Issue 47 / 7 December 2015

BULLYING and harassment in medicine was brought to the public eye in 2015 in a rather dramatic fashion. 
A Sydney-based female surgeon commented that female surgical trainees would be better off accepting the advances of their male seniors or else risk their careers. 
The public airing of this began a process that resulted in a long overdue, independent examination of how surgery has become infested with behaviour that we feel, as a society, is no longer tolerable.
The Royal Australasian College of Surgeons (RACS) committed to an independent examination of bullying and harassment in surgery. An Expert Advisory Group (EAG) was charged with investigating and reporting on this shameful hospital practice among RACS Fellows, trainees and international medical graduates. The results were concerning. Half of respondents reported experiencing bullying or sexual harassment.
Stories that arose from the report and the investigative process have been shocking and saddening. Behaviours that would be considered sexual assault have been reported. Racial and gender slurs, and threats of derailing careers, were all raised, and on more than one occasion. 
The EAG report made a number of sound recommendations. 
Last week, the RACS released a comprehensive action plan. It includes a drive towards promoting more women to senior positions, compulsory education programs and better complaints management.
After the EAG report was released, many surgeons have reported shifts in the behaviour of surgeons at work. The recent RACS Council election saw six of the eight positions filled by women. These positions are voted for by the fellowship group. 
There is a renewed vigour for change among surgeons.
Unfortunately, this is not the end of the road for the RACS. It would be remiss to think that it should be. 
I believe that the RACS has the opportunity to be a world leader here. And make no mistake, the world is watching how we continue to handle this. 
I am looking forward to the implementation of the action plan, but what has been missing is a strong following by other specialty colleges, professional bodies and hospitals. The AMA did release a position statement on sexual harassment late last week. 
Hospitals are, anecdotally, still employing staff members in all professions who continue to behave in a way that is completely unprofessional. 
However, no other specialty college or professional body has come forth to publicly say that they too will aggressively investigate the prevalence of bullying and harassment. 
A start is wonderful, but that alone is not even close to being good enough. A culture shock, not just change, is so desperately needed within our hospitals. 
All staff deserve a safe workplace, and our patients deserve staff who are safe as well as being able to perform to the best of their ability. The RACS has done a truly good thing by admitting its problems, even if the impetus came from public scrutiny. 
In addition to our colleges and craft groups, we all need to draw a line in the sand and, from this day forward, not accept bad behaviour — from ourselves or from others. 
No longer is it appropriate to turn a blind eye, or place a tricky situation in the “too hard basket”. In fact, it never has been appropriate. 
Now is the time to move forward and be proud that our hospitals and our professions are diverse, inclusive and safe places to be. 
Dr Nikki Stamp is a cardiothoracic surgeon based in Sydney. She has her own blog and is on Twitter @drnikkistamp


Should all medical specialities become more proactive in stamping out bullying and harassment?
  • Yes – it’s not just surgeons (89%, 131 Votes)
  • Maybe – some specialties don’t have a problem (6%, 9 Votes)
  • No – change is happening (5%, 7 Votes)

Total Voters: 147

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7 thoughts on “Nikki Stamp: Beating bullies

  1. Jocelyn Lowinger says:

    As an intern in 1994 I was bullied by at least 3 male registrars. Many a good teaching moment lost. Yelling, sarcasm and comments about walking speed are not good teaching strategies for an overwhelmed intern. It doesn’t breed toughness. It breeds disaster. I was a doctor in distress unrecognised by myself and the administration with no support – nobody felt safe to talk to. Ultimately this bullying undermined my confidence so much I left clinical medicine. I’m very happy with how my career has turned out – and from the vantage point of now I wouldn’t change things. But from the vantage point of then, proper support and teaching may have stopped one doctor from leaving the ranks of clinicians. What can I say – I hope things really change and my heart holds hope for the next generation of junior doctors. I really think part of the cure will come when the profession recognises the common humanity we share with each other and with our patients and the entire community. Letting compassion back in will help. 

  2. Sue Ieraci says:

    “Greg the Physician” – the sort of bullying that continues in many areas of specialty training is easily distinguishable from constructive criticism. If you are unable to distinguish the two, or have been accused of bullying, you may need to revise your style for providing feedback.

    Trainees are as intellectually and emotionally “tough” as they have ever been, but, thankfully, many fewer are now prepared to accept poor behaviour from supervisors.

    There are issues related to the way that trainees are chosen, the ratio between vacancies and applicants, and the amount of power that individual referees carry. From my decades of observation and participation in selection processes, these factors tend to occur more in sub-specialty surgery than most other training schemes.


  3. Joanne Taylor says:

    This is a worldwide phenomenon. As a young surgical trainee in the UK I experienced bullying and harrassment from Surgical Consultants who should have known better. It was witnessed by other Consultants who should have intervened and many nursing and theatre staff just glad there was someone deflecting the attention from them. I was a Surgical trainee from 1998-2001, needless to say I didn’t stick around in Surgery and I moved to a different area.  It should also be recognised many of the male trainees are subjected to equally unacceptable behaviour.

    I challenged my bullies, complained to the hospital trust and involved the BMA. Nothing was done, everyone was too scared to come forward. Hence, it’s no wonder that this culture still persists.

    It saddens me that in 15 years things haven’t really moved on at all, I do think the Royal Colleges need to be more proactive in addressing this issue. Over 50% of the medical workforce is now women, yet still women are in the minority in Surgical specialities, I often hear reasons for this cited as the long hours, childcare issues etc but I wonder if the truth is more that trainees are still subjected to the kind of abuse I endured.

    The RCSeng may now have a female president and one would hope that indicates change is afoot, however I hope they follow the lead of RACS and commit to an independant review of surgical trainees experiences.

    I’m now a Consultant in a speciality in which I have never witnessed or been subjected to any kind of bullying. I’m also a Clinical Director, so clearly I wasn’t as stupid or useless as my bullies wanted me to believe

  4. Greg Hockings says:

    I would like to add a note of caution. There is a vast difference between bullying and constructive criticism. I do not know how clinical teaching could continue if trainees or medical students are able to claim that they feel bullied after receiving criticism of their work. Medical practitioners need a certain amount of toughness and resilience to do the best for their patients and professional differences of opinion can and do occur. There are times when trainees may need to be told that they have not met the required standard in the way they have managed a patient. This is not bullying, but an attempt to point out the trainee’s deficiencies and so protect their future patients from harm. If this is interpreted as bullying, I for one will withdraw from the voluntary teaching and mentoring I have done for over 20 years in my hospital work – and I strongly suspect that I will not be alone.

  5. Geoff Toogood says:

    Totally agree its not just the surgeons but great of them to show leadership

    Medical administrators have a survey that shows bullying as well 

    The system is in a very bad state and I have little doubt lives have been lost or careers ruined 

    Sadly it exists at all levels and and all craft groups and sadly it who we call leaders …..maybe like the Devil wears Prada 

    The culture needs a shake up and has done so for while 

    It needs the pressure kept up 

    And the momentun for change 

  6. Vasu IYENGAR says:

    Other colleges are also in the same boat as the RACS as are institutions and professions and boards. The quiet game of complicity and active silence is still played thoughout these sectors. Change needs to sweep through all others too. The fact that all other colleges have not even reacted publicly and issued statements of commitment to change and harmony for all genders is a matter of concern. The sexism that infiltrates higher echelons of professional work forces in Australasia is deep rooted and I applaud the RACS for their leadership albeit one forced upon them by bad publicity and public demand for justice. It’s time everyone else acknowledged their problems and vowed to make genuine changes.


  7. judith o'malley-ford says:

     and it’s not just the medical, nursing and administrative staff involved in this medical crisis. You can include policy makers and politicians themselves who have allowed this to fester and grow.

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