Over the past weeks it has been reassuring to see so much lively debate about the concept of bullying in medicine. Despite the sensationalism, there has been a groundswell of those within and without medicine who simply cannot understand why professions such as medicine can’t adopt the attitudes of most child care centres and kindergartens. The way we encourage 3 year old children to name the behaviour, hold up their hand and say:
‘ Stop it, I don’t like it’.
After completing this first step, 3 year old children are really good at performing the next task. That is,
tell a grown up.
The grown up responds at the time, not days later, sits both down and helps them find a resolution. If discipline is needed that is explained too. Everybody learns and keeps going. Children feel heard, children learn what is unacceptable, and also that grown ups are around when they feel out of their depth, often for a cuddle and reassurance they are OK.
This consistent measured response that infants can understand and take on as they grow up is crucial as a preventative measure for bullying behaviour. Simplistic, kind, immediate actions that leads to long term resilience.
The behavior we see in our profession is the antithesis of this.
So what happens somewhere between leaving the sand pit and entering the operating room? (I say operating room as apparently that’s where the media feel real doctors hang out so it’s always the background scene)
What happens is complex, multi factorial and beyond exposure in a 1 hour documentary. In this blog I am going to explore a bit more about how bullies get to be where they are, the absolute devastation they can cause at the expense of keeping their ivory tower polished and pristine, and why I can’t think of a single organisation that can be the ‘grown up’ in this issue.
Often the ‘grown up’ is the bully.
My definition of bullying is a culmination of my clinical knowledge, my own lived experiences, and where I see the state of play in medicine. It is written entirely as a mark of respect for those of my colleagues and peers who may not have believed they could get through bullying experiences and chose to die instead. Just as in the world of cyber-bullying, suicide is a tragic and common outcome. I am a victim of bullying, and I have had times where I found myself believing their criticism of me, their comments that I should ‘shut up’ and not answer questions for fear of making others look stupid rather than embrace and foster that I was keen and willing to learn.
For no other reason, bullying is dangerous because it takes our minds off our patients, derails us from contributing to medicine and causes us no end of distress and hardship.
A bully is anybody who does something either verbally, physically, or emotionally, with no other reason but to make themselves feel awesome and you to feel dreadful.
I am going to use this blog to profile one of the biggest bullies I had the displeasure to meet through my medical training and beyond. This person still works as a doctor and holds a number of high profile office bearer positions. I am doing this to showcase what is bullying behaviour, how it takes years to develop and to question why it simply continues when everybody knows. Those relevant to my profession will know who I am writing about. Everything I write can be substantiated by others. If I don’t lead by example, I see myself as someone who is colluding with bullying behaviour, allowing the next generation to experience what we did. Those people just like me that couldn’t find a grown up, or instead of getting that reassurance, were treated with disdain, told to shut up and cop it just like everybody else. After all, we are told
being a victim to a bully makes us stronger.
In my scenario, the perpetrator is a male. I preface by stating this is not a gender specific issue, and I have met women who were quite good at bullying as well.
Let’s paint the scene,
A bunch of keen medical students sitting in a large tutorial room of a major teaching hospital waiting for the “Prof”. Waiting as we did at the same time every week for a spray and perhaps a glimpse of something worthwhile learning.
Prof enters the room when he feels like it. He is after all, extremely busy, and often began tutorials by naming which prestigious media person he had just been speaking to on the phone.
We sit in silence. After all, he is the Prof, and we have all heard really scary things about him….
Prof begins the session by reaching into his wallet and pulling out a fistful of business cards, which he then proceeds to flick across the table like some random card game at a casino.
His first question for the audience;
Do you know who I am?
Well, yes, we do, but nobody has the guts to say. Then the following answer to his own question;
I am everything my business card says I am. I am the recipient of all these awards and merits. When I get on the phone to the media, my call goes straight through. I am one of the most influential people in my field.
This was the beginning, middle and end of the tutorial. We all left with a business card after watching a DVD made by a pharmaceutical company, featuring the Prof who had left the room by now.
Now, hopefully, most of the audience saw this ‘tosser’ behaviour for what it was. But maybe some didn’t. Maybe some really started to believe from that moment on, this person was the one to impress if you wanted to get anywhere. Sadly, this was the case. You did have to be a golden child of the Prof to enter his kingdom.
Also, crucially, Prof was being very strategic and targeted with his ‘tom cat’ marking of his territory. He was making very sure that he was and would always be the smartest person in the room. Intolerant of criticism, and insightless to his behavior, not least of which was discouraging some fine future doctors from his area of specialty, the Prof legend continued to grow and the power imbalance became greater.
In later years, if you did decide to chose to enter the Prof’s turf, that is, choose the same specialty as him, and then become his registrar, you would be subjected to public humiliation on a weekly basis. The weekly ward round was your chance to present a case, in front of the patient you were speaking about, as well as the rest of the multidisciplinary team. All would watch in horror as the Prof took you down, bit by bit, in order to once again demonstrate he was still the most important and intelligent person in the room, and that humiliation was the best way to get you to think on your feet faster and suffer the rigors of being a real doctor.
This public humiliation went on for years, consistently, and without any attempts at intervention.
The complexity continues, as the needs of the Prof grow to maintain relevance over the years, to be seen to be furthering his career at every opportunity, getting onto boards, into professional organisations, marking his territory, and ensuring he remains
So faced with this, what do we do? How can we simply say with any hat that we have a zero tolerance to bullying, as if that will solve the problems without understanding where it all began? Shouldn’t we instead say to our peers, do not be defined by the criticism of bullies, but by those you trust and respect as they are everywhere too. Above all else, be defined by your own self worth which should be more than obtaining a fellowship to a college.
I don’t believe any organisation has the capability of removing bullies from medicine. The Australian Medical Association is a membership organisation that takes subs from bullies and victims. It also has a role in defending members who are wrongly accused of bullying. Colleges also cannot rid their hierarchy of bullies, and because of this, cannot offer assistance to members who receive threats from bullies.
In this whole argument, nobody is declaring they have a clear conflict of interest in dealing with bullies
As a doctor, a mother of a son who has been told how to manage bullies in the playground, and as a psychiatrist who sees patients that are suicidal as a result of bullying, I say the best way to manage this is;
1. Keep safe, get help and remember, you are so much more than what your supervisors write on your assessments. Bullies do in fact have much more to lose than you.
2. When you are ready, and if you so choose, name your bully’s behavior to protect others. If you can’t find a grown up to tell, be that grown up yourself and name it to your peers.
3. Take up the charge to rid bullies from the profession we are passionate about, understanding how much they will hang on, and appreciate how entrenched they are within the organisations that state they are trying to ‘out’ their bullies.
I have ‘named’ a bully. Now it’s your turn.