When I was responsible for a JMO Management Unit in a public hospital, I often saw the devastating effects of bullying and harassment in the medical profession, particularly in surgery. The case that stays in my memory is that of a poorly performing surgical registrar, and two new doctors on the same team.
The registrar had failed several terms, and was administratively difficult – he would turn up late, fail to meet hospital requirements, and would routinely irritate the nursing staff. After arriving in my office one morning, I was approached by two very distressed female interns. They recounted how after weeks of being unreasonable, rude, and generally hard to work with, the registrar had started making extremely demeaning and sexist comments, along the lines of suggestions that they ought to be “in the kitchen” or “pregnant” rather than in the operating theatre. There were several witnesses to these events.
After reporting these problems to the senior management in the hospital, the surgeons in charge of the team reacted by threatening to resign, and ruining the careers of all of the complainants, rather than taking action against the registrar. Hospital management acquiesced, and the interns were moved out of the team. Both of those interns are now consultants in specialty fields, and I hope that they are doing their part to cease the cycle of harassment.
It wasn’t the first, nor the last event of its type that I dealt with in that position. That was over ten years ago, and reportedly, things have changed little since then.
Six months after the media bombshell around the comments of vascular surgeon, Dr Gabrielle McMullin, the Royal Australasian College of Surgeons has released a draft report by an Expert Advisory Group (EAG) on discrimination, bullying, and sexual harassment in the surgical profession.
McMullin’s statement to ABC radio in March brought about a level of public awareness about bullying and harassment in the medical profession that may not have existed before.
“What I tell my trainees is that, if you are approached for sex, probably the safest thing to do in terms of your career is to comply with the request; the worst thing you can possibly do is to complain to the supervising body because then, as in Caroline’s position, you can be sure that you will never be appointed to a major public hospital.”
The draft report confirms the concerns that have been expressed in the public discussion and media around the issue, conceding that “there are serious issues to address”. In summary, it was reported that:
49% of Fellows, trainees and international medical graduates report being subjected to discrimination,
bullying or sexual harassment
54% of trainees and 45% of Fellows less than 10 years post-fellowship report being subjected to
71% of hospitals reported discrimination, bullying or sexual harassment in their hospital in the last five
years, with bullying the most frequently reported issue
39% of Fellows, trainees and international medical graduates report bullying, 18% report
discrimination, 19% report workplace harassment and 7% sexual harassment
the problems exist across all surgical specialties and
senior surgeons and surgical consultants are reported as the primary source of these problems.
Aside from the quantitative data highlighted in the report, qualitative information is also included in the form of comments from the participants:
‘… the culture is suck it up, don’t report it or it could affect your career’
‘… the ultimate penalty for a harassed female who speaks out is being unable to find employment in Australia’
‘Why don’t you just go and do the grocery shopping’ … or ‘you can join us in theatre – not to do anything, just for eye candy’
‘I was told I would only be considered for a job if I had my tubes tied’
‘I was asked if I planned to have children’
‘You have one minute to act to save a person’s life … wilting violets may not be able to handle the interpersonal stress and may not make the best decisions for the patient under pressure, so if a trainee can’t respond to fair criticism without labelling it, then what chance they can handle more desperate scenarios? We are not training accountants!’
While the advisory group appear to have made a thorough attempt to explore and articulate the issues, the question remains about whether such an ingrained culture can ever change. Among the key recommendations were:
Cultural change and leadership
Proper complaint management
The final will be presented to RACS by the end of September 2015. In the meantime, the draft report is available here.