Bullying in Medicine - letter to the editor of BMJ & a response

       "The tears ran down my face, hidden by my surgical mask. My consultant continued relentlessly, “Why can't you do this? It really isn't hard. Are you stupid? Can't you see how to help me?”

Some doctors should ask themselves whether they are part of the caring profession

       I hated myself for crying. I avoided her eyes so she couldn't see my tears and the deep hurt in my eyes, but I couldn't speak without betraying myself. I managed a few one word answers. The criticism continued, if not with words, then with sighs and angry tutting.

       The atmosphere in the operating theatre was tense. The staff had all seen this happen many times before—hard working, pleasant trainees reduced to non-functioning wrecks in the space of an operation. I looked helplessly at the scrub nurse, another trainee. She saw my distress immediately and gave me a supporting glance. But she too was suffering. “No, not that one. Why do we have to have trainees in my operations? Not like that,” she lashed out at the scrub nurse. Another hard working, competent trainee, now shaking and anxious, her self confidence fast diminishing.

       I didn't know what to do. I felt uncomfortable continuing in such distress. Either my consultant didn't notice or she didn't care. I wondered what would happen if I asked to leave and decided that it would probably just make things worse for me. I stayed. Three hours of hostility and criticism. At the end I ripped off my mask and gloves and turned, only to find her standing behind me. She registered my swollen eyes and tear stained face in complete silence. I have never seen such a cold, emotionless stare, and I hope never to again.

Her behaviour was always the same—on the ward rounds, in clinics, and in theatre

       Her behaviour was always the same—on the ward rounds, in clinics, and in theatre. She was hostile, critical, and discouraging. I continued in this post for the complete six months, becoming increasingly anxious and depressed. I left my post feeling suicidal.

I am now taking a year away from medicine. The past year has been hard, coming to terms with what happened to me in my last post. I had naively hoped that bullying stopped at school. Now I know that bullies continue to bully people throughout their lives. The bullying I endured has left me traumatised. Despite being told that she treated everyone this way, I believed it was all my fault.

       I couldn't believe that such an intelligent and talented surgeon should need to make herself feel better by making those around her feel terrible. I couldn't believe that this was the basis of basic surgical training. This behaviour is often seen as traditional in surgery, and when I brought it to the notice of consultants at my routine assessment and to the postgraduate dean it was ignored: further abuses of power.

       As I look back on this time, I wonder why I felt so helpless. While trying to come to terms with the fact that I effectively let myself be bullied, I read about the experiments in which learnt helplessness was described. A dog was put in a cage and given electric shocks through one side of the floor of the cage. The dog quickly learnt to stay on the other side. The same happened when the other side was used, the dog avoiding the shocks. Then the dog received shocks from all parts of the floor at random. Initially, the dog tried to avoid them, but when unable to it gave up and lay down and received the shocks. After this the cage door was opened. The dog did not escape but stayed on the floor of the cage receiving shocks. I realised that the feeling of being unable to escape is all part of the torture.

       I don't know why bullying is still a part of medical training. It does not encourage learning and certainly does not bring out the best in the members of a team. In the past I have been cared for by kind and encouraging seniors. I am now a disillusioned junior doctor, not only because I was bullied by my consultant but also because she is considered suitable to train junior surgeons and because evidence of her bullying is ignored by those who should help and protect junior doctors from such inappropriate behaviour.

       Perhaps some doctors should ask themselves whether they are part of the caring profession at all."

BMJ 2001;323:1314.1

ONE RESPONSE:

Surgical Professionalism                        24 February 2002

(The above) "case of bullying of a junior doctor by her surgical consultant and the case currently under trial of a consultant surgeon who stands accused of manslaughter after he allegedly ‘lost his temper’, leads us to scrutinise the behaviour of surgeons.

Anon 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."

By
Dr. Dipan Mistry, SHO General Surgery, Calderdale Royal Hospital &
Dr. Kanchan Bhan, SHO Ophthalmology, Leeds General Infirmary