Unreported bullying plaguing junior doctors

by Chloe Taylor27 May 2015
Reports have emerged that doctors undergoing their prevocational training are being bullied and harassed by bosses in hospitals across Australia – but these behaviours are remaining unreported as victims fear taking action would damage their careers.

This has led to concerns that some doctors’ teaching methods – which are alleged to incorporate fear and humiliation – are contributing to high levels of anxiety, depression and burnout, jeopardising the wellbeing of both resident medical officers and their patients.

A recent study which delved into the experiences of 18 trainee doctors in Victorian hospitals found that most interns and residents have either seen or experienced these incidents themselves – some said that they felt the behaviours were causing clinical anxiety.

This comes after junior doctors’ working conditions were recently called into question following the sudden and unexpected deaths of three trainee psychiatrists and an intern working in Victorian hospitals.

Caroline Lambert, a former hospital social worker, interviewed the interns for a PhD on the topic. She reportedly said that none of them knew the hospitals’ policies on bullying behaviour – but this was irrelevant, as they would never consider reporting it.

“It's a small industry, it's hugely competitive and there are a small number of positions,” she told The Canberra Times. “There is no confidentiality. People say, ‘Oh we won't say anything and no one will ever know where the complaint came from’, but the reality is, they do.”

Lambert added that the participants said several hospitals and senior doctors had reputations for bullying, but that this was expected and often viewed as excusable. They also reported that there was an established culture of fear, humiliation and “tough love” in hospital teaching.

A 2013 study by beyondblue, which surveyed 1800 medical students in prevocational training, found that:
  • 52% were emotionally exhausted and burnt out
  • 7.5% had anxiety
  • 9% had high levels of psychological distress
  • 8% had a current diagnosis of depression
  • One in five had considered suicide in the previous year
For all of these categories, the rates massively exceeded those of the general population.

One of the participants in Lambert’s study referred to “ring of fire” tests of emotional strength and will power.

“You know your years as a junior doctor are supposed to be hell,” another student said.

According to The Times, one participant recounted being asked rounds of impossible questions while she was holding a patient’s heart during surgery; she said that an anaesthetist was attempting to mouth the answers to her as he had seen the teaching technique before.

“The stakes were so high and [the medical student] was so terrified,” Lambert said. “Students talk a lot about this sort of intellectual humiliation.”

Helen Schultz, who is a Melbourne based psychiatrist and mentor to medical interns and residents, told The Times that she was concerned bullying across the medical sector was leading to mental illness among students and newly qualified doctors.

Schultz also suggested that these practices could potentially be causing errors and ultimately harm to patients.

In 2006, a residential medical officer who administered an incorrect dosage that caused severe brain damage to an infant spoke of being intimidated by senior doctors who made her feel she could not ask too many questions.

Schultz said that an independent healthcare authority should be set up to provide those in prevocational training with a platform to submit anonymous reports about bullying.
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How do you handle bullying when the victim won't speak out?
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  • by Bernie Althofer 28/05/2015 4:48:33 PM

    Unreported complaints about workplace bullying and other counterproductive workplace behaviours provides a telling tale about the culture that exists. It does seem that many organisations have developed and implemented a range of policies and procedures to assist managers and workers in the prevention, detection, reporting and resolution of workplace bullying.

    However, it does appear that despite training being provided, managers and workers at all levels seem reluctant to actually formally report incidents. As the numerous discussions have identified, when individuals see that bullying is required to 'get ahead'; that the alleged bullies get promoted or rewarded; that targets are further threatened, intimidated or harassed when the make a complaint; when targets find that work opportunities dry up because they dared to go against the bully and/or their supporters; or when they fear substantial personal economic hardship for standing up to the bully, then in some cases, they may a decision not to respond. They end up suffering in silence, or in some cases, adopt the bullying behaviours and that only perpetuates the bullying cycle.

    When a small group of decision makers wield considerable power that can impact on their careers (or lack thereof), bullying continues although in some organisations it might not be seen as bullying, It might be as a 'master/servant' relationship where the 'master' is able to demonstrate their power in a variety of ways, because that is what they learned from their masters.

    Unfortunately for many reasons, there are those in the medical profession who for necessity already work long hours. When these individuals are already under pressure from medical examinations and advice they are required to conduct and give, their ability to sustain high levels of performance can be severely impacted if they are also being subjected to bullying behaviours. There will come a time when a death is referred to a Coroner and skilful questioning will identify that the doctor had been subjected to a range of behaviours that impact on their decision making processes, leading to and inappropriate or an incorrect diagnosis.

    Organisational health surveys can be conducted in an effort to identify the extent or prevalence of bullying. However, if individuals perceive that even an anonymous survey could be 'traced back' to the person completing it, they may be less than willing to document their reasons for not reporting bullying, particularly if the survey is conducted and analysed internally.

    It does seem whilst some programs have been designed to develop doctor/patient skills, there may well be a need to provide junior doctors or medical students with relevant training and skills so that they can be confident in reporting bullying behaviours without fear of retribution.

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