more_vert
IT is a sad fact that bullying and harassment, both sexual and otherwise, occur today in public and private life.
Recent media attention to comments made by a Sydney surgeon have unfortunately suggested that this is so prevalent and tolerated within the surgical profession that our trainees would be best advised to acquiesce to such behaviour for fear of the effect of speaking out on their future careers.
I support the response of Dr Grant Fraser-Kirk, from the Royal Australasian College of Surgeons (RACS) Trainees’ Association, who, in a letter to all surgical trainees, said these assertions have been met by the profession with a “mixture of disgust, dismay and embarrassment”.
For the majority of us, this is not the defining experience of participation in surgical life.
However, there is no place for this behaviour where it occurs, and the victims should be encouraged to report it through the robust avenues available, which include the RACS, the Australian Health Practitioner Regulation Agency and the human resources department of their employing hospital.
They should be supported through the process of reporting and the subsequent consequences of the report. It is particularly heinous when such behaviour involves our trainees — those who have entrusted their futures to the profession and who are particularly vulnerable.
Our protection of their interests should be vigorous and absolute. Bullying and harassment should not be tolerated by surgeons at any time.
The surgical profession is made up of individuals who have devoted themselves to the care of others. It is a noble profession filled with inspiring doctors whose contribution to society is enormous.
My personal experience of the profession has been overwhelmingly of collegiality, satisfaction and friendship. However, I understand that this is not the experience of all.
Nevertheless, this is not just a problem for the surgical profession. This is a societal problem which we must all commit to correct.
Perhaps the most disappointing aspect of these recent comments is the effect that they must have on young women and men considering a career in surgery. To aspire to become a surgeon is to begin a life of service, satisfaction and some sacrifice to the rigours of acquiring and retaining the requisite knowledge and skill.
The suggestion that to embark on this endeavour is to also accept endemic abuse is untrue, unhelpful and damaging.
The anticipated findings of the recently created RACS Expert Advisory Group over the next few months will provide a framework in which change can happen and provide the background to target areas of particular concern.
The eminent panel, which includes former Victorian Health Minister and current chair of the Royal Children’s Hospital Rob Knowles, current CEO of Oxfam and previously Australia’s Federal Race Discrimination Commissioner and Victorian Equal Opportunity and Human Rights Commissioner Dr Helen Szoke, chair of the Medical Board of Australia Dr Joanna Flynn, former Chief Commissioner of Victoria Police Ken Lay, RACS incoming vice president Mr Graeme Campbell, and incoming chair of the RACS Professional Standards Committee Dr Cathy Ferguson, are well placed for this task. The implementation of their recommendations will be the responsibility of all surgeons.
The past two decades have seen an increase in the number of women training in surgery from just a few per cent to more than 25% today. There is still much to be done to further increase these numbers and to make surgery a welcoming profession for all who wish to pursue it.
This will be achieved by positive and balanced portrayals of surgery, including of female surgeons, by mentoring, by cultural change and by strenuously rejecting bullying and harassment where it occurs.
It will not be achieved by the silence of the victims of intolerable behaviour.
Associate Professor Kate Drummond is a neurosurgeon in Melbourne and is the deputy chair of the Women in Surgery committee of the RACS.
Loading ...
Bullying is very common and affects senior staff as well as juniors and allied health. Men and women can be bullies and junior staff can bully more senior staff.
Sexual harassment is also common, mostly as inappropriate comments and unfunny jokes but can include requests for sex.
Until the Colleges, APHRA, AMA and employers take complaints seriously, investigate properly and punish perpetrators and not victims it will continue. The good men who speak up against evil need to be protected too.
Bullying is rife and not just in surgical training programs. After the birth of one of my children I was told by my department head to ‘take off the next 15 years and then do a two week refresher course’ prior to recommencing work. This statement resulted in me travelling 100kms to a barrister’s rooms for several rounds of ‘mediation’ because the CEO of the hospital found it ‘too uncomfortable to be in the same room’ as my department head. When I was told that ‘compassion, empathy and caring’ did not attract a dollar value and were thus not worth anything it made it very easy to leave the public health sector. Sadly 10 years on I was recently bullied by a junior colleague. He did not extend the same ‘courtesy’ to my male colleagues of a similar age and level of seniority and I have no doubt that he saw me as ‘a soft target’. I am very grateful to the colleague who took umbrage on my behalf. I can provide first hand information of humiliating and sustained vitriolic attacks by a professor of surgery to me as a medical student and the appalling behaviour exhibited towards public hospital gynae patients who would lie in a treatment room quietly crying while having pelvic examinations performed on them by four consultants, a resident medical officer and 5 medical students. When I queried this process (as the lone female) I was told that this was what happened when you were a public patient. I sincerely hope that the days of this sort of ritual bullying and humiliation of patients because they can’t afford private insurance are well gone but I still feel very uncomfortable when I recall those ward rounds which I believe were institution condoned assault.
