Bullying in medicine is a silent pandemic. In this article, we confront and dissect this problem that is often regarded as part of the culture, when it should not. The various manifestations of bullying in medicine and how to deal with it from an Arab perspective.
The unclear plague of bullying between doctors in medicine is common, starting from medical school and does not dissipate once the medical training part is completed. Bullying is defined as “harassment or discrimination that the recipient perceives as humiliating, hostile or abusive.” A 1990 JAMA Study was first to note bullying in the medical field and claimed that 85% of medical students felt they had been mistreated by their faculty. In fact, the evidence states that bullies are often attracted to caring professions such as the one of medicine with women being more likely to be bullied than men, and certain races such as Asians or Blacks more than others. So, what is the deal with this ‘burning’ problem?
Bullies in medicine manifest in different forms such as the “Confuser”, the “Snoozer”, the “Belittler”, and the “Perhaps Later” amongst many other forms. Examples like: destructive criticism, sarcastic comments, humiliation in front of colleagues, and being put under pressure to carry a procedure, all of those happen on an almost daily basis in various parts of the world across different cultures. And it’s not only exclusive with physicians, as nurses frequently are at the receiving end of bullying from physicians.
Bullying is always unreasonable, repeated by serial offenders, and mimicked by others via its ripple effect. Bullied doctors may face derogatory remarks or worse, physical assault (i.e grabbing a junior by his collar and throwing him/her against the wall). There is also the ‘silent bystander’ phenomena where such behaviors are left unchallenged and learned by others. Then there is the constant belittling in which the victim cannot defend themselves until they feel like idiots and break down eventually. This is evident during grand rounds where seniors always critique students presenting in front of patients due to lack of clarity or missing information. Parallelly, patients’ wellbeing is compromised.
Most suffer silently from this unrelenting pandemic that is considered ‘part of the culture’ and often passed ‘down the line’. I had a front-row seat with bullying myself on several occasions. My first year of residency in France was a strengthening fire. It had a hinge moment. A turning point in my career where I had to rise, professionally, morally, and ethically. I missed the solidarity, the sense of being in this together with the increasingly growing silo mentality. Currently recovering my confidence as I advance through my residency and earn more respect from my seniors. I have proved on numerous occasions my competency, knowledge, and have received numerous compliments from patients. There was even this time when a very grateful patient pointed at me in front of the head of the department and said: “This young doctor has hands of gold. I didn’t feel a thing during the procedure.” I blushed in silence with a huge smile drawn on my face.
In the Arab region, little is known about the magnitude of bullying, let alone bullying in medicine. True, multiple campaigns have been recently focused on bullying targeted towards adolescents, but we are far from understanding the factors involved in medicine. The BMJ published a study in 2013 stating that 96.6% of first-year medical residents in Oman believed that abuse and mistreatment existed during their training. To my knowledge, no similar Arab studies are found to date.
The first step to bring awareness is by collecting narratives of bullying experiences in medicine. A national level commitment is required, where medical schools, organizations, and healthcare leaders work together to develop anti-harassment policies that set a tone of zero tolerance and demands greater transparency with better reporting, provide workshops and offer to direct individuals towards help if they feel they are being bullied. The Royal College of Surgeons of Edinburgh (RSCEd) launched a campaign called “Let’s Remove It” that encourages healthcare professionals to speak out. We could possibly start with the ‘Negative Acts Questionnaire-Revised’ tool to begin investigating workplace bullying and tie it up to the field of medicine. If it’s not for the negative effect on the healthcare workers psyche, then let it be for the sake of the escalating socioeconomic costs.
If you have faced bullying like me, my advice is: ‘Don’t take it personally or let this sour you against what you care about.’ We are already under extraordinary demands where life and death decisions are made daily, and error is not accepted. With such tremendous pressure, we don’t need the extra weight of bullying. We need to work in a system where everyone is treated with respect and allows us to stretch our abilities until we become qualified and empathetic physicians who influence our country’s healthcare image positively.
Speak Up if You Have Been Bullied in Medicine
