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EVERY year on the first Friday of June, we pull out our crazy, printed socks to raise awareness and normalise the conversation around mental illness in the medical profession.
We promote self-care, work–life balance, and wellbeing initiatives. We name issues relating to unpaid overtime, inflexible training requirements, and stigma around sick leave. We take fun photos, share baked treats, and check in with each other.
We think about what, as fellow doctors and colleagues, we could do to better support one another.
However, too often absent from this conversation – at least in my experience – is the ongoing contribution of bullying and harassment to the poor mental health of junior doctors. It’s an uncomfortable topic, and one that we frequently struggle as a profession to address in any real or tangible sense.
The irony of our bullies donning their patterned socks each June is not lost on me. Because unfortunately, like most registrars, I have experienced bullying and harassment at work. As a postgraduate year 5 (PGY5) doctor this experience has occurred more than once.
From consultants, to senior registrars, to nursing staff colleagues – I have numerous examples from which to choose. As a junior doctor and trainee representative on various committees, I am aware of many more.
This is not a new story nor an original one, and I am not about to say anything that you don’t already know. From overt threats to subversive undermining, junior doctors continue to navigate these challenges in our hospitals.
Some of these stories will be thrust into the limelight and deservingly so; like the story of Caroline Tan in 2015 or the story of Yumiko Kadota in 2019. More commonly, however, these stories will only be whispered in the corridors or perhaps not told at all.
Frequently, the issue will be placed on the trainee – blaming a misunderstanding, poor performance, or a lack of resilience on the part of the junior doctor rather than acknowledging and addressing the bad behaviour of the perpetrator.
Indeed, as a profession we are so uncomfortable with our own vulnerability that there is no greater insult than to suggest that a colleague “might not be coping”.
It is a narrative that undermines any effort to create a psychologically safe workplace. And without psychological safety, we can never hope to achieve good mental health.
Each time I have raised my concerns about poor behaviour in the workplace, whether experienced by myself or by others, there have been staff ready to defend its occurrence or to justify why it cannot be changed. And there have been others who have been willing to overlook or ignore it altogether.
But equally, there have been champions, and I dedicate this to them:
- colleagues who have called out bad behaviour, even when it might put their own career progression at risk;
- colleagues who have memorised local hospital policies, College requirements, stipulations within the Enterprise Bargaining Agreement and the Fair Work Act (2009) – ready to draw on relevant subsections at a moment’s notice;
- colleagues who have shared their own lived experiences of bullying and harassment, and who have supported others to do the same;
- colleagues who have rallied together, knowing that none of us can ever be safe at work until we are all safe at work;
- colleagues who supported me this past Crazy Socks 4 Docs day, as I lodged my own complaint with human resources.
And as I reflect on my experiences, I find myself thinking about our final-year medical students – currently preparing for internship, full of enthusiasm and excitement to join us as colleagues within the medical profession. Trusting that those who came before them will contribute to meaningful change.
I hope that going forward, their stories will be better.
Dr Skye Kinder is the 2019 VIC Young Australian of the Year. She was recently named by Forbes 30 Under 30 for social impact in the Asia Pacific region. She can be found on Twitter @skyekinder
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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Wow, all the bullying dinosaurs coming out the woodwork. I’m just glad that people like Joseph Moloney sound like they’re retiring. The only real response to someone like that is “ok Boomer”. Good riddance, and what a stunning lack of insight.
Extraordinary!..Relate my experience that bullying was often overcalled – being a far too ready “go to” when feelings of discomfort were experienced – and suddenly I’m “dismissive” of the main article. No time to debate? I suspect some younger doctors are unwilling to perceive distress in the system other than their own! There’s only so much time when you’re working 100 hours per week with almost no time for family, to spend extra time with mentoring. In the country, there aren’t resources to pick up the pieces…As for going with the times….after 30 years of intensive difficult practice, courting burnout, driven by patient demand rather than personal choice (no one wanted to locum in the bush then!), I really don’t see much difference in the range of issues with the difficult doctor learning curve. I really think there should be more data delivered in this area: it’s my perception that the busier the location, the more likelihood of bullying complaints, and is anyone daring to enter the minefield of analysing the types of complaints: there might be helpful data re patient throughput (e.g. a busy A & E in the Gold Coast vs a more hierarchically supported major teaching hospital), or vs the nature of the subspecialty, or the humdinger: female vs male consultants
It’s difficult to decide whether to tackle obvious prejudice. As the one contributor brazen enough to give my name (probably because I’m now retired and it’s likely not to create career consequences), let me reply to anonymous above. Older doctors “oblivious” to the tremendously difficult learning curves of younger RMOs? Each and every one of several intern experiences is etched on my brain!!..Serious bullying by a female consultant who at least apologised while drunk at the subsequent Christmas Party (!), using me wrongly to make a point about someone else, to interfere when I was at home looking after newborn twins, sending me on retrieval trips without warning…..all were toughening experiences distinctly unpleasant. Then to manage hospital responsibilities (NEVER full time – always contracted – to public plus private hospitals in a large rural centre often had me rushing away from the ward to attend to parents and children who’d driven 2 hours through country roads to see me……Keeping in touch with RMOs by phone as much as possible; but despite much attention, being thought of as bullying when only normal personal difficulties intervened (How about the RMO who called me a bully because I had to lean over to hear her timid soft voice when I had presbycusis….well explained beforehand…??). Come on, be fair….your prejudices are obvious!
