“What can be perceived as harmless banter or acceptable behaviour by some people for decades can actually be deeply offensive, or even abusive,” says Judy Evans, consultant plastic surgeon at the private Nuffield hospital in Plymouth. “We’re now at a point where huge numbers of surgical positions aren’t being filled because millennials don’t want a job in which they think they will be bullied.”
Evans lost her job as an NHS consultant in 2000 after standing up for a junior doctor who had been bullied. “The bullying culture in medicine goes back decades,” she says. “Over 30 years ago, I remember turning up for a surgeon’s exam when I was seven months pregnant and being asked bluntly: ‘What are you doing here looking like that?’ Sadly, that kind of behaviour was seen as something women just had to put up with.
“In the past, surgery used to be just sexist – a hangover from the old boys’ clubs, drinking and playing golf – but that’s not the only issue now. Bullying and being bullied is everywhere now, at every level: consultants, juniors, women, men. It can be incredibly subtle but terribly destructive unless we are all more aware of not just where to go for help, but also that you might actually be a bully yourself.
“I know of surgeons who have considered taking their own lives, others who have left the profession because of bullying surgeons’ bad practice going unchallenged. Of course, the ultimate downside to all of this is patient wellbeing being compromised.”
Evans’s concerns about bullying, particularly among surgeons, are backed up by studies. A quarter of doctors say they have experienced bullying, harassment or abuse from other staff in the past 12 months, according to last year’s NHS England staff survey.One in six trainee surgeons, who responded to a web survey, say they suffer from bullying-related post-traumatic stress disorder that is so bad it can leave them suicidal, according to a paper published this summer in the Surgeon journal.NH
A 2014 survey of members of the UK’s oldest and largest Royal College of Surgeons, in Edinburgh – with 25,000 members mainly working in England and Wales – found that 40% of respondents had been victims of bullying, and the same number said they had also witnessed bullying in the workplace.
In addition, a 2015 study revealed that 94% of surgeons had observed unprofessional behaviour, including bullying, among colleagues.. Moreover, it directly impacts on patient welfare.
Evans believes the systemic bullying culture was the reason breast surgeon Ian Paterson, who was jailed earlier this year for 15 years, was able to get away for so long with performing unnecessary surgeries on what could be more than 1,000 women. Paterson was described by colleagues as an “arrogant bully whom colleagues feared to challenge”, she says.
“In the airline industry if someone at any level of the hierarchy finds a fault, they are rewarded because passenger safety is everything – in surgery the opposite has been true. Trainee surgeons, nurses and others lower down the team’s pecking order are frightened about speaking out and receiving negative reactions for questioning that something might not be quite right. Tens of thousands of lives have been and will be at risk if the status quo isn’t changed.”
Evans cites the example of airline pilot Martin Bromiley, who has campaigned tirelessly for patient safety after his wife died 10 years ago during a routine operation because a nurse’s concerns were ignored. “That nurse produced the instruments to perform a simple tracheostomy and save Martin’s wife’s life, but she was pushed to one side,” says Evans. “To be effective we have to work as a team and show everyone respect, whatever their role. Bullying strips away self-confidence, so doctors may not trust their own abilities to make life-saving quick decisions.”
Since Evans left the NHS with a large payout she has fought tirelessly to end the bullying culture among surgeons. She is the first woman to be appointed an office bearer of the Royal College of Surgeons of Edinburgh (RCSEd) and has helped to launch its campaign, Let’s Remove It, to encourage healthcare professionals to speak up and stamp out bullying. Its website directs medics to where to get help if they feel they are being bullied, and has a checklist to see if they are showing bullying behaviour.
Backing the campaign is Anushka Chaudhry, 39, a consultant breast surgeon at the Great Western hospital in Swindon. She says she was constantly bullied by a consultant surgeon during her NHS training at another trust – but she kept the bullying and its effects secret for more than 18 months. “I’ve never spoken publicly about what happened to me, and I know many friends and colleagues will be shocked to hear this,” she says. “From the start that consultant surgeon let it be known that women – or ‘girls’ as he preferred to call us – should be grateful to be there. He’d constantly undermine my professional decisions and comment about my workload, insinuating I was workshy and had no work ethic, which amounted to slander and affected my professional reputation.”
Towards the end of that placement she says the bullying had escalated to the point where the consultant told her in front of colleagues and other trainees that she had “never worked for him”. “He basically dismissed me from surgery, refusing to sign me off so I could start the next step of my career, a career I loved. Instead of feeling that he was in the wrong, I felt ashamed that I was disliked so much. I hid what was going on at work from my husband, became withdrawn at work and lost so much confidence, feeling so alone.”
It was only several months later that she heard three other trainees had also been bullied by the same consultant and that he had been dismissed as a trainer and had left the trust. “It was great news, knowing other trainees wouldn’t have to go through what I did,” says Chaudhry, who now mentors trainees.
The RCSEd is working closely with the General Medical Council and the Royal College of Obstetrics and Gynaecology, to run pilot workshops to help doctors recognise and change their behaviour. NHS boards can apply to send people on its courses, the first of which is planned for February. Says Evans: “Prevention is always better than cure, of course, but we need to change the culture so people can be honest and admit they are doing the wrong thing.”
It is also campaigning for the GMC to introduce compulsory training on bullying for trainee doctors.
Dr Alice Hartley, 37, a registrar at Sunderland Royal hospital who chairs the RCSEd’s anti-bullying campaign, says she regularly sees surgeons brought to tears by other colleagues. “It’s an ego thing without any consideration for nurturing the trainee. In my career I’ve seen constant undermining, talking down to people, making both trainees and also consultants feel small and inferior – it cuts across the whole of the NHS and needs to be stopped.”Hartley says she herself has been a victim. “I’ve been in theatre and had a senior colleague fling instruments on to the floor in a rage when I asked a simple question,” she recalls. ”It just makes you doubt yourself and crucially stops you questioning what’s happening and creating a better team to treat patients more effectively.
“It’s the constant belittling, the making you feel like an idiot that slowly breaks you. Surgery has historically been a cutthroat, ego-driven world where you had to tolerate abuse very regularly if you want to move on – either that, or you leave. We’ve got a massive shortage of surgeons coming through now, and we have to address the working environment.”
Danny Mortimer, chief executive of NHS Employers, says: “Bullying is completely unacceptable. All NHS organisations have clear policies in place to deal with reports of harassment or bullying. This requires employers to take clear action to address those concerns. It is not always easy for concerns to be raised, particularly where those carrying out harassment are in positions of power. Many organisations will have specially trained staff in place to help colleagues raise concerns about bullying or harassment, there are freedom-to-speak-up guardians as well as chaplaincy, trade union and HR staff who can provide support.”
Dr Anthea Mowat, the British Medical Association representative body chair, says: “We know from speaking to our members that a combination of factors feed into creating environments which permit and perpetuate bullying behaviour: the organisational culture in the NHS; workload pressure; the strong hierarchy within the medical profession; and the ‘silent bystanding’ which means behaviours go unchallenged and become learned by newer staff. Ending this issue, which means addressing these underlying factors, is a big challenge and the BMA is committed to raising awareness of all forms of bullying and harassment and the consequences for doctors’ wellbeing and patient care. We want to ensure there is a clear understanding of the issues and people are confident to raise concerns and report problems when they occur. The BMA also offers a 24-hour counselling service and the doctor adviser service, Doctors for Doctors, which gives doctors and medical students in distress the chance to speak to another doctor in confidence.”
For Chaudhry, being bullied was such a horrendous experience that, she says, she only really recovered her confidence almost two years later. “I now want to speak up to help others going through something similar.”
Source: TheGuardian