Bullying in medicine
Encyclopedia
Bullying in the medical profession is common, particularly of student or trainee doctors. It is thought that this is at least in part an outcome of conservative traditional hierarchical structures
and teaching methods in the medical profession which may result in a bullying cycle.
According to Field
, bullies are attracted to the caring professions, such as medicine, by the opportunities to exercise power
over vulnerable
clients and over vulnerable employees.
and increase job-induced stress; it also leads to low self confidence, depression
, anxiety
and a desire to leave employment. Bullying contributes to high rates of staff turnover
, high rates of sickness absence, impaired performance, lower productivity
, poor team spirit
and loss of trained staff. This has implications for the recruitment
and retention of medical staff.
, humiliation
and harassment
(nonsexual or sexual). Discrimination
based on gender and race are less common.
In one study, around 35% of medical students reported having been bullied. Around one in four of the 1,000 students questioned said they had been bullied by a doctor, while one in six had been bullied by a nurse. Manifestations of bullying include:
One study showed that the medical faculty was the faculty in which students were most commonly mistreated.
Trainee doctors who feel threatened in the clinical workplace develop less effectively and are less likely to ask for advice or help when they need it. Persistent destructive criticism
, sarcastic comments and humiliation
in front of colleagues
will cause all but the most resilient of trainees to lose confidence
in themselves.
Consultants
who feel burnt out
and alienated may take their disaffection out on junior colleagues.
, and has traditionally involved teaching by intimidation
and humiliation
. Such practices may foster a culture of bullying and the setting up of a cycle of bullying, analogous to other cycles of abuse
in which those who experience it go on to abuse others when they become more senior. Doctors are increasingly reporting to the British Medical Association
that they are being bullied, often by older and more senior colleagues, many of whom were badly treated themselves when more junior.
patients and nurses.
Speaking of many doctor's predilection of bullying nurses, Teresa Brown writes:
organisation workplace has been identified as one in which workplace bullying occurs quite frequently. It is thought that relational aggression
(psychological aspects of bullying such as gossipping and intimidation
) are relevant. Relational aggression has been studied amongst girls but not so much amongst adult women.
in the film series Doctor in the House
, is often referenced as the archetypal arrogant bullying doctor ruling by fear.
News stories
Hierarchical organization
A hierarchical organization is an organizational structure where every entity in the organization, except one, is subordinate to a single other entity. This arrangement is a form of a hierarchy. In an organization, the hierarchy usually consists of a singular/group of power at the top with...
and teaching methods in the medical profession which may result in a bullying cycle.
According to Field
Tim Field
Tim Field .was a prominent British anti-bullying activist with his main focus relating to workplace bullying....
, bullies are attracted to the caring professions, such as medicine, by the opportunities to exercise power
Control freak
In psychology-related slang, control freak is a derogatory term for a person who attempts to dictate how everything around them is done — "a control freak. Scared to let us have differences"...
over vulnerable
Vulnerability
Vulnerability refer to the susceptibility of a person, group, society, sex or system to physical or emotional injury or attack. The term can also refer to a person who lets their guard down, leaving themselves open to censure or criticism...
clients and over vulnerable employees.
Impact
Bullying can significantly decrease job satisfactionJob satisfaction
Job satisfaction describes how content an individual is with his /her job. The happier people are within their job, the more satisfied they are said to be. Job satisfaction is not the same as motivation or aptitude, although it is clearly linked...
and increase job-induced stress; it also leads to low self confidence, depression
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
and a desire to leave employment. Bullying contributes to high rates of staff turnover
Turnover (employment)
In a human resources context, turnover or staff turnover or labour turnover is the rate at which an employer gains and loses employees. Simple ways to describe it are "how long employees tend to stay" or "the rate of traffic through the revolving door." Turnover is measured for individual companies...
, high rates of sickness absence, impaired performance, lower productivity
Productivity
Productivity is a measure of the efficiency of production. Productivity is a ratio of what is produced to what is required to produce it. Usually this ratio is in the form of an average, expressing the total output divided by the total input...
, poor team spirit
Team Spirit
Team Spirit was a joint military training exercise of United States Forces Korea and the Military of South Korea held between 1976 and 1993. The exercise was scheduled from 1994 to 1996 but cancelled in each year as part of diplomacy to encourage the Government of North Korea to disable the North...
and loss of trained staff. This has implications for the recruitment
Recruitment
Recruitment refers to the process of attracting, screening, and selecting qualified people for a job. For some components of the recruitment process, mid- and large-size organizations often retain professional recruiters or outsource some of the process to recruitment agencies.The recruitment...
and retention of medical staff.