I think a lot of correspondents are confusing bullying, wich can take many forms, with sexual harrassment ,which is a specific problem that can occur from both males and females. Bullying is not uncommon in hospital practice, sexual harrassment in my experience is a particular form of unacceptable behaviour and not common. The two need to be seaparated as they are completely different offences.
Bullying and harassment is extremely common in the Medical profession. Doctors are extremely scared to report to someone about them being bullied or harassed. They are afraid of the repurcusions: loss of job, termination of their contract, being reported to the Medical Board as a means of revenge, being told that they are weak, lazy, incompetent, and inefficient, and being ridiculed by their collegues.
In view of the above, most Doctors prefer to feel depressed, have sleepless nights, be perceived as ‘grumpy’ by their wives/husbands and children, and feel ‘bad’ about themselves rather than report being bullied and harassed at work.
I agree with the comment that bullying is rife throughout the health system including bullying of even established Consultants by their colleagues who may be in positions of some authority. Whilst this can be overt, eg disparaging comments in open forums, it may also be very subtle and covert (white anting behind one’s back), even to the extent of engineering terminatuions of appointments. How many of us know of senior colleagues who have behaved inappropriately not only to trainees but to others in the workplace for years yet even more sadly nothing has ever been done. As with many other circumstances, it all about power and typically those most bullied are the least able to do something about it.I agree that evil arises when good men do nothing but it can be very hard when the good are not in the positions of power and many of those who are already have failed to act.
The big issue for me was not the harrassment, which I believe will always go on in any workplace to some degree, but in the advice the female surgeon gave to her younger female colleagues, which was wrong on every level and unprofessional. I actually couldn’t believe it when I read it. The correct response is, report it to the hospital administration immediately. A properly based complaint will not in my opinion affect a career adversely. The other thing that that the reputations of every male surgeon have been impugned, and I resent it.
I have known a number of junior doctors play the raicsm/ sexism/ gender discrimination “card” when they simply were not good enough or conscientious enough in their work.
In 1990 as a very young intern and about 28 weeks pregnant during my orthopedics term the surgeon I worked for bullied me relentlessly, made me stand for hours without any breaks, made lude jokes to his registrar about how I had clearly spent "too much time on my back" rather than studying and gave me a terrible report despite my having worked harder than ever to try and "make up " for being pregnant. He humiliated me and yet it never occurred once to anyone in that operating room, least of all myself to voice any sort of complaint.
The recent stories brought back these unforgettable horrible weeks I spent in hospital training. But it seems many have endured much worse. Braver women than me, I left for family medicine training as soon as I could. I have no regrets in that choice, but I do regret I didn't stand up against that surgeon then, because 25 years later it doesn't sound like very much has changed at all.
This article denies the gravity of issues raised by Dr McMullin. In a wise piece of advice, former Chief Commissioner of Victoria Police Ken Lay warns medical leaders that “history would show that complaints such as these are more often than not based in truth and, at times, hide a far deeper and more sinister problem.”http://www.theage.com.au/comment/best-bosses-dont-ignore-warnings-of-sexism-at-work-20150310-13znub.html
That “far deeper and more sinister problem” is twofold – profession wide sexism & bullying (of both sexes). The combination is toxic in surgery & ripe for producing a horrific case such as Dr Tan’s. (Astonishingly, I have heard from men complaints that female surgeons have “moved in” & taken away market share!!) I am inclined to agree that those who cannot see the problem are either bullies themselves or have been turning away so long they have become blind. Nor is it good enough to claim that this is a societal problem, no different in medicine than elsewhere. Cardinal Pell has already tried that line with the sex abuse Royal Commission. It did not win him any friends. It is time to face this problem head on
Bullying was alas the norm when I qualified 50 years ago. I do not pretend to know how prevalent bullying and sexual harassment are today. But I do know that silence allows them to continue. Last week’s recommendation that the abused should keep silent did a disservice to trainees.
