Ruth Armstrong: Seeking support

THE surgical profession was somewhat broadsided last week when comments made by one of its members at a book launch took on a life of its own.

Vascular surgeon Dr Gabrielle McMullins’s comments laid claim to two problems for Australian women in surgical training: that they can be subject to sexism and sexual harassment and that, if they make a complaint about such behaviour they are out on their own — professionally and personally isolated, and perhaps with no hope of recovery.

The responses in follow-up media reports suggested that there was substance to her claims, although the AMA and the Royal Australasian College of Surgeons immediately condemned her unorthodox advice for trainees that, if approached for sex “probably the safest thing to do in terms of your career is to comply with the request”.

This week in MJA InSight we publish a comment from Melbourne neurosurgeon and chair of the Women in Surgery committee of the RACS, Dr Kate Drummond who reiterates the college’s position that sexual harassment should be dealt with and reported via the appropriate channels.

Importantly, she adds that those in this situation “should be supported through the process of reporting and the subsequent consequences of the report”.

This incident is not first time this year that we have been asked to consider the failings of support systems in medical training. Back in February, media reports about the sudden deaths of four junior doctors, including an ABC Background Briefing investigation, provoked discussion about why junior doctors have high levels of distress and are reluctant to come forward for treatment.

In a commentary written for Crikey, at around the same time, medical educator Dr Kimberly Ivory said the thinking on this topic needed to move beyond individuals, to acknowledge the “dark side” of medical culture. This is where trainees report a learning and working environment that can include “sexual harassment, bullying, humiliation, physical and verbal aggression and discrimination”.

Dr Ivory cited a recent meta-analysis of 51 studies, showing that 59.4% of medical trainees reported experiencing some form of harassment or discrimination during their training. She pointed out that medical education has an “ethical obligation … to support students and trainees to develop their professional identity with integrity”.

Providing support is an underestimated aspect of medical professionalism. It’s a subtheme that flows through many of the articles we publish in MJA InSight. This week, for instance, the author of a comment article candidly requests medical support for the unique and complex set of circumstances that affect families of people who have died from Creutzfeldt–Jakob disease.

In our news section, one story highlights the importance of showing empathy and support to parents who bring children with respiratory tract infections for medical attention, as a backdrop to avoiding unnecessary antibiotic prescriptions. Another story looks at the function of having a registry of people with asplenia or hyposplenia from the patient’s perspective, concluding that what they value most is the personal support it provides.

Despite recognising our need to support patients, it seems that as a group and institutionally we are less adept at supporting each other.

But change may be coming. Some advice for the medical profession came from an unusual source late last week, in the form of an article by former Victorian Chief Police Commissioner Ken Lay published in The Age.

“At times it is very difficult and painful for a proud organisation to accept criticism, particularly when it comes from within. Instinctively it is sometimes easier to deny, to attack the messenger, or to roll out a myriad of ‘best practice’ policies to defend one’s good name”, he wrote.

“Sometimes however, looking in the mirror and reflecting on the ugliness that may be present will make organisations better, people safer, and build community confidence.”

The following day the RACS announced its intention to hold up such a mirror, by convening an independent expert advisory group to deal with concerns of bullying, harassment and discrimination in the health sector.

In making the announcement, college president Professor Michael Grigg concluded: “The College recognises there are problems but is determined to be part of the solution”.

Let’s hope this flags a future where vulnerable young members of our profession can train in a supportive environment, and are no longer out on their own.

 

Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight