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Bullying in medicinehttp://bmj.com/cgi/content/full/324/7340/786/a
LettersBullying in medicine Those who can, do; those who can't, bully
EDITOR When a serial bully is present, competent staff (the majority) become disempowered and disenfranchised. No one dares speak up for fear of reprisals. If the writer of the personal view hadn't remained anonymous she would in effect be a whistleblower. Friends of the bully, powerful professionals, and their employers close ranks behind the alleged wrongdoer, and the whistleblower's career is effectively over. The stereotype of a bully as a tough dynamic manager who gets the job done is slowly changing as we begin to recognise that the sole purpose of bullying is to hide inadequacy and incompetence. Employers are starting to understand the impact on budgets of high staff turnover, high sickness absence, impaired performance, lower productivity, poor team spirit, loss of trained staff to the profession, and increasing litigation by both injured patients and bullied employees. The stereotype of a "victim" as a weak inadequate person who somehow deserves to be bullied is giving way to the realisation that bullies, who are driven by jealousy and envy, pick on the highest performing and most skilled staff, whose mere presence is sufficient to make the bully feel insecure. Threats (of exposure of inadequacy) must be ruthlessly controlled and subjugated. Those who can, do. Those who can't, bully. Whether you've been a target or believe that it won't happen to you, almost
everyone is at risk of becoming a target.
Both sides need help when bullying happens 
EDITOR Often bullies seek out easy targets: people with a passive nature who do not have much self confidence. Bullies can be openly aggressive and easy to recognise. But you should also beware of those who are indirectly aggressive, who pretend to be nice while stabbing you in the back. Keeping a record of incidents, talking to others, and enlisting the help of witnesses are all important. There is relevant legislation, but work tribunals are not for everyone: they are daunting and stressful, and the outcome is uncertain unless good evidence can be produced. Perhaps even more important is that victims of bullying should learn to stand up for themselves, to see the incident, difficult and damaging as it is, as a growth opportunity in terms of personal development. I found that I could not change the other person but could change myself in a positive way, and now I am much more aware of the issues involved. It is not only the victim of bullying who needs help. Unrelenting perfectionism and intimidation do not always result in career progress and promotion (though they often do, unfortunately) but may result in the person being demoted or losing their job. The situation can be particularly difficult for women bullies. Traditionally, women have been encouraged to adopt more aggressive and dominating behaviour to be able to compete in the male dominated workplace. Now, tough career women are being sent to remedial programmes to learn how to get in touch with their own vulnerability and be intuitive, nurturing, and compassionate. Denying what is at the core of human existence does not make for happy
living, and bullies do this at their peril. It is time for society to
realise that being a caring individual is not a weakness but an
asset, and essential for those responsible for managing
others.
We must all learn from our unacceptable behaviour
EDITOR Unfortunately, many senior doctors are unaware that they have a problem. Only psychopaths are horrible and enjoy it. Most people are rude and horrible because they feel anxious, stressed, and put upon, and these emotions drive chronic bullying and rudeness. Elevated rank leads to years of this behaviour being unchallenged, which removes any chance of insight developing. All of us in the NHS should have constant insight into how our frail emotions can influence our behaviour towards colleagues. Simple psychological models such as transference and projection explain most bad behaviour. It is a tragedy for healthcare workers that they can serve the public tirelessly and with kindness, only to then project their frustrations on to each other, undoing any good they have done with their patients by damaging colleagues. Forgiveness and an open culture of discussion of stress is the way forward. I
am no saint and have been rude and angry on many occasions. I hope
that I learn every time I behave badly and reduce the frequency of
those incidents.
Summary of responses
We received 27 other responses to this personal view, all sympathetic to the widespread problem of bullying at work, 24 of which were published on bmj.com.1 Twelve of the respondents were senior doctors. Only two respondents admitted to having been bullied. One had worked in the civil service and thought that "the history of the civil service as with the NHS is plagued by authoritarian rule. . . . There can be no team working in an environment where people are so busy concentrating on protecting the `self' and completing the `task' that they have no time to be part of the bigger picture." The other, in medical research, said, "When I finally complained and after having a breakdown, the trust responded by trying to have me dismissed." Peter Bruggen, a retired consultant psychiatrist from London, suggested what the anonymous bullied doctor could do to make life more bearable using various techniques from psychotherapy. However, Graham Spiller, a pathologist in Canada, asked: "Why should Anonymous have to relinquish her career for a year? I suggest that the consultant surgeon could benefit from psychotherapy," adding "I suspect that [nasty senior doctors] have personality problems." Peter Devitt, a consultant surgeon in Australia, sought an explanation for the case by describing the stresses and strains of consultants. "Being able to handle those situations is part of the challenge of being a consultant. It would appear that the consultant in question is unable to cope with those challenges." Helen Morant, also from Australia, pondered on the effects of working in the NHS. "Is it possible that the victim of this bullying was less able to cope with harsh criticism because she was physically exhausted from working 90 hour weeks, mentally exausted from studying for exams on top of a more than full time job, and emotionally exhausted from telling several patients that week that they had diseases that would kill them? "Is it possible that the bully had been `toughened' by forcing her way to the top of a male dominated profession, constantly having to prove herself as a woman, and now realising pressures of constant managerial change, budget management, and underfunding as well as clinical commitments?" The imbalance of power was blamed by I Agell, a specialist registrar in psychiatry in Huddersfield: "If a bullied person was capable of ending the incident they would do so." Bullying is ubiquitous, certainly the type of bullying described in this personal view is not unique to the United Kingdom, confirmed Russell Lutchman, specialist registrar in forensic psychiatry at Broadmoor Hospital. "Bullying is not a part of the medical training, but there will always be bullies. Bullying is part of the human condition," argued Neville Goodman, consultant anaesthetist in Bristol. So how can we stop bullying in medicine? John Boulton, a professor of medical practice in Australia, highlighted the importance of communication skills: "Although medical education has espoused the importance of teaching doctor-patient communication, it has lagged behind in doctor-nurse, doctor-doctor . . . and doctor-[other staff] communication skills." Medical and nursing students should be taught how to manage the rigours of interprofessional communication. Jeremy Bolton, associate dean of the Kent, Surrey and Sussex Deanery,
reported that the deanery requires all trusts to have an
anti-bullying policy in place as part of the educational contract
with the deanery. Perhaps all deaneries should do this.
Rapid Responses:Read all Rapid Responses
Other related articles in BMJ:
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 "A foolish faith in authority is the worst enemy of truth." -- Albert Einstein, letter to a friend, 1901 "I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education." -- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820 "What's the point of vaccination if it doesn't protect you from the unvaccinated?" -- Sandy Gottstein "Who gets to decide what the greater good is and how many will be sacrificed to it?" -- Sandy Gottstein |
Those
who can, do; those who can't, bully
The
experiences of the person who wrote an anonymous personal view about bullying in
medicine is one I have heard related to my national workplace
bullying advice line many times.