Kate, I think you are seriously out of touch. Harassment has been very much of the surgical culture. Some specialties more so than others. Why is it that so many women are coming forward with stories of harassment. Why is that so many women in medicine are volunteering that their distaste with the surgical culture is what steered them away from having a surgical career. Latest data demonstrates that we DO NOT have 25% female surgeons. This may represent the numbers of women who are trainees and it is misleading to suggest that 25% of surgeons are female.
Hurrah for these two surgeons for making this issue so public – firstly to Dr Tan, the surgeon who reported the harrassment and bullying, and secondly to Dr McMullin, for her brilliantly scathing comment about how well the complaints process served the complainant. To state that just giving the bully a blow job would have been the least-worse option for Dr Tan really hammers home just how entrenched the misogynistic culture is. May change cut as swiftly and as deep as Dr McMullin’s comments did.
what really strikes me in this article by Kate Drommond is the frequent use of the word should. It implies that it is not the current reality. The medical profession and RACS in particular is the most extraordinary old boys club that I have seen during my clinical work in many continents and countries. It makes me outright sick to witness what they get away with. The behaviour towards female trainees and colleagues is only the tip of the iceberg. I am what they call an IMG Australian citizen, who is compelled to leave his family and work overseas in order to make ends meet. The public defamation, lies and bullshit I had to put up with, surpasses anything an ordinary human being would imagine in his wildest dreams. All thanks to RACS and the AOA.
I am a consultant of 35 years standing, and still recall the bullying that occurred during my training. I ensure it does not happen to my trainees, but that is not the case with other Consultants, who indeed bully their trainees. Bullying starts from the top down, and in the Institution I work in that is exactly the case. The Medical Director bullies all doctors, the Executive bully Heads of Services to do more with less, and want instant answers while giving none themselves. The support given when there are adverse outcomes in all fields is minimal to say the least, and any appeal is heard by the Executive! No wonder people are wanting to leave the profession in droves, and only the very hardy make it to the training schemes for all specialties or even to their MBBS. Those are hardened by their experiences, and perpetuate the problem as they continue. That is never going to be good for patients, and it seems we have lost the notion that we are in this profession to look after people, not denigrate them. Bullying is rife in medicine, and until a decent review from the top down, including politicians, is performed and actioned, there will not be any change.
Anon, simple solution is to report him to the medical board. That behavior will stop very quickly.
I work in a regional health service and a surgeon is well known for harrassment of the younger and more inexperienced nurses (graduates and specialist year nurses). His behaviours include taking photos of his own genitals on his phone and asking young nurses to scroll through and find something so that they are sure to see the photos, and comparing the bodies of the people on the operating table to the bodies of the young nurses, among other things. Everybody knows this, including theatre and hospital management, but nobody will address the issue. Theatres are all about making surgeons happy, and that includes not calling them out on their behaviour. The older and more experienced scrub / scout nurses will address the behaviour as a joke, boiling on the inside, to let the younger nurses know that they are aware of the issue, but that’s as far as it is addressed.
And so, ad infinitum, until the next generation of surgeons come through, many of whom seem to be differently enculturated through their training. I entered the profession as an older nurse and never experienced this personally but have seen it in practice more times than I care to remember.
The comments say it all – an article by a leading surgeon who has never witnessed bullying in her career when even the Chair of the RACS admits that 50% of trainees experience bullying. If you don’t see it you have either looked the other way or you have bullied yourself.
Until the perpetrators have to do time for their crime nothing will change. We’ve had investigations, committes and reports a plenty after the Dr Reeves harrassment, the Dr Patel saga – every time the findings were the same: there is an old boys club and a code of silence and whoever speaks up gets crushed and it should be changed.
We don’t need another investigation and committe, we need the law to be used to appropriately punish the perpetrators and the ones under whose watch it happened. That will send a signal very quickly and it will change the culture in no time. Just look at the Church and the Military.