To the tired excuse of ‘medicine is a hard game’ and ‘if we condemn bullying we’re left with nothing but a grey zone in which we can’t speak hard truths’: There are legal definitions of bullying, seemingly lost on most of our dinosaur consultants and apologists, like it was on the Church covering up the crimes of their child-torturing priests:
‘Bullying is when people repeatedly and intentionally use words or actions against someone or a group of people to cause distress and risk to their wellbeing. These actions are usually done by people who have more influence or power over someone else, or who want to make someone else feel less powerful or helpless.’
https://humanrights.gov.au/our-work/commission-general/what-bullying-violence-harassment-and-bullying-fact-sheet
‘Workplace bullying occurs when an individual or group of individuals repeatedly behaves unreasonably towards a worker or a group of workers at work, AND the behaviour creates a risk to health and safety.’
‘In Amie Mac v Bank of Queensland Limited and Others[4] the Fair Work Commission indicated that some of the features which might be expected to be found in a course of repeated unreasonable behaviour constituting bullying at work were:
“… intimidation, coercion, threats, humiliation, shouting, sarcasm, victimisation, terrorising, singling-out, malicious pranks, physical abuse, verbal abuse, emotional abuse, belittling, bad faith, harassment, conspiracy to harm, ganging-up, isolation, freezing-out, ostracism, innuendo, rumour-mongering, disrespect, mobbing, mocking, victim-blaming and discrimination.”
https://www.fwc.gov.au/anti-bullying-benchbook/what-workplace-bullying
Ignorance is no defense against allowing, encouraging or perpetrating an offense at work – and hopefully one day the ones responsible and the ones that have looked away will be brought to account.
Sadly bullying exists at all levels and it gets worse the higher one goes. My worst experiences were when a senior consultant. I know many others who have been bullied out of consultant jobs. The culture needs to change and the ‘caring’ profession’ needs to care. This is not about being too soft or unable to handle criticism. It is about gaslighting, mobbing, misrepresenting the person who is the target of the bullying and treating that person differently to the way others are treated.
If we want docrtors to be strong and resilient we need to make them feel supported and included.
It will immediately be regarded as ‘old fashioned’ to say that Medicine is a tough game. Be that as it may, that doesn’t mean it’s untrue. Resilience is needed.
No one could profess to support bullying, but when we as a society have legislated (as we have) to say that bullying is anything that the apparently-bullied person says is bullying, then we have nothing but one big ‘grey zone’, and nothing but subjectivity.
I will relay the information as sensitively as I perceive it needs to be related. But if hard truths are interpreted as bullying, then yes, some people need to harden up if they are to survive in Medicine.
And that has nothing to do with the ‘culture’: that’s just real life in Medicine, which every now and again is life-and-death.
Dr Maloney’s perspective that ‘bullying is overcalled’ reveals an antiquated view of one who appears not to have moved with the times. First and foremost, all patients under a consultant’s care are their direct responsibility. Doctors-in-training are precisely that, in training. Their time management skills, much like their other clinical acumen requires supportive coaching and guidance, not the frustrated criticism of jaded senior colleagues. If there is inadequate time for tasks to be completed to a sufficient standard, this is an issue to raise with medical administration as one of staffing, not one to take out on junior colleagues.
The response from Dr Maloney dismissively undermines Dr Kinder’s brave and raw piece. Yet, as she rightly points out, this is not be surprising as, when poor behaviour is raised, there will always be those “ready to defend its occurrence or to justify why it cannot be changed”. One may try to make a similar argument to Dr Maloney’s, that things are merely often a misunderstanding, about other issues that our profession faces, such as sexual harrassment. To those brave souls, I say “good luck”.
