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MOST health care organisations have policies to deal with aggressive patients but it is aggression from co-workers that causes greatest harm to doctors’ health and happiness, according to new research published in the MJA. (1)
A survey of almost 10 000 Australian doctors from general practice and hospitals found 68% had experienced workplace aggression from a patient or other “external” person in the previous 12 months, and 27% had experienced aggression from a co-worker.
While both kinds of aggression were associated with reduced job satisfaction, life satisfaction and self-rated health, aggression from co-workers was most damaging on all counts.
The researchers wrote that co-worker aggression could be expected to have a greater negative impact than patient aggression because of the greater likelihood of repeated and ongoing exposure.
“Being targeted by those with whom one ostensibly shares the altruistic goals of providing the best possible care may be multiply distressing, particularly for younger and less experienced clinicians, who may not possess the skills or resources to effectively manage aggressive behaviour, especially from more experienced or more senior colleagues”, they wrote.
The study was based on 2010–2011 data from the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey and adjusted for the effects of a range of personal, patient and work-related factors.
It found that 15% of doctors working in general practice reported experiencing aggression from a co-worker, compared with about 30% of specialists. Co-worker aggression was often less “visible” than patient aggression, making it harder for organisations to combat it, the researchers wrote.
They concluded that workplace aggression was a “major professional and health workforce policy concern, in terms of occupational health and safety, and the potential impact on care quality, safety and access”.
A previous report from the MABEL study found that younger doctors were more likely to experience aggression than their older colleagues, as were females, those working in hospitals and international medical graduates. (2)
Professor Simon Willcock, professor of general practice at the University of Sydney, whose research interests include doctors’ health, told MJA InSight there was “undoubtedly a lot of low level bullying in the workplace, not just from medical colleagues but even more so for junior doctors from administrators and other clinical staff such as nurses”.
“The irony is that this often contravenes workplace bullying guidelines but is often fine by people who are senior in the system,” he said.
Professor Willcock said there should be more focus on developing appropriate and effective “resilience strategies” for junior doctors, including the ability to label and resist bullying behaviours.
“Junior doctors often perceive that they have no 'power' to do this, which results in a victim mentality that mirrors the bullying culture”, he said. “Standing up to bullies, without adopting their own bullying tactics, is ultimately the way to go and will lead to the best outcomes for junior doctors.”
Associate Professor Frank Jones, president-elect of the Royal Australian College of General Practitioners, told MJA InSight the issue of bullying was a challenge for general practice principals, particularly those in larger practices.
“I always encourage staff to come straight to my door and discuss things in person if they have a problem with me or another colleague, to prevent tensions from escalating”, Professor Jones said. “Email communication can compound the problems.”
At his practice in Mandurah, WA, which employs more than 30 staff, there was a culture of debriefing after difficult patient encounters to help staff cope with the stresses of the job.
“Dealing with unwell, anxious patients with sometimes unrealistic expectations is stressful, whether you’re the doctor or the receptionist behind the front desk”, Professor Jones said.
Alison Verhoeven, chief executive of the Australian Healthcare and Hospitals Association told MJA InSight it was “in all our interests to ensure safer workplaces for health care professionals”.
She said this included ensuring the physical security of facilities and staff, developing organisational cultures which discouraged bullying and intimidating behaviours, and implementing strategies to better manage violent or high-risk patients and visitors.
1. MJA 2014; 201: 535-540
2. MJA 2012; 197: 336-340
(Photo: skynesher / iStock)
An unbelievable and unforgiveably ignorant statement from Professor Simon Willcock to say ” “Standing up to bullies, without adopting their own bullying tactics, is ultimately the way to go and will lead to the best outcomes for junior doctors.””
Standing up to minor bullies and secondary bullies maybe remotely successful however many bullies up the heirachy have personality disorders (PD) and will show a different face to others. An educated, intelligent PD Dr (white collar psychopath or narcissist) are adept at pulling the wool. Indeed, they usually have most of the upper heirachy thinking they are wonderful despite clear evidence to the contrary and despite a clear history of people having left or changing shifts to avoid them.
