Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
An inappropriate response to stress
- Peter Devitt (30 November 2001)
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Bullying in medicine
- Mike Divers (1 December 2001)
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Bullying in Medicine
- John Storrs (1 December 2001)
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Re: Bullying in Medicine - the solution.
- Ruth Hadikin (3 December 2001)
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unsuprising
- Helen Morant (4 December 2001)
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Bullying the bullied
- I Agell (4 December 2001)
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something can be done
- Peter Bruggen (6 December 2001)
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Help for the Victim
- Jeremy Bolton (6 December 2001)
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Borstal Boys & Girls
- Alexandra Bullough (7 December 2001)
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Bullying is part of the human condition
- Neville W Goodman (7 December 2001)
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WHEN THE MEDICAL PROFESSION SHUTS DOWN
- Rita Pal (8 December 2001)
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Patients are bullied Too!!!!!!!
- Pat Davis (10 December 2001)
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The law is more powerful than the bullies
- Dominic Stevens (11 December 2001)
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Bullies, psychopaths and hopelessness
- Russell Lutchman (11 December 2001)
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Bullying: how to help both sides
- Kristin Becker (11 December 2001)
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Bullied for years
- Donna Grant (11 December 2001)
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Re: Patients are bullied Too!!!!!!!
- David Thompson (11 December 2001)
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Those who can, do. Those who can't, bully.
- Tim Field (12 December 2001)
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Unacceptable Behaviour
- Graeme M Mackenzie (14 December 2001)
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Re: Those who can, do. Those who can't, bully.
- Joseph Watine (14 December 2001)
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Re: Bullying the bullied
- Natalie Sturt (14 December 2001)
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learning doctor-doctor communication skills would defeat workplace bullying
- John Boulton (14 December 2001)
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“Powerful” bullies cannot be punished?
- Joseph Watine (21 December 2001)
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Vote with your feet
- Richard Ganz (28 December 2001)
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Re Bullying in medicine
- Alistair P J Thomson (2 January 2002)
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Re: "Powerful" bullies cannot be punished?
- Joseph Watine (28 January 2002)
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Surgical Professionalism
- Dipan N Mistry, Kanchan Bhan (24 February 2002)
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Bullying in medicine
- Daphne I Austin (5 April 2002)
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Peter Devitt, Consultant Surgeon Royal Adelaide Hospital
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This Personal View is a sad tale. Most doctors who have risen through the ranks to consultant status have learnt from their own experiences that junior staff are vulnerable and need support. The consultant described here would appear to have her own problems and her inability to handle the stresses and strains of her position are deflected by taking in out on those around her. Of course, junior staff, through their own lack of experience are not going to provide the sort of help that a fellow consultant might. Being able to handle those situations is part of the challenge of being a consultant. Taken at face value from the views expressed, it would appear that the consultant in question is unable to cope with those challenges. I do not have a solution, only to say to the author that most consultants have more insight than the individual concerned in this case, and not to give up on aspirations of a chosen career, based on one bad episode. |
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Mike Divers, postgraduate clinical tutor Nobles(IOM) Hospital Isle of Man
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Editor The bullying described in a recent personal view 1 is completely unacceptable. Whilst I have every sympathy for the writer wishing to remain anonymous she must report the consultant involved both to her specialty training committee and trust medical director. Unless this difficult step is taken how many more trainees will be unnecessarily lost to the profession at a time when appropriately trained doctors are in short supply? If seemingly appropriate action has already been taken and discretely ignored then regrettably the consultant trainer should be reported to the GMC. Mike Divers Postgraduate Clinical Tutor Nobles (IOM) Hospital Isle of Man IM4 6DG miked@manx.net 1 Annonymous. Personal View: Bullying in Medicine. BMJ 2001; 323:1314 (1 December) No competeing interests |
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John Storrs, Chairman,CCSC Surgical Specialties Subcommittee Kent & Canterbury Hospital, CT3 1NG
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It is a pity that the author wished to remain anonymous. If he or she can substantiate his or her allegations then there is a strong case for "name and shame". Like everybody else consultants can have a bad day but proven persistent behaviour of the type described is totally unacceptable. "Courage mon brave" |
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Ruth Hadikin, Professional Coach and co-author of The Bullying Culture self-employed based in West Lancashire. (previously 18 years in NHS)
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Be a coach! The solution is coaching. Coaching is the oppostite of bullying in that whereas bullying is a negative, disempowering,interaction, coaching is a positive, empowering, interaction. Once Senior doctors realise this they will see that there is a positive way forward through which they can develop their own leadership skills whilst developing their junior staff. This will also enable them to leave a legacy by coaching their successors to provide a service and skill level equal to if not better than their own. Coaching differs from mentoring in that mentoring is simply about what you do... coaching is about who you are. Had this senior consultant been coached herself, she may have been more aware of the effect her actions were having on her junior staff, and been more conscious of her own behaviour. Coaching improves performance. Bullying is counter-productive. There is no doubt that if senior consultants wish to improve the performance of their staff they should think about becoming masterful coaches rather than bullies. It is simply a matter of intention and attention. If you are not paying full attention to your interactions with your colleagues and trainees, and don't fully intend to coach them well, then chances are that under pressure you may inadvertantly bully them. Coaching is an enjoyable experience which enhances your sense of fulfilment and work satisfaction. References: Hadikin,R; O'Driscoll,M (2000)The Bullying Culture. Butterworth-Heinemann: Oxford. Whitmore, J.(2001)Coaching for Performance. Brealey Publishing: London. Whitworth,L; Kimsey-House,H; Sandahl,P. (1998) Co-Active Coaching. Davies-Black:California. |
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Helen Morant, RMO, Gastronenterology Repatriation General Hospital, Adelaide
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Is it possible that the victim of this bullying was less able to cope with harsh critisiscm because she was physically exhausted from working 90 hour weeks, mentally exausted from studying for exams on top of a more than full time job, and emotionally exhausted from telling several patients that week that they had diseases that would kill them? Is it possible that the bully had been "toughened" by forcing her way to the top of a male dominated proffession, constantly having to prove herself as a woman, and now realising pressures of constant managerial change, budget management, underfunding as well as clinincal committments? As a very junior doctor, my perspective on looking at those further up the tree is that they value their tough times as fantastic learning experiences, possibly irrationally. Now they'vebecome consultants the length and severity of their training is what they value. They compare their experience with that of junior staff, (with the easy partial shift rotas, educational supervisor, and protected teaching time)and are afraid that the new breed will not be so clinically conpetent. Any senior who has discussed hours or teaching time with a junior, will have uttered the words "when I was a house officer..." This reinforcemnet of the "all progress in training / hours is bad, because you won't get the training I did, which made me th consultant I am today" attitude, constantly and inherently devalues the work of junior staff. Bullying of this nature is institutional in the NHS, and there needs to be a huge cultural change before it is solved. |
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I Agell, Specialist Registrar in Psychiatry St Luke's Hospital, HUDDERSFIELD, HD4 5RQ
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I read with interest the Personal View "Bullying in medicine" published in your journal on the 1st of September 2001. Previous electronic responses seem somehow to send the message that the author should do something about the whole incident. Bullying exists in the health professional culture despte the caring nature of doctors and other professionals' work. If a bullied person was capable of ending the incident they would do so. The imbalance of power is the most important factor to the determine inaction. Bullying need first to be accepted as existing by those in power and routine screening put in place to deal with it when appears without asking the vulnerable individual to further risk their careers. Some job applications demand references from your last consultant, should we also start changing this culture?
References: Anonymous, (2001) Bullying in medicine. BMJ 323, 1st December 2001, 1314. Green, S.,(2001) Systemic vs individualistic approaches to bullying. Journal of the American Medical Association,286(7) 787-788 Hicks, B., (2000) Time to stop bullying and intimidation. Hospital Medicine (London). 61 (6):428-31 No competing interests |
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Peter Bruggen, retired consultant psychiatrist
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Dear Anonymous I like not knowing who, what or where you are. It frees me to write to you like this, publicly. We might even have a correspondence. You told a shocking story. While I sympathise with those who wish you had gone public, I think they do not understand all the risks. When I was interviewing people for my book 'Who Cares? True stories of the NHS reforms' I met an ex-senior manager who had been advised that he could fight being told to resign and might win at a tribunal. But the cost could be the label of troublemaker. I hope that those who wish you to come into the open, might challenge themselves to be more observant or questioning in their roles of tutor, consultant, or colleague. There are others who have had experiences like yours. You may have read 'Workplace bullying in NHS community trust: staff questionnaire survey' by Lyn Quine (BMJ 1999; 318: 228-232). I have met doctors far more senior than you who would plan journeys through the corridors to avoid certain people or who, if they heard those individuals were in the hospital, would tremble. If I had learned what had happened to you earlier, here are some of the things I might have said. While feeling that we understand others can sometimes be helpful, it is not all. When victimised or afterwards, there are things we can do to make life more bearable and recovery quicker. I might have suggested how you could gain more control of events and your own experiences. I could advise on the use of mental imagery, guided fantasy, and different strategies. I would have told you of the senior consultant who found himself in a meeting when a greatly feared colleague joined it. He survived by imagining, in great detail, that person asking for a private meeting and in it, apologising for lying to him. I would have told you of techniques which use no personal disclosure, but yet can be useful in changing the detail or quality of memories we carry with us. (We might even have tried that 'long distance'.) I would have told you of the many children who had become less fearful of bullies after imaging them naked, squatting and constipated. Although I hope you will reply in some way, I know that you might not even read this. But I do have a question to ask you. The BMA started a help-line a few years ago. Do you think the BMJ should start a web site for conversations of this kind, between the 'Anons' and others? Of course there may be editorial considerations over propriety that I've not thought of, but I have the idea that many people could find it helpful. Do you think it would be a good idea? Yours sincerely Peter Bruggen (retired psychiatrist).