The reality is that we should not be debating the behaviours that fall into any “grey zone” of acceptability. We should not be arguing about who’s point of view is correct. Our obligation to each other is, rather, to provide psychologically and physically safe places to work. This means navigating well away from any grey zones. It requires a change of mindset, such that we all behave not just from a perspective of “not bullying” each other, but, rather, actively going out of our way to be respectful to one another and to applaud where this is done well.
We are not too busy. We can’t be. We all must make the time to behave well. Our collective mental health depends on it.
A word of advice to those holding similar views to Dr Maloney… Please, for the sake of your colleagues’ wellbeing and mental health, get with the times.
A difference of opinion is neither hurtful nor minimising of another’s contributions. It is telling and sad that speaking up with our own truth and experiences is supposedly belittling those of others.
I have found the strongest stigma re mental disease is from our own colleagues, and that is my lived experience as a consultant dealing with mental disease in a family member in our public health system. The cutting down of others on an opinion forum such as this is unprofessional and hypocritical imo – we do not have to conform to a prescribed train of thought or opinion in order to gain approval from anyone, whether they are an “influencer” or otherwise. We each have our own unique stories and each one is important and valuable. And I am positive Dr Toogood would agree.
Dear Helen, thank you for your insightful background to our Crazy Sock Day, it’s an inspiring story and needs to be retold frequently, I agree. Yet I do not see the author having in any way denigrated the actual day, to the contrary, she celebrates it and its theme.
Yet ‘the irony of our bullies donning their patterned socks each June is not lost on me’ – and not on anyone who has experienced bullying or witnessed bullies being selective in their prey, seemingly flamboyant and kind to one team-member or on one day, yet deadly and vicious on another.
It’s the joy of absolute power without any risk of repercussions that has transformed one of our noblest profession into a cesspit of bullies and silent enablers who lack the balls and decency to call out their incompetent and dangerous peers in high office.
‘The lucky country’s medical system – run by second rate people’ as the saying goes.
I find it interesting that Dr Maloney has an issue with RMOs not being able to time manage, while also stating consultants don’t have the time to *not* provide *effective* mentoring.
Thanks for your comment, Helen. This article is not intended to act as a commentary about the Crazy Socks 4 Docs initiative, but rather it is a reflection of a real world experience that coincided with that day. As I say in the piece, the irony of our bullies proudly parading their crazy socks (meanwhile, overlooking the mental health harms caused by bad behaviour) is not lost on me. It was a poignant juxtaposition for me, which is why I have chosen to mention it.
While the sentiment is appreciated I am dismayed that Geoff Toogood’s campaign has been singled out as merely just a day to reflect, to share baked treats and take photos. Geoff founded this campaign because he was bullied and discriminated against for wearing odd socks after returning from sick leave due to mental illness. He is one of the true champions in this space – a humble, tireless worker who toils all year round and has literally saved lives. He has the support of opinion leaders all around the world. His ‘crazysocks4docs’ campaign is not about 1 day. When I was running my after hours doctor’s clinic many of the people I saw told me if it wasn’t for Geoff they would not have come forward. And a lot of them were really in a very dark place.
The longer I have worked in the doctor MH space the more I have experienced bullying and harassment from within – people who are glad to run me down and bully me. I don’t care, but I care very deeply when my friend and his work is minimised in this way. After all, isn’t this a form of bullying too?
There are unfortunately quite a few sycophants in this space – those who wish to appear as though they are doing a good job, then there are those that do a good job. I don’t know Dr Kinder so I am not pointing the finger. But this article is unfortunately very hurtful to Geoff and those who know him well. I think the author owes Geoff an apology. I don’t tolerate bullying or harassment in any fashion, and I don’t abide by people hurting my mates.
I’d say that we as the medical profession could stand to say that bullying, genuine bullying is an intrinsic element of human to human behaviour. But our profession was built on the pillars of a society that included class and social norms of deliberately treating people badly to keep those class structures in check. Learning by humiliation and such have no place anymore. Junior colleagues are not owned and should not be belittled simply for the crime of being younger.
So people will bully, meaning find a target and home in, unless that person refuses to accede. We can continue working to stop our professions additional will to treat people badly.
And wearing funny socks isn’t a wonderfully powerful thing to do.
A well-educated and decent doctor can teach, inspire and direct during an arrest call – an experienced bully on the other hand is able to turn even the daily hand-over into a mismanaged catastrophe that everyone apart from him dreads.
