Doctors seek cure for bullies
rebuked the paint would be peeling off the walls.’’
However, unacceptable aggressive behaviour is still a reality, he acknowledges, and has partly been fuelled by the disappearance of down-time — which used to give opportunities for nurses and doctors to have morning tea, celebrate a birthday or have an unrushed training session.
‘‘ Twenty years ago hospitals would run at 80 per cent occupancy so there were slow periods. Now we are at 100 per cent occupancy most of the time, and every day is a hard day,’’ he says.
A 2007 Australian Royal College of Nursing report, National Overview of Violence in the Workplace, included the following definition of bullying: ‘‘ coercive, unethical activities which create an environment of fear through acts of: cruelty, belittlement/ degradation, public reprimand, ridicule, insult, sarcasm, destructive criticism, persistent nitpicking or devaluation of a person’s work efforts, trivialisation of views and opinions and unsubstantiated allegations of misconduct’’.
Lyn Turney, senior lecturer in sociology at Melbourne’s Swinburne University of Technology, says these less overt forms are the hallmark of bullying among the professions, whereas often bullying in the trades, for example, is more obvious — and easier to deal with.
A number of factors in professional workplaces combine to create a toxic atmosphere ripe for bullying: highly competitive, high-achieving people with a masterapprentice power relationship built into the training process, says Turney. ‘‘ High achievers are very vulnerable to bullying because they have so much to lose — you may have spent half your life training to become a surgeon, and then you find yourself at the mercy of the more senior surgeon who has supreme power over your marks and reports.’’
Bullying often destroys self-confidence, says Turney. This often results in the victim becoming compliant and accepting of the behaviour, as one nurse in an Australian study tells: after many episodes of being directed with a point of the finger to stand silently in the corner while the more senior nurse took over the care of patients, she would ‘‘ automatically follow the finger’’ in ‘‘ non-thinking robotic mode’’ ( ContemporaryNurse 2006;21:228-23).
Bullying is not confined to the health system, says Judith Meppem, former chief nursing officer of NSW, now investigating bullying at Sydney’s Royal North Shore Hospital at the request of the Area Health Service.
However, the recent tumultuous times in the management of hospitals have a lot to do with creating a stressful environment that encourages bullying. ‘‘ The hospitals have had constant change over the last 15 years, and the staff at the grassroots level are affected by it.’’ Strong, consistent leadership that has the confidence to allow staff to disagree is what is needed, she says.
‘‘ All staff need to acknowledge that bullying is unacceptable, and that no one is exempt — including senior people,’’ says Meppem.
And unless all staff are on board nothing will change, she says. If someone is benefiting from the current situation, they will sabotage any efforts to get rid of bullying.
Associate professor Stephen Bolsin, anaesthetist at Geelong Hospital, says the current training system seems to teach junior doctors a ‘‘ hidden curriculum’’ of keeping quiet if they see more senior staff committing unsafe practices.
Bolsin himself reported a higher than usual death rate of babies undergoing cardiac surgery at the Royal Bristol Infirmary in the UK in the 1990s — then found himself unable to get a job anywhere in the UK and so relocated to Australia.
Bullying has been a problem in medicine for a long time, he says. ‘‘ I remember training with a surgeon who did not consider his day complete unless he had reduced a nurse to tears, and another who threatened female medical students and junior doctors with a negative reference if they wore trousers to work.’’
Exposure to bad role models perpetuates the problem, he says. ‘‘ Some of the medical schools are repositories of the worst behaviour, but they don’t subscribe to the view that they are bad role models,’’ says Bolsin.
However, there are some strategies to help the profession break out of the current cycle. For example, making the reporting process easier greatly increases the likelihood of junior staff speaking up, he says.
‘‘ We also need to evaluate the behaviour of teaching staff and reduce students’ exposure to bad role models and increase their exposure to good role models,’’ says Bolsin.