In 2015 Dr. Gabriele McMullin, a vascular surgeon, went public with stories of the bullying she had experienced as a surgical trainee, and bullying that is still being experienced today.(1,2)
This led the Royal Australasian College of Surgeons (RACS) to call for a review, after initially denying there was a problem.(3)
The review found that nearly 40% of respondent surgical fellows and international medical graduates had experienced bullying, 20% had experienced discrimination and 7% sexual harassment.
These shocking figures led to an apology from the RACS president to those concerned and later to a Royal Commission. The RACS report included a case where sexual favours were expected in return for tutorials, but in the main, stories were about constant belittling, intimidation and humiliation.
When these stories went to press, the Australian public was shocked. These were stories about a trusted and respected profession. Were we as a profession shocked? I do not think so. We have all heard stories of bullying, many have been bullied – it was almost expected. What was challenging, was that our dirty washing was being aired in public and the question being asked loudly was:
“Why did the profession let it happen?”
Bullying has been a part of training in Medicine for decades, considered by some a necessary part of that training. Medical student bullied by teachers, trainees bullied by seniors, junior doctors being bullied by nurses, nurses being bullied by doctors, students bullying one another. It is not gender specific; doctors of both sexes report bullying, and the perpetrators themselves may be men or women. Neither is it specialty specific. Although bullying appears to be rife in surgical training, it occurs at different levels in all specialties. And they call ours a “noble profession”.
This is not just an old problem
Over the course of my medical career I had felt the situation was improving, but these figures suggest a different story. I had thought there were a limited number of bullies persisting in the medical field and that as they moved towards retirement, a different generation would emerge. I was wrong.
In a recent “Well-being” session I ran with medical students, both male and female students reported being bullied. One had been told, for others to hear, that they looked like an “F…ing idiot”; another when asked a question in theatre had loudly been told “you are an F student, a complete failure.” Is this the way to teach medical students compassion?
In another session for women students only, a group of female surgeons told stories from their own training. They had not all been bullied, but shared stories of experiencing or witnessing bullying or harassment not only by other doctors, but by patients. Their experiences ranged from mild humiliation to moderate bullying to out-and-out sexual harassment, including rape.
So why have we let this happen? Has it simply been passed from one generation to the next? Any educated person knows that humiliation and intimidation are not effective in teaching children, so why are medical students and trainees any different? Perhaps it comes down to something more fundamental.
Is it possible that we accept being bullied because we are in the habit of both being bullies and allowing ourselves to be bullied?
Simply to gain entrance into medical school is for a majority extraordinary stressful. The highest of marks are required and in the modern system, extensive selection exams. Many have their dreams dashed before they are ever admitted. Medical schools today have not only barrier exams, but repeated more minor, but summative assessments which create levels of stress that have been compared to a war zone. High levels of competition mean that students are continually pushing themselves, leading to high levels of anxiety.
The system is bullying, but we have created the system
The system itself is bullying from medical school entry onwards. Young interns have always needed to push themselves mercilessly, suffering sleep deprivation and anxiety while working in a highly charged emotional environment. It is simply expected.
In such an environment where there is lack of support for self-care, where altruism is lauded, where stress levels are high, is it perhaps surprising that they push themselves to their limit? It may be this self-bullying that not only accepts the bullying of others, but indeed may be the root cause of doctors becoming the bully.
We may criticise “the system”, while in reality we have ourselves created this system or at least allowed it to persist. We need to say NO to bullying and we need to stand up to a system which produces an environment where self-bullying is necessary for survival, and where bullies have ruled for too long. This is not the way of compassion, this is not the way to create a loving and nurturing environment for our patients, this is not how a caring profession should behave.