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The ABC’s Four Corners program God Complex should be regarded as a catalyst for change. Speaking up — safely, lawfully and together — is the first step.
The message is clear: the time for silence is over. The health system must lead, not lag, in complying with workplace laws — before the next crisis or media exposé forces us to do so. There are serious legal, financial and reputational consequences for inaction and non-compliance with contemporary workplace health and safety (WHS) laws.
The medical profession stands at a crucial crossroad: do we speak up to address abuse in our workplaces or are we complicit?
In response to the ABC’s Four Corners recent airing of God Complex, the Royal Australasian College of Surgeons issued a public statement concluding: “While the vast majority of surgeons are dedicated professionals who make a substantial contribution to patients and their communities, we recognise that unacceptable behaviour by a minority can have serious consequences for individuals and for trust in the profession”.
In this article, I will outline laws and codes of conduct to assist most of the dedicated medical practitioners to manage the minority of colleagues who perpetrate medical workplace abuse.
God Complex brought into sharp focus what the medical profession has been grappling with for a very long time. Hierarchical abuse is unlawful, harmful to patients, staff, students and the community — and a colossal waste of the health system’s scarce resources.
The Australian Medical Association (AMA), the Australian Salaried Medical Officers Federation (ASMOF), Medical Deans of medical schools, colleges, medical indemnity organisations, movements like A Better Culture and Civility Saves Lives, as well as many other dedicated clinicians (here, here, here, here, here) have relentlessly pushed for change and have implemented many worthwhile initiatives to eliminate unlawful bullying, sexual harassment, discrimination and racism in medicine. Despite this concerted effort, annual medical training surveys conducted by the Medical Board have documented intractable medical workplace abuse of doctors in training, mainly perpetrated by senior doctors over the last six years.
The ABC’s central question — why have doctors allowed this to persist? — deserves a transparent public response.
In my response, let me be very clear.
The purpose of this article is not about any individual. It is to support anyone who was directly or indirectly triggered by the findings of the ABC investigation; to emphasise that all medical practitioners must comply with WHS and other laws and codes to uphold the highest standards of patient care and maintain public trust; to prevent another damaging media exposé of medical workplace abuse, and to speak up constructively by focusing on system-wide solutions.
As the first part of this series for the MJA Insight+, I will address some common myths that are deterring the medical profession from speaking up.
Myth 1: what doctors do in their personal lives is none of our business
A medical practitioner’s personal conduct can impact their registration, even if the conduct occurs outside of work. This can be enforced by the Australian Health Practitioner Regulation Agency (Ahpra).
These rules under the Good Medical Practice: a Code of Conduct for Doctors in Australia apply to any doctor charged with serious criminal offences such as assault, domestic violence, fraud, drink driving convictions, possessing or using illicit drugs recreationally, or alleged criminal vandalism or malicious damage.
Private actions that damage public confidence suggest poor judgement or show a lack of control and may be seen as professional misconduct. Even without a criminal conviction, personal conduct that is dishonest, violent, threatening, discriminatory or exploitive can lead to regulatory consequences.
It is therefore appropriate for employers to remind doctors to always maintain high standards of conduct both inside and outside of work.
Myth 2: work health and safety laws cannot be enforced in health care
Most health care workplaces claim to place patient care first and to have a zero-tolerance’ approach to staff misconduct and abuse. It is well known that patient health and safety is significantly influenced by the health and safety of the health workforce, and yet, many employers do not comply with or enforce contemporary WHS laws.
Recent government legislated changes to the Managing Psychosocial Hazards at Work Code of Practice to prevent work-related mental injury, the amendment to the Sex Discrimination Act (here, here), the national anti-racism framework, the Whistleblowers Act and industrial manslaughter laws (which also address suicide due to work-related mental injury) are relevant to all Australian workplaces and health care is not exempt. In previous MJA Insight+ articles (here, here), I summarised the major penalties for perpetrators and their employers (including directors and officers) for non-compliance with new WHS laws.
Recent changes to WHS laws are clear, and the moral responsibility of the whole medical profession to uphold them is undeniable — especially to protect staff who may feel powerless to speak up.