Bullying of medical students
Medical students, perhaps being vulnerable because of their relatively low status in health care settings, commonly experience verbal abuseVerbal abuse
Verbal abuse is best described as a negative defining statement told to you or about you; or by withholding any response thus defining the target as non-existant...
, humiliation
Humiliation
Humiliation is the abasement of pride, which creates mortification or leads to a state of being humbled or reduced to lowliness or submission. It can be brought about through bullying, intimidation, physical or mental mistreatment or trickery, or by embarrassment if a person is revealed to have...
and harassment
Harassment
Harassment covers a wide range of behaviors of an offensive nature. It is commonly understood as behaviour intended to disturb or upset, and it is characteristically repetitive. In the legal sense, it is intentional behaviour which is found threatening or disturbing...
(nonsexual or sexual). Discrimination
Discrimination
Discrimination is the prejudicial treatment of an individual based on their membership in a certain group or category. It involves the actual behaviors towards groups such as excluding or restricting members of one group from opportunities that are available to another group. The term began to be...
based on gender and race are less common.
In one study, around 35% of medical students reported having been bullied. Around one in four of the 1,000 students questioned said they had been bullied by a doctor, while one in six had been bullied by a nurse. Manifestations of bullying include:
- being humiliated by teachers in front of patients
- been victimised for not having come from a "medical family"
- being put under pressure to carry out a procedure without supervision.
One study showed that the medical faculty was the faculty in which students were most commonly mistreated.
Bullying of junior (trainee) doctors
In a UK study, 37% of junior doctors reported being bullied in the previous year and 84% had experienced at least one bullying behaviour. Black and Asian doctors were more likely to be bullied than other doctors. Women were more likely to be bullied than men.Trainee doctors who feel threatened in the clinical workplace develop less effectively and are less likely to ask for advice or help when they need it. Persistent destructive criticism
Criticism
Criticism is the judgement of the merits and faults of the work or actions of an individual or group by another . To criticize does not necessarily imply to find fault, but the word is often taken to mean the simple expression of an objection against prejudice, or a disapproval.Another meaning of...
, sarcastic comments and humiliation
Humiliation
Humiliation is the abasement of pride, which creates mortification or leads to a state of being humbled or reduced to lowliness or submission. It can be brought about through bullying, intimidation, physical or mental mistreatment or trickery, or by embarrassment if a person is revealed to have...
in front of colleagues
will cause all but the most resilient of trainees to lose confidence
Self-confidence
The socio-psychological concept of self-confidence relates to self-assuredness in one's personal judgment, ability, power, etc., sometimes manifested excessively.Being confident in yourself is infectious if you present yourself well, others will want to follow in your foot steps towards...
in themselves.
Consultants
Consultant (medicine)
In the United Kingdom, Republic of Ireland, and parts of the Commonwealth, consultant is the title of a senior doctor who has completed all of his or her specialist training and been placed on the specialist register in their chosen specialty...
who feel burnt out
Burnout (psychology)
Burnout is a psychological term for the experience of long-term exhaustion and diminished interest. Research indicates general practitioners have the highest proportion of burnout cases; according to a recent Dutch study in Psychological Reports, no less than 40% of these experienced high levels of...
and alienated may take their disaffection out on junior colleagues.
Bullying cycle
Medical training usually takes place in institutions that have a highly-structured hierarchical systemHierarchical organization
A hierarchical organization is an organizational structure where every entity in the organization, except one, is subordinate to a single other entity. This arrangement is a form of a hierarchy. In an organization, the hierarchy usually consists of a singular/group of power at the top with...
, and has traditionally involved teaching by intimidation
Intimidation
Intimidation is intentional behavior "which would cause a person of ordinary sensibilities" fear of injury or harm. It's not necessary to prove that the behavior was so violent as to cause terror or that the victim was actually frightened.Criminal threatening is the crime of intentionally or...
and humiliation
Humiliation
Humiliation is the abasement of pride, which creates mortification or leads to a state of being humbled or reduced to lowliness or submission. It can be brought about through bullying, intimidation, physical or mental mistreatment or trickery, or by embarrassment if a person is revealed to have...
