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Rapid Responses: Rapid Responses published:
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Does belittlement equal bullying?
- Jeremy Oates (2 October 2006)
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Remedial training - ethics and sensitivity
- P.A. Geis (4 October 2006)
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Bullying and harassment by professional colleagues in Pakistan
- Amin Ali Muhammad Gadit (7 October 2006)
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Zero tolerance to bullying and harassment
- Rajesh K Choudhary, Manaswini Choudhary (10 October 2006)
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Could the difference be attributed to the amount of clinical exposure?
- Jeffrey Lim (11 October 2006)
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''Bullying''Institutions need watch dogs
- a -wahab yousafzai (27 October 2006)
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Bullying and Harassment in the UK Hospitals: a continuing enigma!
- Wael Al-Daraji (20 November 2007)
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Jeremy Oates, Clinical Research Fellow Paterson Institue for Cancer Research, Manchester M20
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Editor, In the recent editorial "Bullying and Harassment in Medical Schools", Dr Wood makes some extremely valid points about the negative impact bullying may have. I do wonder though about the validity of some of the conclusions drawn from the quoted studies. To compare one study which looks at incidents of belittlement and harassment with one reporting incidents of bullying is not comparing like for like. Whilst I was a medical student, I'm sure not a day went by when I did not feel belittled in some way for not knowing what I felt I should know. Equally, I would be surprised if there is a single medical student who hasn't felt harassed by nursing staff within twenty minutes of setting foot on the ward, generally for getting in the way! This in my opinion does not equate to bullying and it would appear that 83% of UK medical students agree (1). Surely a more simple explanation for the low reported rates of bullying in the UK is that bullying occurs less frequently in the UK. Must we look for reasons to refute positive findings, instead of congratulating those involved in teaching medical students for educating and supporting them in a correct manner? Jeremy Oates
1 British Medical Association. Medical students welfare report. London: BMA, 2006. Competing interests: None declared |
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P.A. Geis, na na
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In a previous BMJ issue, it was recommended that med students be instructed in "ethical writing" so as to avoid plagiarism. The author Dr. Roig saw the benefits of such instruction*: "Consequently, I believe that when we internalise and apply its basic principles they will significantly reduce plagiarism and generalise to other areas of scientific research and personal conduct. " In this issue, Dr. Frank, et al.** speak to the teaching of ethics and call for more sensitivity (in context of addressing bullying and harrassment). "If the medical profession is serious about creating a satisfied workforce and about teaching students to behave ethically with colleagues and patients, we ourselves must behave in an ethically appropriate and sensitive way." Understand the sentiment but wonder at the efficacy of teaching ethics (to those likely established in their ethical practices) and requesting sensitivity (of those perceived to be insensitive). Would it also be useful to focus more intensely on ethics, confidence and collegiality in med school admissions? Samuel Roig Ethical writing should be taught. BMJ 2006;333:596-597. **Erica Frank, et al. Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey BMJ 2006;333:682. Competing interests: None declared |
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Amin Ali Muhammad Gadit, professor of psychiatry Memorial University of Newfoundland
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A systematic study is being conducted in Pakistan on the serious issue of harassment and bullying among professional colleagues.This is common among doctors in all specialties but the discipline of psychiatry is particularly known about this issue. There is evidence of rampant personal and professional jealousy which is manifested in the form of defamation, character assasination,emotional torture,spreading rumours,false reporting,threats and even physical attacks.This problem has resulted in many good professionals leaving the country and deterring others who wish to come back and serve the nation.There is a need for appointment of a medical ombudsman who can redress the grievances of the affected professionals. Competing interests: None declared |
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Rajesh K Choudhary, Staff Grade Surgeon, Department of Surgery Darlington Memorial Hospital, Darlington DL3 6HX, Manaswini Choudhary
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Zero tolerance to bullying and harassment We have read with interest the article ‘Bullying and harassment in medical schools.’ For most people the vision of universities is that of a peaceful sanctuary protected from the ‘real world’, where students are taught high-level academic and research skills. It is also thought that equity, dignity, respect and justice are emphasised in these environments.1 Research shows that work place bullying and harassment of doctors occurs across the medical workforce, from medical students and junior doctors in training to consultants and general practitioners. It has been argued that training is often seen as an ‘initiation rite’ into medicine, justifying the bullying and harassment that is often a feature of the undergraduate medical culture. Some argue that the established culture of the medical profession is one that potentially perpetuates an environment of bullying and harassment, especially during training.2 In the National Survey of Medical Students in the United Kingdom almost a fifth report experiencing bullying and harassment infrequently and two percent being victimised monthly. More than half of the respondents do not think universities make the rights of the students with regards to bullying clear.3 A zero tolerance approach to bullying and harassment has to be implemented from the top of an organisation. Zero tolerance must be made explicit in all medical schools, deaneries and trusts.2 If the medical profession is serious about creating a satisfied workforce and about teaching students to behave ethically, we ourselves must behave in an ethically appropriate and sensitive manner. Manaswini Choudhary, A-level student, Durham High School for Girls, Farewell Hall, Durham DH1 3TB Mr Rajesh K Choudhary, Staff Grade Surgeon, Department of Surgery,
Darlington Memorial Hospital, Darlington DL3 6HX