There’s a nice collection of the usual excuses here all pretending that anyone trying to highlight the reality of hard work, lacking resources and critical issues in the medical system gets framed as a bully.
The opposite is true: all upright medics blowing the whistle shortcomings of seniors, management or the system get either branded as a ‘sensitive’, ‘weak’ and ‘not-hardened’ or simply bullied out of the department – see Bundaberg, see Bristol, see anywhere with incompetent bullies in charge.
It is difficult to find the balance between calling out bullying behaviour and asking folk to be a bit tougher. It is wrong for someone to bully another, and we as individuals and organisations must do all we can to create systems that actively promote the kind of behaviour we want to see. The other side of the coin, however, is that it is a fact that the world in which we have to live and practice is not a perfect one. The world will not necessarily accommodate itself to our particular wants or needs. There is a need for us to learn to deal with that, and to manage until the change occurs. I believe it is incumbent on senior clinicians to model appropriate behaviour both in how we relate to our junior colleagues but also in how we cope when things are less than perfect. I believe mentoring has a significant role in this.
Thanks for the very important article Skye. Yes bullying is an indecent act which cause enormous harm to the victims. As a GP I see people coming with severe impact in their day to day life. Specifically if senior doctors are not supportive at work place the poor young doctors with not much experience will be affected mentally at their early life. Can be in the hospital system and outside in the GP (very common) community. This will impact their relationship at home , work and the entire life. So please support the juniors. If they are doing wrong tell them in a way the young person can accept and acknowledge. Often this will help the young person and gives a greater satisfaction than punishing them.
Watch question time in Parliament and you’ll quickly learn why bullies do it – it’s rewarded.
Listen to the jibes of big tough men like Premiers McGowan and Andrews against Premier Berejiklian, see how much airtime that gets compared to the dignified silence of Premier Gutwein, who maintains the same border restrictions but does not demean and belittle his colleague.
Look at the votes awarded for the Berlin Wall of Coolangatta or the East of Kalgoorlie Checkpoint Charlie.
When a leader can be re-elected after turning away a sick baby who died, with a mob-rallying xenophobic cry of “Queensland hospitals are for Queenslanders”, there is little reason to expect a non-bullying culture in the health system.
I don’t know how to fix it, but the problem starts far higher than ward level.
As a former medical administrator I’d like to point out NSW Department of Health policy to
1. All junior doctors should be paid ALL overtime
2. Medical administration and senior doctors MUST NOT obstruct their overtime claims.
Dr Moloney gives a shining example on how some old doctors are oblivious to the fact that at some stage all doctors start their career and need to be taught by good educators who can guide them with clear, kind and preemptive instructions, patience and supervision through that steepest learning curve of their lives.
Running off after a quick ward round to do private practice while being in a full-time public health job, as so many of them do, is not part of that.
Neither is shaming doctors for being sensitive or taking time to talk to patients when the main cause for complaints is lack of empathy and communication – something like bullying much more prevalent in male and older doctors by the way, as complaints analyses show.
Agree with the comments that although bullying of junior doctors is undoubtedly a major issue, we must not forget that bullying of more senior doctors is also an issue that is rarely addressed or acknowledged. The Head of Department where I work is notorious for bullying, intimidation and unethical behaviour , and it is consultant staff in the Department who are frequently targeted. They are often female, relatively recent graduates and vulnerable to criticism and their issues often go unseen and unspoken. It is to the point they have commented to colleagues they have felt suicidal and physically sick because of the way they are treated. Some hospitals seem to have a culture that turns a blind eye and allows this bullying to continue and this needs to be stopped.
Intelligent bullies usually have a lot of Cluster B traits. Those unfortunate “crazy made” by these types usually end up hammered at both ends; by the bullies themselves and then by their supervisors/medical administrators/managers/colleagues to which the bully has endeared themselves to.
HR, in my experience, make the situation worse. They are a gutless department lacking insight such that mediation is forced even when it is known that victims rarely come through in one piece and never get validated. The bully more often than not, comes out glowing.
All bullies have “flying monkeys” that will socially and career wise protect them and all bullies rely on others being complicit. It is those by-standers, those that are in management, those that are supervisors that need to act. They need to have the integrity and courage to speak out and stand by the victim despite the accolades or position the bully gives them. It is those by standers that need to advocate for the victim who by now is usually quite distressed.