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Jeremy Bolton, Assoc Dean, KSS Deanery KSS Deanery,WC1N 1DZ
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I share the dismay and concern expressed by other correspondents. Another source of help and support is, or certainly should be, the Postgraduate Dean.In the former South Thames and now Kent, Surrey and Sussex Deanery we have had an interest in this mattr for sometime (see the B.Hicks reference quoted by Dr Agell) In our quetionnaire for PRHOs prior to a Deanery visit we have questions designed to capture and identify such problems either at Medical School or in the PRHO's present post. This helps generate an atmosphere which "gives permission " for the subject to be raised. We have had instances where a victim's colleagues have raised the matter with a visiting team because they appreciate the difficulties the person concerned has in raising it themselves. It is not unknown for the bully to be a more senior junior doctor who is, presumably, often following the example set by, or experienced at the hands of, his or her more senior colleagues in the past. It is often the case that the bully is either unaware of or unable to stop the abusive behaviour without help and almost always the problem is well known to other Senior Staff who have bennunable or unwilling to take action - more often than not because they do not know what to do in away that can be contructive for all concerned. Our Deanery now has a requirement that all Trusts have an anti- bullying policy in place as part of the educational contract with the Deanery. All of us involved in the education and training of junior doctrs need to promote an atmoshere in which these matters can be discussed more openly and honestly as, without the victim being prepared to "go public", with appropriate support and protection, it is difficult to effect change. |
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Alexandra Bullough, Visiting Instructor in Anesthesiology University of Michigan 48105
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Borstal Boys & Girls Editor: O tempora O mores; Oh the times! Oh the manners! Whilst I feel tea and sympathy for anonymous I also feel angry that she allowed herself to be manipulated in this way and did not have the courage to tell surgeon XX, after the procedure, the exact intraoperative issues that would be worth discussing at a later date mutually convenient to both parties preferably in the presence of an independent witness. A support infrastructure for such incidents should also be easily accessible to the trainee. The response path to such events are fraught with concern for personal reputation and future job prospects however to be humiliated to the extent of crying in public, having feelings of suicide and taking job time out are in my opinion a far worse cross to bear. With any further action taken, one must be prepared to see it through to the end. Strap yourself in; this white-knuckle ride will be unpleasant and highly stressful. Hence this action must not be taken lightly. Again one may even choose the option of bailing out after an impasse has been reached. The end point is that this 'colleague' has been flagged up as a bully or rather behaviorally challenged. A paper trail has been laid and should further incidents occur in the future with other unsuspecting trainees then greater notice and action will hopefully prevail in response to witnessed inappropriate behavior on the work floor. I abhor bullying in any shape or form however I am fully aware that it does go on under a covert almost tacit acceptance of fellow senior colleagues and nursing staff. This is unacceptable however if enough colleagues, trainees, nursing staff, and other unwitting targets were prepared to stand up to these miserable characters and react in a positive active fashion instead of a passive “that’s how they always are” acceptance then less such antisocial behavior would arise. I personally find this bullying behaviour the height of bad manners and simply put it down to where it comes from. Despite being in the ‘caring profession’ I believe anonymous experienced a taste of the oftentimes-quoted ‘real world’ mentality and attitude. The key word is experience. Chalk it up or as they say in the States, suck it up and be better prepared for the next gladiatorial encounter. Dr A S Bullough
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol
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The anonymous writer of the article doesn't know why "bullying is still a part of medical training". This is not really so: bullying is NOT a part of medical training, but there will always be bullies. Bullying is part of the human condition. We can try - and we must try - to make it less likely and to lessen its effect, but we will never prevent bullying completely, whether in medicine or in any other walk of life. |
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Rita Pal, Human Rights Campaigner
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In life, to all those who wonder into medicine, chatter at meetings about the latest research paper and lead a relatively uneventful life, bullying and harrassment is something that " could never happen to them". Human nature seeks acceptance from ones peers. To deviate from this norm and to be oneself is probably the most difficult thing for any doctor to do. There is a certain decorum to medicine. A certain "way" in which you are accepted by your boss, your colleagues. To be an outcast is something noone wishes upon themselves. Yet, amongst all of us there is that one doctor who has differing views or perhaps wears glasses and sits quietly and does not indulge in the banter of normal topics. There is always that one person who may be rather different from the norm. For whatever reason, bullying and harrassment commonly occurs to people who for whatever reason find themselves disliked by the team or their colleagues. Human nature is one where the majority will follow like sheep and so bullying becomes a domino effect. For any of you interested, my name can be searched through www.google.com to find that I have been in an environment where the team has bullied and harrassed me to the point where my life was made miserable by a few people. Nothing I did made the matter better. In my case, I wrote poetry that was "not the normal vocation for a junior doctor". Surgeons would poke fun and question my ability to perform. Rumours would fly around about the distinct form of worded poetry I wrote. And so the scenario began where the domino effect