Myth 3: doctors cannot speak up without ruining their medical careers
Unfortunately, calling out poor medical workplace cultures and conditions can be detrimental for early career doctors because of the highly competitive nature of training programs and the short tenure of their contracts. Often, early interventions by workplace wellbeing officers (when they are available) and harm minimisation strategies prevent problems from escalating. However, when there is a climate of fear of health system hierarchies, doctors who raise risks, report incidents or make complaints may be unfairly labelled as troublemakers and sustain career damage.
Notwithstanding these barriers, doctors in training can safely make their voices heard by participating in anonymous AMA and Medical Board surveys, completing deidentified workplace incident reporting systems, attending confidential employee assistance programs, and enlisting protections under the Whistleblowers Act. These actions are more powerful than currently realised in exposing the scale of the problem.
Senior doctors have a special responsibility under WHS laws to collectively speak up about hostile work cultures and safeguard our trainees. This means modelling respectful behaviours and mentoring junior colleagues in professionalism. When multiple like-minded senior doctors raise concerns to employers together — and request formal workplace health and safety assessments — the issues are reframed as systemic failures, not personal disputes. Under contemporary WHS laws, this should activate employers’ legal responsibilities under government legislation on WHS.
Myth 4: Narcissistic doctors lack insight and therefore cannot change
A doctor’s lack of insight into the negative impact of their behaviours can be caused by a number of conditions — such as substance abuse disorder, other serious mental illness (including narcissistic personality disorder [NPD]), and cognitive impairment. It is the responsibility of medical colleagues to ensure doctors with these conditions receive urgent specialised care.
Narcissism in doctors is often bandied around to excuse uncivil behaviours in the medical profession. Many doctors are aware they can display narcissistic traits when under intense pressure and they possess the self-awareness to immediately apologise for any uncharacteristic behaviours. The more we recognise this, the less it is a problem.
Narcissistic Personality Disorder is very different. It is a serious psychiatric condition that requires comprehensive specialised clinical assessment. Doctors with NPD may threaten litigation after being slighted by constructive feedback, and then conduct character assassinations on those who could threaten their status. These tactics are very effective ways to deter bystanders from intervening effectively.
While managing damaging behaviours is challenging in any workplace, the medical profession is in a better position than most to intervene early in cases of lack of insight due to temporary or permanent impairment — to prevent patient harm and reputation damage.
Myth 5: doctors in training should toughen up, especially women
Medical workforce committees, surveys, industrial actions, and countless first-hand accounts identify the same health system issues: Australia’s medical workforce is leaving. We are in the grip of a preventable retention and participation crisis — fuelled by poor working conditions and chronic under-resourcing. Skeleton staffing levels, excessive workloads, unsafe rosters, deferral of leave entitlements, and health care access blocks due to the financial non-viability of health care are creating disunity, tension and conflict among colleagues and harming clinicians as well as patients. Doctors in training are particularly vulnerable in this environment.
Within this context, safe and healthy workplaces are not optional. They are a legal requirement, a critical measure for patient safety, and a cornerstone for retaining a functioning, skilled medical workforce — irrespective of gender.
God Complex was re-traumatising for many who have experienced bullying, harassment, and abuse in medicine. Health care systems continue to underestimate the prevalence and impact of work-related psychological injuries, including acute stress and post-traumatic stress disorder (PTSD) in doctors. The re-traumatisation of colleagues demands evidence-based, trauma-informed care, professional support, peer understanding, and a clear assurance from the profession that their experiences will no longer be minimised or dismissed.
Telling doctors in training to “toughen up” under these conditions is not resilience-building — it is a form of abuse.
The first solution: speak up
God Complex ignited a spark, and it is clear that the medical profession is listening. This moment is more than just another exposé.
The call to action is different this time —and even more urgent than before.
The health system should be an exemplar of WHS compliance and a leader not a laggard on cultural safety in the best interests of a healthy clinical workforce, and by extension, healthy communities and patients. Investment in safe systems of work not only saves lives — it also saves scarce health care dollars.
The medical profession is at a crucial crossroad.
