Bullying in surgery isn’t just Australia’s problem

We read with interest The BMJ’s articles on bullying and sexism in surgery.1 2 3 We commend the journal for publishing on this issue, but we see some notable shortcomings in the articles.

It may seem logical to attribute bullying to a macho culture in Australia and in surgery, but this is a gross simplification of why bullying exists in surgery. In the Royal Australasian College of Surgeons Expert Advisory Group’s investigation,4 bullying, discrimination, and sexual harassment were found to stem from a complex set of circumstances. These include the hierarchical structure of medicine, apprenticeship-type training, and a highly competitive environment for training and jobs. This is common to medical and surgical training the world over, as is an aggressive approach to teaching that persists and continues to be modelled to younger generations.

The report found that nearly half of all surgeons (including trainees) had experienced bullying in the workplace. By contrast, a rate of bullying of 8%,1 as noted in a 2014 UK survey by the General Medical Council, would be not only the lowest in medicine worldwide but probably the lowest in any workplace of any industry. One must query the source of this outlier: junior doctors are beholden to the system to train and employ them, so they are likely to under-report the true extent of difficulties encountered.

We would caution against assuming that things aren’t quite so bad elsewhere as in Australia. This thinking may have contributed to such behaviour persisting for so long and to so many people suffering in silence. We implore all training bodies globally to look at what’s being done to assess the true nature of bullying and harassment in hospitals and training programmes, before saying that the situation is taken care of.