Interesting panel, well thought out with people who are high up there, but have you thought of having a few trainees on the panel. You wont solve the problem unlesss you have people who are actually doing the job and help see where the gaps lie in reporting sexual harassment. I believe this needs to happen in all colleges, it may be more rife in the surgical college but it does need addressing across all the colleges and it does need to be taken seriously as there are people out there who are suffering silently and these are the people you need to figure out how to encourage them to have a voice.
Initially i was outraged at the surgeon’s comments, but not so much anymore at least something will be done to help future trainee’s, if they have problems
I am so dissapointed that people (surgical heirachy) are trying to brush this serious issue under the carpet.
60% of the respondents from a staff survey at a tertiary public hospital had said that they have witnessed bullying in the operating theatre environment.
Absolute rot.
Harrassment is so much a part of the fabric of surgical training, as to be woven into the very fabric of the day-today running of a unit.
Kate, you *are* the exception, not the rule – most of us didn’t experience “collegiality, satisfaction and friendship,” because it simply wasn’t there. Humiliation, abandonment, aggression, and hostility more accurately describes training for many of us. For others, the harrassment involves physical or emotional abuse.
I expect very little from the College’s token attempt to respond to harrassment, expect a talk-fest, many committee meetings, consultation fees (which or course will be exorbitant, perhaps even justifying a training fee increase), and nothing to show for it, except a footnote in the next college publication.
Is it a coincidence correspondence on this subject from involved parties has been anonymous?
Would you put your name to having been through a scheme that treats its members with such disdain?
Bullying occurs at many levels in the medical profession but is often excused as “in the patients interest” or “in the heat of the moment”. Often it is forgiven when a flippant apology is made. Iimagine if the public was exposed to some of the bullying that we witness in the medical workplace.
I believe the public would be astounded. Although it is not too common, when it does happen, it is scary to watch the abscence of any response to the person doing the bullying by those watching. While we all say nothing the bullies win. I have seen nurses abused in front of medical students, residents and other senior senior staff. Nothing is said, shoulders shrug, faces look away and we go on with our work. This behaviour won’t change unless we state at the time that it is unnacceptable. Even in robust medical meetings some go too far and behave as bullies. Often senior doctors don’t pull the bullies, who threaten and imply legal action, into line.
The battle may never be completely won, but bullies need to understand that their behaviour is not admired. Their behaviour is merely a sign of their insecurity and a defect in personal communication skills. Such behaviour should lead to a negative consequence for them, even if it is only a rebuke at the time.
At the same time correction of a mistake, guidance in learning and promoting patient advocacy should be accepted by us all and we should not hide behind an accusation of bullying to prevent correction or promote good care in the workplace.
“The only thing necessary for the triumph of evil is for good men to do nothing”
Undeniably, it is only a few rotten apples who behave badly, but as long as the profession does not take the transgressions seriously and appropriate consequences are not enforced, and as long as the victims of this behaviour face greater sanctions than the perpetrators, then the profession is being complicit in sexual harassment and bullying.
The establishment of the RACS Expert Advisory Group is encouraging, as is the even gender mix of the panel, but the real test will be the response of the College and the profession to the findings and any recommendations which are made.
Oh, ha ha ha. Shoot the messenger, and… say that the worst part of the message is that women will not enter the profession. I remember when the drugs in the Tour de France story broke. Some cyclists said that the press did the Tour harm because it would ruin its reputation. I have an idea: why not say that it is the bullies who are hurting the profession? Hmm?
Whilst I’ve (fortunately) never been subjected to sexual harrassment, I believe that bullying is endemic in the healthcare workplace. It comes from all levels – from the Ministry of Health downwards. Ridiculous “key performance indicators” are forced on departments, there is pressure to do more with reducing resouces, job security is threatened, and when the inevitable mistakes occur, then the support from line managers is underwhelming. Medicine is increasingly more complex and the problems of the ageing population with increased family expectations of what is achievable with modern medicine create a complex situation, not helped by hospital inpatient teams which often seem only to exist to serve their own interests, and are quick to block referrals and waste time, when time is such a precious commodity. Those who think bullying is NOT endemic, are probably the bullys.
I find the ‘quick and dirty’ Poll unfortunately designed – providing an ‘all or nothing’ set of choices which really have nothing to do with each other.
Where, for example, is an option for ‘sometimes a serious problem in medicine’?