- Do we unite to collectively comply with our positive duty to create healthy, safe medical workplaces to comply with new WHS and other laws together (here)?
- Or do we, through silence and inactions, inadvertently seek enforcement, penalties and fines from work health and safety regulators and invite another media investigation (here)?
Do we speak up or are we complicit?
Clinical Professor Leanne Rowe AM is a GP and non-executive director. About two decades ago, her registrar was killed by a patient — a tragedy that shaped her career-long advocacy for healthy medical workplaces. She is a co-author of the 2nd edition book ‘Every Doctor: Healthier Doctors = Healthier Patients’ published internationally by Taylor and Francis
Please consider joining the conversation and using the MJA Insight+ comments section anonymously and constructively.
Where to get help
Your trusted GP or psychologist
Call the Doctors’ Health Line 24/7: 1800 006 888 to be directed to your local doctors’ health service. Doctors’ Health Services are free and available across Australia for doctors and medical students.
OR
NSW and ACT: 02 9437 6552
NT and SA: 08 8366 0250
Queensland: 07 3833 4352
Tasmania and ACT: 1300374 377
Victoria: 1300 330 543
WA: 08 9321 3098
New Zealand: 0800 471 2654
OR be connected to a counsellor through Drs4Drs: 1300 374 377
Lifeline: 13 11 14
Other supports:
- Hand in Hand Peer Support
- Your employer or college may have a wellness program or a confidential employee assistance program (EAP).
- Your union (ASMOF, HSU, AMA) for confidential representation or advocacy.
- Confidential legal advice, but as this can be personally expensive, combative and time consuming, first seek information freely available through the Human Rights Commission or State Anti-Discrimination Board, the Fair Work Commission, or your state WHS regulator.
- There are many other supports available on the websites of our member medical organisations, colleges, movements such as Crazy Socks for Docs and the Hush Foundation, and others.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.
If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
“ The first solution: speak up “. There is a culture of silence in the health industry. Nearly all health staff in Australia sign agreements – these agreements are enforced both in official and unofficial ways. There is a risk to speaking up. Many leaders in the health system may not want policies such as speaking up – particularly to the media – changed.
Health departments in particular have media policies that restrict comments. Many contracts explicitly state that unauthorized media communication is a breach of employment terms and may result in disciplinary action.
Health staff are generally not allowed to speak to the media in any professional capacity without prior approval from the department’s media or communications team. This includes interviews, social media posts, or opinion pieces that relate to their work, department policies, or public health issues.
Staff are usually instructed to refer all media inquiries to the health department’s media office. Even factual, non-controversial comments can be restricted to avoid misrepresentation or miscommunication.
While Australia has whistleblower laws, protections do not usually extend to public media disclosures, particularly if internal reporting channels haven’t been used.
Justifications for these policies include –
• To protect patient confidentiality
• To ensure consistent messaging to the public
• To avoid reputational damage or legal liability
• To maintain public trust during emergencies
These policies suppress transparency and accountability, particularly when health staff want to raise concerns about safety, resource shortages, or policy failures or there is a mismatch between internal realities and public messaging.
Health staff who speak out risk being disciplined, demoted, or dismissed, even when raising legitimate concerns in the public interest.
The media can be an effective means to bring about change. I challenge the author and others to see if policies with regards to speaking up to the media can be changed. I suspect we all know the answer.
Myth: Male surgeons are the only group to abuse their power and bully
While many men are perpetrators of domestic violence and abuse of power, women are certainly not immune from doing these things. I personally suffered mentally and career-wise from a very smart and manipulative bully and she happened to be a female surgeon.
Interesting that the last third of the Four corner program (15 mins of it) somehow involved gender issues rather than bullying/power imbalance. As if there are no bullying issues in nursing (a profession mostly dominated by women),
Unless the Whistleblowers act can guarantee no repercussions for the whistleblower, there will still be perpetrators who can leverage their position and power to make life very difficult for the whistleblower.
Hospitals tolerate things that wouldn’t be acceptable in other industries and the community.
We’ve all seen it and hospitals continue to make excuses. They don’t understand that incivility will actually cause harm to staff and also patients.