escalated to such an extent that it was intolerable to stay any longer. I happened to be different from many doctors, I happen to be a different person. It is most interesting that my poetry was correlated to me having a "nervous breakdown" by my colleagues. I was actually shopping in the Trafford Centre that weekend they spread rumours about my admission to some psychiatric unit. The problem with petty rumours even petty harrassment is that life can be made unbearable. Usually, your colleagues will not support you but walk away to the other side. I have a thick skin and have never really cared what people thought. This is not possessed by many people. There are many who crumble under the pressure. They suffer in silence and although none of us realise as colleagues how that person is suffering, they may well be extremely unhappy. I knew a medical student who threw himself off the tenth floor due to bulling by his fellow students because he was from a "poorer background". In summary, whatever we all do, our colleagues in our workplace may be a victim. The easier choice is to protect ones self. The correct choice is to support our colleagues and friends. For support, http://www.successunlimited.co.uk/ www.nhs-exposed.com has a selection of resources for whistleblowers and also those who are victims of harrassment. I always wonder whether Mr Richard Smith would print this but our resource is especially for doctors to empower themselves. Thankyou BMJ for taking the time to feature the issue of Bullying within the NHS. Kind Regards Dr Rita Pal |
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Pat Davis, Thyroid Group Helper home
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Thousands of patients are bullied mercilessly by arrogant doctors who refuse to even listen to their symptoms much less bother to make a correct diagnosis ot try a range of treatments until a suitable one is found for the patient. None more so than in Endocrinology where Hypothyroid patients are treated with disdain and indifference and even if they do eventually get diagnosed the only treatment allowed is Thyroxine which dismally fails to treat the symptoms of many patients and even makes them worse. These arrogant doctors refuse point blank to even consider the use of T3 or Armour Thyroid in the blind belief purported by the drug companies that Thyroxine is perfect and one size fits all ..........Oh for the day when these medics themselves develop Hypothyroid and suffer the same hell . |
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Dominic Stevens, GP locum 65 Riverview Grove. London W4 3QP
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Today I have just had a gratifying response to advice that I gave only last week. A patient was in tears because of workplace bullying, and felt helpless. I suggested going go to a solicitor, and one letter has already produced an offer of £10,000 in compensation. Bullies could become too expensive to employ. Your contributer perhaps had more power than he or she knew. | |||
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Russell Lutchman, Specialist Registrar in Forensic Psychiatry Broadmoor Hospital, RG45 7EG
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I was saddened to read the author's personal account of what by its nature, pattern and persistence must be bullying. My medical experience spanning four countries in the last 20 years is a sufficient for me to declare that the kind of bullying described is not unique to the United Kingdom. Unfortunately, many doctors at every level of seniority, know not that they know not, what bullying is. From personal observation, many still think it is some kind of forceful banter, physical aggression or sexual harassment. Those who are inclined to speak or write about their experiences of bullying are likely to be labelled 'whimps' or 'softies', in the background, by their colleagues. One's closest colleagues are likely to raise issues of 'stuff' i.e. 'Are you the right stuff if you can't manage the rough and tumble of the medical arena?' Such is the culture of machismo in the medical profession. The author is therefore perfectly correct to write anonymously. The symptoms and signs of the presence of a bully often stare senior doctors and human resources personnel in the face e.g. very difficult to fill training posts, poor retention, sickness, number and kind of complaints made, trainee underperformance, missed training opportunities, overcaution in providing feedback. But a collective cognitive dissonance allows a rationalisation of the situation, at individual and institutional levels, to a shortage of trainees, individual personal circumstances, 'the wrong stuff', or an unfortunate spate of errors by selection panels. Bullying is a form of abuse, like sexual abuse. In common with the latter, it may cause a whole range of psychiatric, psychological and physical disorders - sometimes chronic or with residual features. Those who are not made medically ill may be so psychologically scarred for life that they are predisposed to repeated bullying. Medical bullies have the cunning and manipulativeness of 'psychopaths'. They cause fear and disgust in many who work in close contact with them, while they may command high levels of respect and admiration from senior colleagues. Investigation of complaints against them lead to the classic 'splitting' into opposing camps, commonly seen in psychiatric institutions that manage personality disordered patients. Medical bullies are often known to be working against all odds in difficult circumstances. Their association with other senior figures may be used to lead those they abuse to an overestimate of their power and influence. But some medical bullies are genuinely very productive clinically and academically. Co-workers may hint at their abusiveness but quickly balance such comments with 'the good side'. Medical bullies may engage in 'cascaded bullying' - which means involving others, lower in rank, to carry out abuse, in their slipstream. But the most dangerous and difficult kind of bullying to detect or manage is group-bullying, where a number of powerful figures take turns, from different directions. This may not be a conscious process for them, but they each reinforce each others observations and behaviour. It is in these two forms of bullying that anti-bullying policies fail most miserably. Today's medical bully is stealthier, swifter, more tactical and strategic in order to survive. S/he is not simply the classical incompetent manager who misuses power. What standard of evidence is needed to