There is no doubt ‘bullying’ is overcalled. Trying to give oversensitive young RMOs with no previous toughening work related experience, firm directions when they risk lives through inability to prioritise or time manage, can be a nightmare of misunderstanding. Consultants simply don’t have the time to undertake ‘feel good’ mentoring. What is happily accepted as critical feedback by some RMOs can be called bullying by others. RMOs who feel offended should develop a deeper understanding of work related issues, instead of going straight to ‘bullying’ as a diagnosis. I could give some classic examples!0
What a great and timely piece, thank goodness! Time to recognize that the bullies do indeed enjoy their bullying power and are – usually – not just aware but proud of it and supported by their peers through silence or applause for sexist, racist and destructive jokes and behaviour.
‘We’re the toughest here’ and ‘if you can’t stand the heat get out of the kitchen’ is the usual swagger that accompanies destructive and demeaning workplaces – be that bullies in the military, in medicine or in free enterprise.
Independent external controls have proven the only measure that actually clean up – because the fish stinks from the top – and if you touch that from within you quickly find yourself without…
Thank you Skye for your courage, conviction and support.
I am a senior doctor who has actively chosen to intervene on many occassions, suffered the consequences frequently but will continue to intervene.
I also work with doctors at all levels to teach and train ways of stopping this going forward (some voluntarily, some mandated).
It may be surprising to hear that, in the experience of the who provide these services, almost all ‘bullies’ are not aware they are. They have adopted ways of behaving that are maladaptive and clearly harmful to those around them. Once this is dealt with head on, by their choice, a tap on the shoulder or imposed by employers, the vast majority can and do change. In some cases, they then become active supporters of similar intervention going forward.
All specialty colleges and all employers have access to EAPs who can provide this service – personally, confidentially and away from the workplace so no one notices the intervention, only the positive change from it.
Thanks for this important article. One of the factors that is not always considered is that bullying is a cover for insecurity. Individuals who are not feeling confident in their own abilities or safety may displace this tension onto others. Irritability is frequently a sign of anxiety. The behaviour can only be perpetuated in a culture that does not understand it deeply enough, and therefore is unable to make significant cultural changes. Perhaps, instead of paying lip-service to anti-bullying messages, organisations should look at the driving factors for poor behaviour and address them. For those who refuse to engage with the effort to change, disciplinary action may then be required. Just telling people not to be bullies, while forcing them to work in a toxic workplace, is no more effective than providing yoga lessons.
Thank you Skye
Bullying by all levels of managemnt and management directing how clinical decisons are made also add to the powerlessness of senoir doctors who become disengaged. This is, as you rightly point out is a systemic issue. Persistence from all of us in calling out the bullying will one day hopefully need to lead to a much safer workplace. I say this as a senior doctor working outside of hospital system BUT one who expereinced sexual harrassment (frequently),bullying in the name of teaching,and just downright power displays (and I am talking 40 years ago). My feeling is that it has become worse not better. Thank you for highlighting this again so we may continue to fight for change and asafe workplce wether in the hopsital or the community medical settings.
Indeed it is time now to say enough is enough. Bullying is never ok! Speaking as a RN and midwife I have been subjected to pretty foul conduct by peers and nursing management. I have witnessed bullying to the most junior medical student through to a Registrar. I have spoken up at great personal cost. The imbalance of power and being scared of being shown up as less competent are often at the core of bad behaviour.
Nurses and Midwives against bullying is an Australian group that has been formed as a network for support and guidance for those affected. Sadly the various industrial bodies do not want to assist or recognise this scourge. How can change occur if the various bodies do not acknowledge or work to eliminate bullying in the workplace.
My personal experience of those that abused their personal position of power to cause gratuitous distress are perfectly well aware of what they are doing. I have experienced such abuse from individuals at every level. It is no excuse that those doing the bullying might also be experiencing similar from hospital management.
Thank you Skye for this article. I have a few comments:
Senior doctors also experience bullying. Managers, colleagues or yes again, our nursing staff colleagues, an issue which definitely needs addressing. Our esteemed Colleges are good at saying the right feel-good words but really doing nothing. Our Regulatory Bodies often contribute to the bullying itself.
And there are junior doctors who are themselves bullies.
It seems to be a national problem.
“The irony of our bullies donning their patterned socks each June is not lost on me.”
Sadly some of these bullies do not realise that their behaviour is unacceptable and require a tap on the shoulder by a colleague to tell them so. I have heard form experienced doctors who are shocked when they are told that their behaviour is causing hurt and offence. Culture change requires a concerted effort every day of the year. An example needs to be set by the senior members of the profession and they also need to be prepared to speak up when they see inappropriate behaviour by colleagues. Junior doctors need to keep these issues on the agenda by facilitating discussion with articles like this. This is not an easy issue to fix but we must all persist and keep raising awareness.