Competing interests: None declared 1 Wood D F. Bullying and harassment in medical schools. BMJ 2006; 333:664 – 665 (30 September). 2 Rautio A, Sunnari,V, Nutinen M, Laitala M. Mistreatment of university students most common during medical studies. BMC Med Educ 2005;5:36. 3 BMA Health Policy and Economic Research Unit. Bullying and harassment of doctors in the workplace. London: BMA, 2006. www.bma.org.uk/ap.nsf/Content/bullying2006 (accessed 25 Aug 2006). 4 British Medical Association. Medical students welfare report. London: BMA, 2006. www.bma.org.uk/ap.nsf/Content/WELFARE2006 (accessed 20 July 2006). 5 Frank E, Carrera J S, Stratton T, Bickel J, Nora L M. Experience of belittlement and harassment and their correlates among medical students in the United States longitudinal survey. BMJ 2006 doi: 10.1137/bmj.38924.722037.7C. Competing interests: None declared |
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Jeffrey Lim, F2 SHO in surgery Princess Royal Hospital, Haywards Heath. RH16 4EX
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Dear Editor, I find the difference in bullying rates between US and UK medical students to be very striking. Although the lower rates experienced by UK medical students might be due to better coping strategies, I wonder if it could also be due to the different amount of clinical exposure between the two groups of students. I am unaware of any material that quantifies and compares the experiences of UK and US medical students in terms of patient contact or time spent on the wards. However from anecdotal evidence, it seems that US medical students are more involved with patient care in their clinical years and hence spend more time interacting with healthcare professionals. With a high incidence of bullying and harassment in the NHS especially for junior doctors(1), might this not reflect that, like their US counterparts, UK medical students suffer a similar amount but only when they graduate as they are spending more time on the wards and with other healthcare professionals? Perhaps the intensity of their clinical experience (their 2 compared to our 3 clinical years in medical school) also partly accounts for the difference. Consequently, it would be interesting to compare the incidences of bullying in both student groups if the amount (or intensity) of clinical exposure is accounted for. Yours faithfully, Dr. Jeffrey Lim. (1) BMA Health Policy and Economic Research Unit. Bullying and harassment of doctors in the workplace. London: BMA, 2006. http://www.bma.org.uk/ap.nsf/Content/bullying2006~Incidence(accessed 11th October 2006). Competing interests: None declared |
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a -wahab yousafzai, chief resident psychiatry department aga khan university hospitsl karachi
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Dear editor,you have touched upon a very imporatant issue,this is even more important in countries like ours,where there is great likelihood of bullying due to many reasons.one of the important reasons could be lack of institutionalized mechanisms to address the grievances of victims.In our culture,in the name of discipline,obedience, and even religion bullies enjoy the freedom to bully. Which not only affects patient's care but also sets a stage for cycle of abuse. There has been no such study done in our country so far, Dr. Syed ahmer consultant psychiatrist in Aga khan University Hospital has got an ethical approval from university ethics review committee(ERC)and is about to start the project.The study would be a replication of previous similer studies in a pakistani setting.the components of the project comprised of running a pilot which is in the offing at this point in time. This exploratory study first of its kind in pakistan would helP us to raise awreness and subsequently prevent bullying at various levels. BMJ has been playing pivotal role in this regard an constantly raising this issue now and then. I hope Dr.Ahmer's study would be first step farword and i wish him all the best. Competing interests: None declared |
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Wael Al-Daraji, ACF and SpR in Histopathology University of Nottingham, School of Molecular Medical Sciences, Nottingham, NG7 2UH
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Bullying and harassment in the workplace is an old problem1. According to the charted Institute of Personnel and Development (CIPD), over the last 20 years, organisations have moved from the perception that it does not happen here to acceptance that it does and the introduction of policies to address the problem. Work place bullying and harassment have been recognised in all sectors of the workforce, particularly in a hospital’s setting. It has been suggested that bullying and harassment in the National Health Services (NHS) is indeed a widespread and serious problem which needs to be viewed in the context of various organisational settings and manifestations. Evidence suggests that the prevalence of bullying and harassment in both medicine and the NHS more generally is high. One of 10 callers to the UK National Bullying advice line are health care professionals, including nurses and GPs; the result of a CHI survey for example found that more than a third of NHS staff had been bullied, harassed and abused, usually by a senior member of the staff, managers or even patients and their relatives. A useful definition of bullying is ‘persistent, offensive, intimidating, malicious or insulting behaviour, abuse of power or unfair panel sanctions, which makes the recipient feel upset, threatened, humiliated or vulnerable, which undermine their self-confidence and which may cause them to suffer stress’.2 Whilst various types of harassment are covered by UK legislation, there is currently no specific legislation dealing directly with the issue of workforce bullying. However, other parts of the law may be applicable. Contract law is one example, as it includes an implied duty on the part of the employer to provide an appropriate and safe working environment for staff. This is even more explicit in the Health and Safety at Work Act, which places a general duty on employers to protect the health, safety and welfare for their employers. Equality legalisation can be applicable in cases concerning gender, race, sexual orientation and recently religion. Age will also be covered as from last December 2006. The Criminal Justice and Public Order and the Protection from Harassment Acts may also be useful in some cases. We think it is important to remind doctors working in the UK of their rights. Doctor's rights in the UK are: 1. Employment rights under law.
Reference: 1. Wood DF: Bullying and harassment in medical schools. Bmj 2006, 333:664- 5 2. Rayner C and Hoel H 'A summary review of literature relating to work place bullying' J Comm Appl Soc psychol. 1997; 7:181-91. Competing interests: None declared |
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