted cultural problem. She was not “just” gay but transgender and wanted to live her life openly in one of the most conservative professions in the world. Smart, polished and articulate, she was an asset to any profession but in medicine she found a tough enemy, evident in her account of the sly insults and abhorrent behaviour directed towards her by people meant to be healers. The support of her few defenders would be no match for the dogma that only “regular” men and women could be real doctors. Another day, another place. A fellow doctor rushed past me and it was impossible to miss the leak of breast milk starting to stain her shirt. She had a four-month old baby at home and was back at work to fulfil her training requirements. “I need to express,” she said tearfully, “but my boss hates it. It slows down clinic.” I stared at her aghast. “I’m going to have to stop breastfeeding. Otherwise, she’ll make my life impossible.” I wanted to be simultaneously furious and supportive but we both knew that the easiest solution was to let her breast milk dry and let the clinic numbers stay. Yet another day, another place. A doctor received a prestigious award and his colleague felt threatened. A stream of abusive behaviour and unprofessional conduct led the doctor to wonder how he could settle the one-sided feud. He took turns being discreet, friendly, diplomatic and firm but the colleague simply wasn’t interested, for his goal was not resolution, rather retribution. The senior doctor was intimidated and humiliated and his personal life was thrown into chaos. When I saw him next I pulled up the definition of bullying on my phone. His eyes widened. “That’s me.” I realised then that the senior male doctor, supposedly the most protected species of all in medicine, wasn’t all that protected either. I thought of all these people upon hearing that the intensive care unit of a large and prestigious Sydney public hospital, Westmead, had been stripped of its accreditation following a series of bullying and harassment allegations. The allegations have not been made public but suffice to say, it is rare for a teaching hospital to lose accreditation altogether when there are lesser actions such as limited-time or provisional accreditation. For a training facility to be called out by its own college, in this case the College of Intensive Care Medicine, is tantamount to saying that the alleged behaviours have been too egregious, too widespread and too embedded to go away with a quiet warning. Doctors work in all sorts of trying conditions and the unpalatable truth is that all junior doctors work at the pleasure of senior staff, but the conditions at the Westmead intensive care unit were deemed so injurious to health that the only way to protect trainees was to remove them. Amidst this decisive action followed by a swift government enquiry, the only jarring note was the reassurance that there was no problem with the quality of care at Westmead. In fairness, the speaker went on to lament the conditions leading to bullying but the soundbite on the news was that Westmead was safe for business. In other words, the doctors might be bullied but it’s not like anyone was turning the ventilators off. In one fell swoop, this statement succeeded in diminishing the serious issue of bullying and harassment and make it out it as a problem of individual doctors rather than a rotten system. While I sympathize with the need to defend a reputation, I found the comment disingenuous. Many doctors have scoffed at the suggestion that any hospital with a culture of bullying can claim its clinical care to be faultless. I know from experience. Decades ago, I experienced my year of darkness, which started with being told that I was a disappointment to medicine. The prolonged yelling took place in a corner room – after hours, without warning, and without the right of reply. After this came the hostility, disdain and lack of opportunity which left me in no doubt of my smallness. The bile used to rise in my mouth as I neared work and my most constant companion became fear. What would I be blamed for today? There was a glimmer of hope when a different consultant noted my unhappiness. That hope was extinguished when clearly feeling awkward, he counselled me, “Look, forget it. It’s just the way he is.” At the time I was astonished, but as so many others would reveal, this was in fact the healthcare system’s time-honoured response to bullying – ignore the bullied, cover for the perpetrator. What was that year like? Well, to my knowledge, no one died at my hands. I didn’t knowingly prescribe a wrong drug or administer the wrong fluid. I didn’t cut corners at resuscitation, pretend to know more than I did or deliberately delay clinic patients. All this would more than qualify as clinical care worthy of accreditation, because it never struck me that the balm for my pain was to be a negligent doctor. But what I know for sure is that during that year, I was far from the best doctor I could be for I was emotionally depleted. I treated the disease but not the person. I prescribed drugs but couldn’t find compassion. I knew that medicine should mean more but I had nothing to give. In those circumstances, making a grievous error was only a matter of time. Later on, in response to my plea to never let this happen again to another trainee, the hospital’s response was famously succinct. “We asked him; it didn’t happen.” Times have changed and with them, the seriousness with which many hospitals take bullying and harassment. But as the incident at Westmead lays bare, there is still a propensity to treat the matter as some kind of an aberration rather than what it really is, a deep-rooted cultural problem that is perpetuated by those who should know better but get away with behaving badly because they have power and influence. The scourge obviously impacts doctors, driving them to drugs, despair and suicide – but make no mistake, it compromises patient care. Doctors who bully and harass their colleagues cannot be beacons of good medical practice. Holistic care cannot take place in a dysfunctional hospital. Patients cannot be made whole by broken doctors. A patient of mine once mused that it never crossed her mind that doctors couldn’t look after each other. No patient would want to be treated in a hospital that can’t take care of its own doctors. When incidents like Westmead happen again (and they will) our support for doctors should not be conveyed as a mixed signal. We should honestly admit that when doctors are bullied, all of society is harmed. To ask our patients to believe anything less does them a disservice. Medicine is better than that. Source