confront the bully? Who will believe a junior complainant's evidence? Who will confront the bully? Who is prepared to see bullying as bullying? Who is prepared to be so unpopular in the NHS? Does the BMA offer practical support against bullying? How eager are Trusts to sack their highly respected seniors for bullying, in specialities where there are serious recruitment problems (e.g. 20% vacancies of consultant posts?). What happens next if your complaint is upheld or not - move to Greenland? Who tackles bullying scheme organisers, deans and professors? Who of the bullied are prepared to risk their whole medical careers? In reality only the most overt cases of bullying will ever be seen or tackled; the tip of the iceberg phenomenon as usual. Present day anti-bullying policy is a trick and a trap for fools! My request for see anti-bullying policy was ignored twice, in the lead up to a complaint of harassment, which then did not materialise - so bold and over-confident are some organisations. It is they who support a culture of medical bullying. Perhaps, wishfully, in twenty years, when the culture-busting recommendations of the Bristol Inquiry have been fully implemented abused doctors will have a voice and some redress. In the mean time I advise all doctors who find the culture of medical bullying so unbearable and endemic to leave medicine, develop alternative careers in information technology and/or law, and discourage their friends and relatives from becoming doctors. |
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Kristin Becker, Consultant in Clinical Genetics Level 8V, North West London Hospitals NHS Trust, Watford Road, Harrow, HA1 3UJ
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Workplace bullying is widespread, and happens at all levels. I have experienced it myself within the NHS, and I have seen it happening to other people. The usual scenario is people in a position of power bullying people in training or lesser grades, but it also happens among peers, and I have seen people bullying their seniors. It takes two for bullying to happen: someone with the intention to hurt, humiliate, intimidate, undermine or even destroy another person, and someone who allows it to happen. Often bullies seek out “easy” targets: people with a more quiet and passive nature, and who do not brim with self-confidence at that particular stage in their lives. Bullies can be openly aggressive and easy to recognise, but also beware of those who are indirectly aggressive, who pretend to be nice while sabotaging you in the background. Keeping a record of incidents, talking to others and enlisting the help of witnesses are all important. There is relevant legislation, but there is no doubt that work tribunals are not for everyone: they are daunting and stressful, and the outcome is uncertain unless good evidence can be produced. It is perhaps even more important that victims of bullying learn to stand up for themselves, to see the incident, difficult and damaging as it is, as a growth opportunity in terms of personal development. I found that I could not change the other person, but I could change myself in a positive way, and I am much more aware of the issues involved. An important thing to avoid is to become a bully in the process. It is not only the victim of bullying who needs help. Unrelenting perfectionism and intimidation does not always result in career progress and promotion (unfortunately it often does), but can backfire and can result in being downsized, losing one’s job, or other self-destructive events. The situation can be particularly difficult for women bullies. Traditionally, women have been encouraged to adopt more aggressive and dominating behaviour to be able to compete in the male-dominated workplace. Now, tough career women are being sent to remedial programs to learn how to get in touch with their own vulnerability, the soft person inside which they have lost touch with, and be intuitive, nurturing, and compassionate. Denying what is at the core of human existence does not make for happy living, and bullies do so at their peril. It is time for society at large to appreciate these values, and to realise that being a nice caring individual is not a weakness, but an asset, and essential for those with the responsibility of managing others. |
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Donna Grant, research Institute of Neur National Hosp LONDON
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I was bullied and sexually harassed for years by a professor of medicine - when i finally complained and after having a breakdown, the trust responded by trying to have me dismissed. Until the entire profession are committed to eradicating the abuse - it will continue. |
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David Thompson, none none
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I was intersted to read your small article about patients being bullied. I have also been through much of the same treatment by GP's, and consultants over the past six years - although I do not have thyroid difficulties. Strangely, the bullying followed me to another nhs gp surgery. Infact it came to a head, when a lady gp was really spoiling for an arguement, and got angry with me. It ended with her following me out of her room, and attempting to literally throw me out of the building. I resisted, and when another patient appeared she scuttled back into her room. I made a written formal complaint about the incident, to which she denied with the help of some medical union. I was satisfied with making the complaint and left it at that. Shortly after she left the surgery. But I have also had doctors give me the 'spanish inquisition', ignore what I think the condition is, miss diagnose, mistreat, write biased reports about incidents (not mentioning their part in the incident), and to listen to part of a sentence I make only to cut in and say what they think is wrong with me. You are not on your own!! |
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Tim Field, Author - Speaker (Home) PO Box 67, DIDCOT, Oxon OX11 9YS
