Bullying in medicine


 * This article primarily concerns bullying involving doctors. For bullying involving nurses see Bullying in nursing.

Bullying in the medical profession is common, particularly of student or trainee doctors. It is thought that this is at least in part an outcome of conservative traditional hierarchical structures and teaching methods in the medical profession which may result in a bullying cycle.

According to Field, bullies are attracted to the caring professions, such as medicine, by the opportunities to exercise power over vulnerable clients and over vulnerable employees.

Impact
Bullying can significantly decrease job satisfaction and increase job-induced stress; it also leads to low self confidence, depression, anxiety and a desire to leave employment. Bullying contributes to high rates of staff turnover, high rates of sickness absence, impaired performance, lower productivity, poor team spirit and loss of trained staff. This has implications for the recruitment and retention of medical staff.

Bullying of medical students
Medical students, perhaps being vulnerable because of their relatively low status in health care settings, may experience verbal abuse, humiliation and harassment (nonsexual or sexual). Discrimination based on gender and race are less common.

In one study, around 35% of medical students reported having been bullied. Around one in four of the 1,000 students questioned said they had been bullied by a doctor, while one in six had been bullied by a nurse. Manifestations of bullying include:
 * being humiliated by teachers in front of patients
 * been victimised for not having come from a "medical family"
 * being put under pressure to carry out a procedure without supervision.

One study showed that the medical faculty was the faculty in which students were most commonly mistreated.

Bullying extends to postgraduate students.

Bullying of junior (trainee) doctors
In a UK study, 37% of junior doctors reported being bullied in the previous year and 84% had experienced at least one bullying behaviour. Black and Asian doctors were more likely to be bullied than other doctors. Women were more likely to be bullied than men.

Trainee doctors who feel threatened in the clinical workplace develop less effectively and are less likely to ask for advice or help when they need it. Persistent destructive criticism, sarcastic comments and humiliation in front of colleagues will cause all but the most resilient of trainees to lose confidence in themselves.

Consultants who feel burnt out and alienated may take their disaffection out on junior colleagues.

Bullying cycle
Medical training usually takes place in institutions that have a highly-structured hierarchical system, and has traditionally involved teaching by intimidation and humiliation. Such practices may foster a culture of bullying and the setting up of a cycle of bullying, analogous to other cycles of abuse in which those who experience it go on to abuse others when they become more senior. Doctors are increasingly reporting to the British Medical Association that they are being bullied, often by older and more senior colleagues, many of whom were badly treated themselves when more junior.

Bullying in psychiatry
The psychiatric profession might be expected to be particularly sensitive to bullying and its consequences. However psychiatric trainees experience rates of bullying at least as high as other medical students. In a survey of psychiatric trainees in the West Midlands, 47% had experienced bullying within the last year with even higher percentages amongst ethnic minorities and females. Qualified psychiatrists are not themselves required to be psychiatrically tested.

Doctors bullying/abusing patients and nurses
There have been quite a few proven cases of doctors bullying and/or sexually harassing patients and nurses.

Speaking of many doctor's predilection of bullying nurses, Teresa Brown writes:
 * "...the most damaging bullying is not flagrant and does not fit the stereotype of a surgeon having a tantrum in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults."

Bullying in nursing
Nurses experience bullying quite frequently. It is thought that relational aggression (psychological aspects of bullying such as gossipping and intimidation) are commonplace. Relational aggression has been studied among girls but not so much among adult women.

In popular culture
Sir Lancelot Spratt, a character played by actor James Robertson Justice in the film series Doctor in the House, is often referenced as the archetypal arrogant bullying doctor ruling by fear.

In the American sitcom Scrubs, Dr. Cox uses intimidation and sarcasm as methods of tormenting the interns and expressing his dislike towards them and their company.