How to spot a bully in medicine and what to do about it

Greetings all,

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

Untouchable

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.

Sleep and psychiatry – time for a tweet chat!

Greetings all,

I have been involved in the area of sleep psychiatry and have been running medical education workshops, known as SleepSchool since 2008.

I have been running these in conjunction with Dr David Cunnington, director at Melbourne Sleep Disorders Centre, and creator of Sleep Hub.

We have run quite a number of workshops around Australia since 2008, but haven’t done so for a while. We used to have great support from pharma but for many reasons this is no longer the future of medical education.

Anyway, not to worry, as now that both David and myself are actively engaged on social media, and I am guesting at @WePublicHealth this week, we have decided to trial a tweet chat that highlights the intricate relationship between sleep and mental illness. This will occur on Friday 22nd May 2015 at 1430 AEST.

We will be using the hashtag #sleepschool although popular around mums and babes with sleep issues, it carries on our workshop name as it moves into the Twittersphere!

Find out more about #SleepSchool here

 

 

Uncharted territory – cyberstalking in the new age

Greetings all,

I spoke to the topic of trolling and cyber stalking at @MedicineSocial on Saturday. I chose the topic as I wanted to explore whether this was a new phenomena, or simply, what we know about stalking behaviour in general, but on a different playing field. I also wanted to relay the message that on or offline stalking is a crime, victims are protected by the law, and that they are often very distressed by the behaviour.

I also wanted to provide a profile of the different types of stalking behaviors well known to those working in forensic psychiatry and the judicial system.

What I found when I researched this area, was that other terms and behaviours such as trolling were less well defined, and often confused with stalking. It speaks to the heart of the matter that most of the information I could find about internet trolling  was derived from Wikipedia and Google. Hence I believe we are walking into uncharted territory when it comes to these understanding these behaviours.

When it comes to trolling, it is very hard to recognise or manage the behaviour when we are still unsure about how to define the behaviour.

Trolls

At @MedicineSocial, I made the point that I do believe trolls differ from stalkers. Notwithstanding this, the behavior of trolls causes all sorts of distress and can lead to catastrophic outcomes for the victim. The victim is often shocked and thrown off-topic from the feed the are contributing to. The troll’s motivation seems to be to cause intense emotions in somebody they have often not even met. I have noticed trolls pop up and go away and don’t seem to have a consistent pattern to their behaviour, except to throw everybody off the topic and cause anguish. I mentioned that it seems consistent that the best way to deal with trolls is to block them and most importantly not to engage with them.

I also made the point that trolling is not the same as somebody having a different view to you and expressing it in a way that upsets you. That’s the world of social media. Post something, and you may very well upset others by your comments or beliefs. It’s the way that trolls go about their business that seems different to me, that is, they tend to show discord on the internet by;

  • Starting arguments
  • Upsetting people
  • Posting inflammatory, extraneous or off-topic messages in an online community

with the deliberate attempt of

  • Provoking readers into an emotional response
  • Or of otherwise disrupting normal on-topic discussion.

The references I used to present this can be found here.

Cyber-stalkers

When preparing my talk I thought back to my training in forensic psychiatry, and re-visited the types of stalking behaviors that Prof Paul Mullen, Michelle Pathe et al identified way before Google and the internet. One of their first articles published can be found here. Their work has well and truly stood the test of time, and I note that some of these types of stalkers now carry on with the same behaviour using the internet as a new way of carrying out their acts, often alongside off-line behaviour.  And although social media sites state they have methods and policies around incorrect use of the internet, I wonder if they truly understand the complexity and diversity of these behaviours. For example, reporting such behaviour may have an alleged stalker taken down, who can obtain another twitter handle or facebook page with another email address and continue along their way.

Also, if a potential stalker is reported and blocked one may be placated that they are safe when in fact all that happens is  they can no longer see what the alleged stalker is up to 

My best advice is to take screen shots of everything you may see that you will need as evidence before blocking and reporting potential stalking to behaviour to the sites and/or the police. If their site or page is taken down, or you block them, you lose your evidence. Don’t presume sites such as Facebook will assist you in retrieving this information.