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Dear Sirs, Re: Bullying in medicine The experience in the letter "Bullying in medicine" is one I have heard related to my UK National Workplace Bullying Advice Line many times. Nursing and healthcare sector staff comprise about 12% of over 5000 cases, behind teachers and lecturers (20%) and ahead of social services (10%) and the voluntary sector (6-8%). Bullies are attracted to the caring professions for the opportunities to exercise power and control over vulnerable clients, and over vulnerable employees who will go to great lengths to protect their relationship with their vulnerable clients. When a serial bully (profile at www.successunlimited.co.uk/bully/serial.htm) is present, competent staff (the majority) become disempowered and disenfranchised. No-one dare speak up for fear of reprisals. The reason why the writer wishes to remain anonymous is that if he or she reveals her identity they will attain the dubiuous distinction of whistleblower. Friends of the bully, powerful professionals and their employers close ranks behind the alleged wrongdoer and the whistleblower's career is effectively over. If in doubt, cast your mind back to the recent Bristol Royal Infirmary case. For other reasons see www.successunlimited.co.uk/bully/bystand.htm The stereotype of a bully as a tough dynamic manager who gets the job done is slowly changing as we begin to recognise that the sole purpose of bullying is to hide inadequacy and incompetence. Employers are starting to understand the impact on budgets of high staff turnover, high sickness absence, impaired performance, lower productivity, poor team spirit, loss of trained staff to the profession, medical blunders and increasing litigation by both injured patients and bullied employees. Similarly, the stereotype of a "victim" as a weak inadequate person who somehow deserves to be bullied is giving way to the realisation that bullies, who are driven by jealousy and envy, pick on the highest- performing and most skilled staff whose mere presence is sufficient to cause the bully's insecurity to go exponential. Such threats (of exposure of inadequacy) must be ruthlessly controlled and subjugated. Those who can, do. Those who can't, bully. Whether you've been a target, or whether you believe "It won't happen to me", the page at www.successunlimited.co.uk/bully/bully.htm#Why reveals how and why almost everyone is at risk of becoming a target. To receive monthly updates on bullying, including developments in the healthcare sector, drop me an email: timfield@successunlimited.co.uk Yours faithfully, Tim Field DBA (Hon)
Author, "Bully in sight",
www.successunlimited.co.uk/books/bismain.htm
Webmaster, Bully OnLine at www.successunlimited.co.uk |
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Graeme M Mackenzie, GP Maryport Cumbria
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15 years as a GP has seen me watch people in the NHS being horrible to each other. In many ways it is often the system which causes this behaviour. Most anger and criticism as described in this article is caused by anxiety and unhappiness in the "bully". The trouble is that in many senior doctors I suspect there is little insight that they have a problem. Only psychopaths are horrible and enjoy it. Most people are rude and horrible because they feel anxious, stressed and put upon themselves. It is very difficult for senoir doctors to see that low levels of these emotions drive chronic bullying and rudeness. Elevated rank leads to years of this behaviour being unchallenged which removes any chance of insight following. All of us in the NHS should have constant insight into how our frail emotions can influence our behaviour towards our colleagues. Simple psychological models such as transference and projection explain most bad behaviour. It is a tragedy of health care workers that they can serve the public tirelessly and with kindness only to then project their frustrations onto each other and on a population level undoing any good they have done with the patients by damaging colleagues. Forgiveness and an open culture of discussion of stress is the way forward. I am no saint and have been rude and angry on many occasions. I hope people forgive me and that I learn every time I behave badly and reduce the frequency of those incidents |
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Joseph Watine Hôpital de Rodez, France
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Many thanks for all these links. May I add the following one: |
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Natalie Sturt, Locum Biomedical Scientist Addenbrookes Hospital CB2 2QQ
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Bullying is an organisational problem and thrives in the negative working environment. In extreme forms, usually initiated by conflict within the working environment, an individual may be literally 'mobbed' by their colleagues and forced out of the workplace. The psychological effects of such victimisation can be severe and may include longterm debilitation due to post traumatic stress disorder and depression in patients with a predisposing trauma history. Bullying is not as simple as name-calling, criticism and humiliation. The most common workplace bully will commit serial offences where their prime motive is erradication of a competent and hard-working individual. If this individual protests, whistle-blows or resists subjugation the bullying is increased until often the target becomes incapacitated and destroyed. Bullying is a serious cause of ill-health in the NHS and is rarely admitted or adequately addressed. Zapf Dieter and Heinz Leymann 'Mobbing and victimisation at work' European Journal of Work and Organisational Psychology (1996) Volume 5, No.2 Tim Field 'Those who can, do, those who can't, bully' at www.successunlimited.com. |
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John Boulton, professor of medical practice learning doctor-doctor communication skills would defeat workplace bullying
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The Personal View "Bullying in Medicine" (BMJ 1 dec. p1314) must have both appalled many, as well as resonated in the collective memory of those of us in the later stages of our careers who experienced similarly dysfunctional behaviour at the hands of our elders many decades ago. Communication skills are now taught as a fundamental plank in student learning: in the University of Sydney medical program it forms part of the doctor-patient theme, and in the University of Newcastle the domain of professional skills includes both interviewing and interactional skills, for example, breaking bad news. So although medical education has espoused the importance of teaching doctor-patient communication, it has lagged behind in doctor-nurse, doctor -doctor, doctor-allied health, and doctor-clerical staff communication skills. If the traumatised young doctor whose story we heard had had the opportunity to role-model a communication strategy based on a solid theoretical understanding of dysfunctional power play, then perhaps she could have been able to look the surgeon in the eye at the end of the operation and say, "Your behaviour was unacceptable; I am seeking advice from the Human Resources department on the avenues available to lodge a formal complaint, and I intend to lobby for your removal as a supervisor". Bullies only respond to a demonstration of strength and resolve to resist. Even though I am fortunate to work in a harmonious hospital, with young and forward-looking consultant staff, we are starting a course for medical and nursing students, in collaboration with our academic nursing colleagues, so that they learn how to manage the future rigours of inter- professional communication, and are equipped to create a happy working environment based on mutual respect for all in their future careers. |