. Such practices may foster a culture of bullying and the setting up of a cycle of bullying, analogous to other cycles of abuse
Cycle of abuse
The cycle of abuse is a social cycle theory developed in the 1970s by Lenore Walker to explain patterns of behavior in an abusive relationship....
in which those who experience it go on to abuse others when they become more senior. Doctors are increasingly reporting to the British Medical Association
British Medical Association
The British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association’s headquarters are located in BMA House,...
that they are being bullied, often by older and more senior colleagues, many of whom were badly treated themselves when more junior.
Bullying in psychiatry
Intuitively, the psychiatric profession might be expected to be particularly sensitive to bullying and its consequences. However psychiatric trainees are in no way exempt with rates of bullying at least as high as other medical students. In a survey of psychiatric trainees in the West Midlands, 47 per cent had experienced bullying within the last year with even higher percentages amongst ethnic minorities and females. Qualified psychiatrists are not themselves required to be psychiatrically tested.Doctors bullying/abusing patients and nurses
There have been quite a few proven cases of doctors bullying and/or sexually harassingSexual harassment
Sexual harassment, is intimidation, bullying or coercion of a sexual nature, or the unwelcome or inappropriate promise of rewards in exchange for sexual favors. In some contexts or circumstances, sexual harassment is illegal. It includes a range of behavior from seemingly mild transgressions and...
patients and nurses.
Speaking of many doctor's predilection of bullying nurses, Teresa Brown writes:
- "...the most damaging bullying is not flagrant and does not fit the stereotype of a surgeon having a tantrum in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults."
Bullying in nursing
The nursingNursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
organisation workplace has been identified as one in which workplace bullying occurs quite frequently. It is thought that relational aggression
Relational aggression
Relational aggression, also known as covert aggression or covert bullying, is a type of aggression in which harm is caused through damage to relationships or social status within a group rather than by means of actual or threatened physical violence...
(psychological aspects of bullying such as gossipping and intimidation
Intimidation
Intimidation is intentional behavior "which would cause a person of ordinary sensibilities" fear of injury or harm. It's not necessary to prove that the behavior was so violent as to cause terror or that the victim was actually frightened.Criminal threatening is the crime of intentionally or...
) are relevant. Relational aggression has been studied amongst girls but not so much amongst adult women.
In popular culture
Sir Lancelot Spratt, a character played by actor James Robertson JusticeJames Robertson Justice
James Robertson Justice was a popular British character actor in British films of the 1940s, 1950s and 1960s.-Biography:...
in the film series Doctor in the House
Doctor in the House
Doctor in the House is a 1954 British comedy film, directed by Ralph Thomas and produced by Betty Box. The screenplay, by Nicholas Phipps, Richard Gordon and Ronald Wilkinson, is based on the novel by Gordon, and follows a group of students through medical school.It was the most popular box office...
, is often referenced as the archetypal arrogant bullying doctor ruling by fear.
See also
Further reading
- Mistry M and Latoo J Bullying: a growing workplace menace BJMP Mar 2009 Volume 2 Number 1
- Vanderstar ES Workplace Bullying in the Healthcare Professions 2004 8 Employee Rights and Employment Policy Journal 455
- Wood DF Bullying in medical schools Student BMJ October 2006
External links
- Bullying and harassment British Medical AssociationBritish Medical AssociationThe British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association’s headquarters are located in BMA House,...
8 May 2007 - Guidance for medical students on harassment, intimidation, victimisation and bullying British Medical Association 21 December 2007
- Bullying and harassment of doctors in the workplace Report British Medical Association Health Policy & Economic Research Unit May 2006
- The cost of bullying to the NHS
News stories
- Bullying on the NHS BBC NewsBBC NewsBBC News is the department of the British Broadcasting Corporation responsible for the gathering and broadcasting of news and current affairs. The department is the world's largest broadcast news organisation and generates about 120 hours of radio and television output each day, as well as online...
January 22, 1999 - Bullying 'ruining NHS workers' lives' BBC News 6 December 2000
- Many junior doctors bullied BBC News 11 April 2002
- One in four junior doctors bullied BBC News 26 September 2002
- Dunne R 'My fellow doctors bullied me' BBC News 9 June 2003
- NHS anti-bullying culture ordered BBC News 12 January 2006
- Targets' triggering NHS bullying BBC News 18 May 2006
- Surgery team 'unsafe' - and at times 'dangerous' Staffordshire Newsletter 10 March 2011