Mediation makes the victim look the crazy one and usually places them in a worse position. Should the bully be identified, they avoid accountability some way, most often in the hospital system as being a victim themselves or being depressed, take leave and come back and start their predatory behaviour again.
Until institutions utilise forensic psychiatrists to work in HR and deal with such cases, most victims will be further victimised. Once targeted by a primary bully (PD), it is unlikely much can be done in the present system.
Professor Wilcock sadly shifts the responsibility for bullying from the system and its bullies to the victims by advocating more ‘resilience’ as the solution. Like not wearing short skirts or not going out at night, learning self-defense etc to avoid sexual assault, right? Why not penalize bullying and the ones who tolerate it on their watch instead? That would bring the numbers down rather quickly only the medical fraternity is too frightenened to challenge the old boys up high – it is a ‘self-regulating’ profession after all.
Claiming that ‘standing up to bullies will lead to the best outcome for (the bullied) junior doctors’ in my experience would hardly ever be claimed by someone who decided to stand up to a bully in his life, not even by someone who supported anyone standing up to a bully (in superior position) and living through the shambles his or her professional and private life is likely to have become as a consequence. Of course not standing up to them is a worse outcome in many ways but to ignore the havoc superiors can wreak over a junior doc who dares to openly call and non-aggressively resist their bullying behaviour just adds to my impression that this comment comes from the ivory tower of power rather than the brittle glasshouse of working under bullies.
We are always told to respect the nurses (and other allied health and admin less often). They can make life hell otherwise. However so many times my fellow female(and male) juniors and I have all been subjected to berating and bullying from them. Unrealistic work expectations are not just from our superiors but more so from the nurses. It’s often the feeling to keep them happy at all costs or risk their wrath and potential further torment.
The prevalence of aggressive and abusive behaviour from colleagues in medical profession is common and significantly underplayed. Aggressive behaviour from patients is at most times understandable, and I have never experienced distress in handling them. But it is the abusive and bullying behaviour from some senior doctors is almost impossible to handle. These are the same persons who are supposedly responsible in upholding decent behaviour norms. Whom do you address this to ? There are many repurcussions even if you take that step. You are a junior, and will be working these people all the times, and there is increased risk of escalation of abusive behavior, being declared incompetent and the risk of losing job with bad references for future. Low morale, helplessness, nightmares and depression follows. On the contrary I have never lost sleep over an abusive patient. I don’t think anything can be done, inspite of all the so called ‘bullying-prevention’ in place as the supposed upholders are often the perpetrators.
The MABEL study simply confirms what I’m sure what many of us see, daily. What I’ve noticed is that anyone who lies slightly outside the “cookie – cutter” idea of what a junior doctor should be (female, IMG, older, ATSI, even someone with a different accent, etc) is often singled out and bullied. Let’s face it, no-one knows everything, so it’s easy for a senior doctor to find the chink in a junior doctor’s knowledge and then focus their attention on this and humiliate them in front of peers, patients and other staff. In reality, no junior doctor wants to fail a rotation, so they just tolerate the bullying and persevere. Of course, ultimately, often the abused become the abusers as they progress up the ladder.The results of this study are useless unless action is taken to decrease bullying in our workplace. All doctors should familiarize themselves with Australian laws (http://www.fairwork.gov.au/employee-entitlements/bullying-and-harrassment). As is usually the case, it’ll take just one high profile court case to cause our profession to really wake up to the reality that bullying is just part of our culture! That’s a shocking statement of truth. In reality, any profession that has such a strong hierarchical basis is often prone to a culture of bullying. The airline industry has focussed on changing this culture while maintaining respect for senior pilots. This has not only improved the welfare of junior pilots/engineers but has improved safety. Certainly, the stress of being a junior doctor is added to by bullying. Many will say that it’s the worst part of being a junior doctor.