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Joseph Watine, consultant, laboratory medicine Hôpital de Rodez, France
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In the French university hospital of Fort de France, a consultant cardiologist, who had been appointed “praticien hospitalier” (the French equivalent of consultant) in 1992, has been suspended from duty since April 1998 and probably harassed for many more years. His suspension was based on false testimonies (he was accused to have mismanaged a patient who might have died from this, but he was not working the day when this happened), as well as subsequent falsification of administrative documents by hospital administrators. These falsifications have recently been qualified as “voies de fait” (an equivalent of delinquency) by the French appeal court of Fort de France [1]. In the French university hospital of Brest, a consultant and professor of surgery has also been banned from duty for unclear reasons, since January 2001 and harassed for years. The “conseil d’état” in Paris (the French supreme court) has recently demanded that this consultant and professor of surgery should be allowed to work again [2]. Unfortunately, the current French laws enable all the people from whom all these falsifications originated to remain appointed without any real problem for them [1,2]. Would it be the same in the UK? [1] This real story was published in the medical trade-unionist journal “Les Médecins des Hôpitaux Publics (MPH)”, number 184 (November- December 2001), pages 16 and 17. [2] This other real story was published in the same issue, pages 18 and 19. |
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Richard Ganz, private practice, internal medicine, california 95448
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When I was in Georgetown Medical School in the 70's, my surgical rotation exposed me to a number of bullies in that department. As a medical student in surgery holding retractors, I either cut the sutures 'too short' or 'too long', depending on the mood of the surgeon. Finally, I told myself I had taken enough abuse, so when I went into the next surgery, I introduced myself to the surgeon and asked if he wanted me to cut the sutures too short or too long that day. He replied, not unkindly, "Son, you're not planning to go into surgery, are you?" "No, sir, I'm not", I said, and he left me alone. So I went into internal medicine, have had a very solo happy practice for 20 years, and, happily , it turned out better to be a primary care doctor than a surgeon in the current environment. And when I encounter a surgical or medical bully, I just don't send him or her patients. |
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Alistair P J Thomson, Postgraduate Clinical Tutor Mid-Cheshire Hospitals NHS Trust, CW1 4QJ
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Re Bullying in medicine EDITOR - The anonymous personal view (BMJ 2001;323:1314) describes an episode of persistent bullying and its destructive effect. The author attempted to get help from the Postgraduate Dean (PGD), but does not mention the Postgraduate Clinical Tutor (PGCT) in the hospital. All trainees should be within the care of a PGCT. All acute Trusts have at least one PGCT, responsible jointly to the Trust and to the PGD. Most PGCTs are active consultants. Their role is to oversee the education of trainee doctors and their responsibilities include a pastoral element. Training for PGCTs is from the National Association of Clinical Tutors (NACT), which provides an ‘Effective Clinical Tutor’s Course’, including counselling skills. Therefore, in the context of perceived bullying, the PGCT can provide support for the trainee and local, practical help to resolve the problem. The PGCT will also be aware of any previous trainee allegations against a consultant and has a duty to draw persistently poor trainers to the attention of the Deanery. PGCTs can offer confidentiality (within the parameters laid down by the GMC) and considerable experience. Anecdotal evidence suggests PGCT services are underused. Trainees who are reluctant to approach their supervising consultant, educational supervisor or specialty/college tutor – or cannot do so, as was the case in the article, should arrange an appointment with their PGCT. Alistair Thomson
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Joseph Watine, consultant, laboratory medicine Hôpital de Rodez, France
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Some fresh news about the scandal in the university hospital of Fort de France [1]: Yesterday, our medical trade-union received the copy of an order by the first president of the “cassation” court (the French supreme court regarding civil affairs). This order rejects the petition of the university hospital of Fort de France, and its chief administrator, against the decision of the court of appeals [2]. Thus the court's decision agrees with the decision of the court of appeals and the legal process is now exhausted. This also means that the court of appeals’ “jurisprudence” is now consolidated. The “cassassion” court also determined that Mr Christian D’s letter is "of a highly suspicious authenticity". Bearing in mind the usual vocabulary of this court, this confirms what we already knew: Mr Christian D’s letter was quite simply a fake [1, 2]. But the “cassassion” court could not determine if this deception was made in Paris, in Fort de France, or the middle of the Atlantic ocean!!! Since then, Mr Christian D has “logically” been promoted and will remain appointed in his new post, and thus, he escapes any punishment to his career. What is also hard to swallow is that neither the university hospital of Fort de France, nor its chief administrator, get any sentence