Some people who stalk victims on the internet may be mentally unwell. They may have a paranoid delusion that in some way a person or an organisation they may have never met has caused them harm. Sometimes this is the case, often it is up for debate, but no matter what, the matter should be dealt with off-line through appropriate channels. In these cases, the actual stalking behaviour occurs as a way of ‘exposing’ or ‘getting back’ at someone they feel has delivered them a gross injustice. No matter what, victims must and should feel able to report such matters to the police, and in an ideal world, a forensic psychiatry assessment would occur as part of the investigation.

I also spoke about cyber-bullying, which is more clearly defined, probably as a result of high profile cases with tragic outcomes that have turned society’s attention to this phenomena. Bullying is bullying no matter where it occurs. It has been thought that the main targets are adolescents who are often bullied at school, but now, the behaviour doesn’t stop when the school bell rings. In cases I have been involved with as a psychiatrist, the victim is well known to the perpetrator, often a classmate or a peer. But this is not always the case.

I concluded my presentation with reflections I gleaned after reading the wonderful new book “So You’ve Been Publicly Shamed” by Jon Ronson. In this latest book, one of my favourite authors has interviewed victims of shaming that has generally occurred on-line. Shaming that has occurred in the name of ‘good’.  That is, an interviewee has made a monumental mistake on social media, often even one tweet as in the case of Justine Sacco, but has had no way of coming back from that. Jon Ronson’s article in the NY Times can be found here and is a very thought provoking read. After I read it, I came to the conclusion that:

Just as we need  policies and guidelines about how to behave on social media, we need policies and guidelines on how to be able to apologise if we make a mistake.

It led me to ponder the idea that if we expose someone on social media whom we as an online community feel has behaved badly, and we shame them by setting up hashtags for retribution, or lobby to expose them, are we in fact trolling? Don’t we also cause harm? Isn’t it just better to promote forgiveness in certain cases?

A final tribute to another favourite author, Dr Samuel Shem, who wrote the incredible novel  ‘The House of God’. In this novel the protagonist is an intern at ‘The House of God’ after graduating from ‘BMS’ (Best Medical School). The novel chronicles his journeys through internship and many years later, still resonates with junior doctors worldwide.

One of the laws from the ‘House of God’ was;

At a cardiac arrest, the first procedure is to take your own pulse. 

Perhaps, if we take our pulse before we reply to something that enrages us on our twitter feed, and decide to delete the post before sending, or even mull over it before we do, we may continue to keep the social media space as kind as possible.

Special thanks to Dr Tim senior and Dr Brad McKay for helping me prepare my talk on this important topic. 

 

 

 

The legal fraternity may disagree,

Good morning @WePublicHealth!

Greetings all,

Between caring for patients and advocating for doctors mental health, I will be managing the popular twitter handle @WePublicHealth.

I am extremely honoured to be given this opportunity, and plan to tweet on matters social media and medicine after running a highly successful workshop for doctors, called, MedicineSocial last weekend in Melbourne.

I am extremely passionate about writing, blogging about all matters psychiatry. I truly believe most stigma around mental illness lies within the medical profession, and that many doctors don’t actually know what we do! Many of my patients are unaware that I am a doctor with a specialty qualification in psychiatry. This lack of understanding of what we do leads to an under utilising of our our ability to diagnose, manage and treat mental illness.

I also know that psychiatry is controversial. I struggle at times with how to work within such a broken public mental health system. I care about doctors mental health, as I feel that without a healthy workforce we cannot expect patient health.

I will be tweeting regularly, and welcome your questions and thoughts. In particular, I am going to be investigating how the professional and powerful use of social media can break down barriers between doctors and patients, allow us to be on the front foot when it comes to the delivery of evidenced-based scientific health information, and to allow us to learn and grow as a community of like minded people.

I have also been asked to talk about the rise in cyberstalking, the phenomenon of trolling, and the roles of caricatures and parodies in delivering messages around health. I spoke about this on the weekend, profiling types of stalking behaviors based on what we know about off-line stalking, and how this is playing out on social media, often with deleterious consequences.

Please share my tweets, reply, tell me what you think, and keep it real!

Best wishes,

Helen