The last few months have seen surgeons in particular gain notoriety as tyrannical teachers at best and destroyers of dreams and souls at worst. The 4Corners episode last night entitled ‘At Their Mercy’ set out to expose some of the terrible behaviour that goes on in hospitals. I only managed to watch it, piecemeal, this evening. The show told the story of Dr Caroline Tan, Melbourne neurosurgeon and Dr Gabrielle McMullin, whose throw away comments (now known as blow-job-gate) at a book launch launched not a book, but a ground swell of support from doctors around the country. The momentum with which the masses have moved to get bullying, harassment and doctor wellbeing on the table and in the minds of people everywhere has been extraordinary. What has been particularly positive is the Royal Australasian College of Surgeon’s response. For something that has allegedly in the past been swept under the rug, they have mounted a credible response on this occasion. It may well be in response to media pressure but nonetheless, it is a step in the right direction.
When Dr McMullin’s comments first came to light, there was a number of people both within the medical community and outside who dismissed her claims as preposterous. This was followed by a very swift and growing counter response from young doctors everywhere who have seen or been bullied, harassed or generally down trodden. It has become very hard for anybody to deny that we have a serious problem here.
The bulk of reporting, including 4Corners, has focussed heavily on surgeons. I suppose it is with good cause. Surgeons have the worst reputation amongst other doctors for being ‘difficult’. But let us not forget that bullying and harassment happens not only in all walks of life but within a hospital, from many different groups within health care. Nurses, all kinds of doctors, allied health, medical administration all bully within their craft groups and to others. Junior doctors can be especially vulnerable to insults from all sides. What really needs to come from this process is for any positive changes in surgeons to overflow into the whole of hospital life.
Hospitals are actually the employers of young surgeons, not the Royal Australasian College of Surgeons. As such, they are beholden to provide workplaces that are safe from problems like bullying and harassment. 4Corners touched on some of the alleged problems with the hospital response to complaints, such as those made my Dr Imogen Iblett. The response of the hospital concerned with regards to her complaint was described as manifestly inadequate. The Royal Australasian College of Surgeons has borne the brunt of the media attention but I would definitely like to see a shift to the hospitals, the employers. They too have a role to play. It is not unusual when a doctor is badly behaved for it to be acknowledged that the hospital knew about it and apparently did nothing, aside from a slap on the wrist.
With the now growing acknowledgement that we are in a very messy situation here, I’ve noticed amongst friends and colleagues a change in how we all look at our own behaviour. Some of us will of course be more insightful than others, but a degree of introspection is occurring. Questions like ‘Am I a bully?’ seemed to be asked. I would possibly say that if you have enough insight to ask the question, your behaviour is probably okay! But again, a lovely side effect of the media attention is to make all of us aware that the little off the cuff remarks or hard-line teaching may actually be very hurtful to someone. It should make us assess our teaching methods. Hell, it should potentially make us want to learn some teaching methods! A mentor of mine once told me that insight is one of the most important characteristics for a surgeon to have.
Bullying is a little hard to define for some people. Particularly for some of our senior colleagues where there was not just teaching by humiliation but by annihilation. There were racial slurs, name calling, denial of training opportunities. And they were for the most part, shaken off. It was just the way things were. The denial of those kinds of behaviours as inappropriate will only lead to their perpetuation. The philosophy and pattern of ‘It was done to me, I’ll do it to someone else’ rests largely on the premise that I survived it, therefore, it couldn’t have been that bad. Today’s trainees just need to toughen up. That is entirely the wrong approach. This is not about mental or physical toughness. Yes, there is a degree of tenacity and thick skin that I think you truly do need in surgery. But nobody should have to endure character assassination and racial, gender or other slurs. They are not okay. How would you feel if it was your daughter who had been groped at her workplace? Had listened to sexual innuendo? It would be, I suspect poorly tolerated. Educating our doctors on what is okay behaviour and what is not will go a long way to creating the generational change we so desperately need.
The Expert Advisory Group from the Royal Australasian College of Surgeons has released a survey yesterday to trainees, fellows and international medical graduates (IMG) to truly gauge the magnitude of the problems of bullying. I would implore everyone, whether they have been bullied or not, to complete the survey. I feel very strongly that we need to stand with the College on this matter, whether you trust them, believe them, have been hurt by them or wholly disagree with the existence of widespread bullying or not. They are a group who have a very real chance to make a difference. Whilst it remains to be seen if real tangible change will happen in workplaces, the movement is here. It’s in our College, it’s in our doctors. Keep the momentum going and let’s make our noble profession proud.