for their act of deception/deceit. Both parties are however sentenced for "voie de fait" [1, 2]. Finally, this chief administrator is lucky: she is sentenced for "voie de fait" but she remains appointed as chief administrator, and the university hospital is going to pay all expenses (60 797 Euros). A consultant would certainly not have remained appointed and the hospital would not have paid in his place. In conclusion, there really is a problem in France: some powerful people are completely immune from any form of legal punishment. Thieves in supermarkets or people who steal cars are much more at risk to be punished than these powerful people whose “voies de fait” are much more damageable than simple thefts for the victims. Is France therefore living in a period of history that resembles the years before the French revolution i.e. in which true justice was rare? [1] http://bmj.com/cgi/eletters/323/7324/1314#18201 [2] Affair published in the medical trade-unionist journal “Les Médecins des Hôpitaux Publics (MPH)”, number 184 (November- December 2001), pages 16 and 17. |
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Dipan N Mistry, SHO, ENT Leeds General Infirmary, Kanchan Bhan
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A recent article in the British Medical Journal of a case of bullying of a junior doctor by her surgical consultant (1) and the case currently under trial of a consultant surgeon who stands accused of manslaughter after he allegedly ‘lost his temper’ (2), leads us to scrutinise the behaviour of surgeons. Anon (1) writes of her consultant ‘She was hostile, critical and discouraging’ and adds ‘This behaviour is seen as traditional in surgery’. No surgeon would condone such behaviour and most would in fact, consider such behaviour as being unprofessional. However, many of us know that to a greater or lesser degree, this kind of behaviour goes on, particularly in the operating theatre. In stressful environments, people react in different ways, some calm and collected, others becoming frustrated and bad-tempered with ease. Should we expect more from doctors? If we equate loss of temper with loss of control, then yes. Of course, being the surgeon, and having overall responsibility for the care of the patient means that in the theatre environment, control of external factors is vital. Utmost awareness of the central and peripheral 'goings-on' in the theatre and reacting appropriately to them is crucial. This heightened sense of awareness required may actually be aided by the ‘stress’ of operating. However, surgeons need to be able to control the effects of he 'fight-or-flight' reaction that is going on within them, otherwise it can be detrimental too. Just as one is encouraged and taught to be methodical and calm in cardio- respiratory arrest situations, can the same be taught to operating surgeons? As trainees, we are exposed to many different types and styles of surgery and surgeon. As well as gaining surgical skills from this, we also form opinions of how we should behave as surgeons ourselves. ‘Bold and brash’ or ‘meek and mild’ or ‘somewhere in-between’? It is important that we have good role models to base these opinions on, so that this aspect of our professional behaviour is correctly developed. In theatre, the operating surgeon is at the top of a pyramid with the assistants, theatre nurses and ancillary staff forming its base. In this position, surgeons must not lead by their subconscious selves, but by their conscious, intelligent and rational selves. Only if this is done, can they maintain their professionalism. 1. Anon. Personal views - Bullying in medicine. BMJ 2001;323:1314 (1 Dec) 2. Dyer C. Teenager died after surgeon ‘lost his temper’. BMJ 2001;323:1387 (15 Dec) By Dr. Dipan Mistry, SHO General Surgery, Calderdale Royal Hospital and Dr. Kanchan Bhan, SHO Ophthalmology, Leeds General Infirmary |
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Daphne I Austin, Consultant in Public Health Sout Worcestershire PCT
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I have read the correspondence relating to bullying with interest. Bullying remains one of the few endemic abuses which society appears to tolerate. It is sad to reflect that the organisation which has the lead in promoting well being has not dealt with the issue in any serious way (and I firmly believe this is possible). The recognised bully in the workplace is however only one form of bullying behavior in the NHS. Disrespectful behaviour, often across professional or organisational boundaries, is a cultural norm in the NHS - as Dr Mackenzie observed people can quite simply be 'horrible to each other' - or indeed about each other. I too have observed quite unacceptable behaviours which at best can be considered unprofessional and at worst abusive. The source is generally within the higher levels of an organisation and sadly most frequently medics. However many of the people involved would not generally be considered bullies. Serious political bullying has to be added to the list. The NHS is being asked to meet targets which have gone beyond the 'challenging yet achievable' without either the time nor the resources people need to meet them. We are all being set up to kick the cat. This does not strike me as being consistent with Dignity at Work and indeed one could argue that being asked to spin gold out of straw transgresses human rights. In many cases the route of communication is remote - either via mail or telephone - but the effects are no less demeaning or undermining. One example is of a consultant who directly stated that he held a lay commissioning manager personally responsible for killing a patient because of refusing to fund a drug (palliative at that. Any concerted effort to tackle bullying must also address, in my view, the tone and quality of day to day interactions within the NHS. This is both a collective and individual responsibility. Individuals, particularly those higher up in the organisation, can exercise some choice over what they do and so not collude with. However, in the end it is only political and organisational will that can effect the profound changes necessary to make the NHS a pleasant and positive environment in which to work. Finally, I would suggest that the time is ripe for a systematic attempt at describing the nature and scale of bullying and poor behaviours in the NHS in order that the anecdotal can be translated into evidence. References: Mackenzie We must all learn from unacceptable behaviour (letter) BMJ 2002, 324:787 |
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