Medicine as Sport?: Bullying in the Medical Profession
No, it wasn't quite like that. Nobody punched me in the face. Maybe I would have preferred being punched in the face, though. And yes, I was bullied. I'm not going to talk about my own experience in this post however, because I already have post-traumatic stress disorder from the experience. I'm not ready to revisit it in detail yet.
I don't need to talk about myself to tell you about bullying in the medical arena. I know a lot of other people who have experienced it, and their experiences are plenty to talk about. Some of these people are still in their workplaces. Others have left and moved on to better things. Some had to leave medicine entirely to get away. But in each case, it profoundly damaged the physician's self esteem and her trust in herself and her colleagues. That, in turn, damaged the ability to care for patients in the best way possible, because it caused self-doubt and made it hard to ask for help.
Let me start with the story of a younger colleague working in an academic system. She is the most junior person in a group of subspecialists. She came into the practice as a full-time clinician, with the promise that she could reduce her clinical sessions as she took on teaching and research projects. However, the senior doctors in the practice were happy to take advantage of her junior status and assign all urgent visits and new patients to her, lightening their own clinical loads. She very quickly was so busy with patients that her schedule was full and even double-booked at times, and she often saw patients straight through lunch time. In addition, she often had inadequate support staff and found she was sometimes left alone with patients in the office after hours, or had to do tasks that seemed like they should be done by support staff.
When she sat down with the managing partner to discuss the situation, she stated that it was not sustainable for her to work at this pace; without a lunch break she was feeling ill in the afternoons.
She also said she felt it was unsafe and unprofessional to be left alone in the office with patients. She was told that there were no alternatives, because there were not enough doctors to care for the patients. No additional staff time could be added, and despite the fact that she was well exceeding the RVU's needed to earn her salary, they needed her to continue the pace. The managing partner stated that 'he often missed lunch and he was fine', so she should be able to do the same. He also stated that 'he did all kinds of tasks that were beneath him' and 'if she didn't like working there, she should leave.' Hearing this, she immediately doubted her own perceptions and felt she shouldn't complain. Within a few months, she was feeling quite depressed and defeated, and began to question her medical decisions.
A classic example of bullying is the story an ER resident I met a few years ago told me. He thought his choice of residency programs might have been a mistake. He had come from a medical school in a smaller, midwestern town, where he had done extremely well in all his rotations. At first, being in an urban Philadelphia ER, with full trauma bays and frequent drug overdoses, was exhilarating. But after about 6 months, he began to feel helpless and depressed by the constant despair he saw each day. He reached out to his program director, who had told the residents that they 'could always come to him with issues.' But instead of listening to his concerns , the director told him that 'if he couldn't handle the program, he should leave,' and that 'the ER doesn't leave room for doubt.' After that, the attendings started watching this resident more closely and constantly criticizing his performance, which made him increasingly anxious. He received his first negative evaluation shortly thereafter. At the time I spoke with him, he was taking some time off from his program and considering his options.
Let's look at one more situation. Another colleague reported some unsafe patient conditions in her workplace to her office manager. The office manager not only refused to take action, but denied that the situation existed. The physician then reported the situation to administration at her academic institution. Again, no action was taken, so she escalated the report to risk management. At that point, the situation was corrected. Shortly thereafter, her office manager made false complaints about the doctor's behavior to HR. She was 'written up' by HR despite her denial of the behavior. An administrator also chastised her for 'going over his head to risk management', saying that action was going to be taken but he had not had adequate time. She was told by administration that she was a 'troublemaker'.
There are many other forms that bullying in the medical world can take. In the first two examples, there is clearly a power differential- a senior partner and a junior partner in the first, a trainee and a supervisor in the second. But increasingly, physicians are also bullied by administrators. Physicians have lost their power in the world of 'corporate medicine', in which we are beholden to just about everyone. Even office managers, who used to be part of the support structure for physicians, now seem to have more leeway than the physicians themselves, who are often punished for anything that makes someone in the hierarchy look bad- even if it's in the interest of patient safety.
It is most saddening to me, however, when doctors bully each other. While self-care is a great goal in the fight against physician 'burnout', it is really crucial that we learn to take care of each other. Supervisors and mentors are charged with the task of helping students, residents, fellows, and other trainees grow into caring, compassionate and resilient healers. How can this happen if they are already beaten down by the time they reach the end of training? And the repeated trauma of being bullied over years can make even the most seasoned physicians run out of steam. The only thing that can take the pain away is the corrective experience of being cared for before it is too late. If we don't do it, who will?