October 31, 2018
Bullying of medical students has consequences — for future doctors and patients
ABC Life / By Ben Bravery
There are many reasons why doctors have poorer mental health than non-doctors. But surely the way we treat each other is one reason, Ben Bravery writes.
Two minutes after meeting me, my bully was on the attack.
I was a medical student on placement in a busy medical facility when I met my bully.
Normally we students travel in packs, but at this facility I was the only one. My supervisor was having a bad day, so they sent me off to join another senior doctor.
Their interrogative 'teaching' style is all too common in medicine and so I'm somewhat hardened to it.
What I wasn't prepared for was the way the bully chipped away at my confidence and undermined my sense of purpose.
When I was confused about an artery I was being asked to name, the doctor waved their arms around and loudly proclaimed they were going to email the dean of my medical school about my apparent incompetence.
When I couldn't name the Greek word for an organ, they said that I reminded them of when they were in medical school — when they "didn't know anything and didn't care".
That I didn't care was news to me.
I had decided to enter medicine after bowel cancer treatment, beating thousands of other students for a place at medical school at the age of 32. The bully didn't know any of that, nor did they care.
From that point on the bully had a pet name for me and it wasn't nice — I'm not even sure they knew my actual name. Once the bully sneered that if I didn't study harder I'd end up a social worker, insulting me and the social worker I was chatting to at the time.
On this occasion my face felt hot and my heart was racing. I wanted to crawl under the desk and cry.
There are some very good reasons why this kind of behaviour needs to stop. Doctors need to start treating each other better, and senior doctors in particular need to cultivate a culture of support and compassion.
We are, after all, caring for society's sick and vulnerable. But how can we do that well when many of us are riddled with fear, guilt and embarrassment?
But that's not the only reason.
Bullying of medical trainees is widespread
In 2013, a beyondblue study of doctors and medical students found that 20 per cent had been diagnosed with depression, 25 per cent had contemplated suicide, and one in 50 had attempted it.
Just to be clear — all of these stats are much higher than for the general population, the report adds.
Last year an Australasian College for Emergency Medicine survey of 2,100 emergency physicians found more than one-third had experienced bullying.
There are many reasons why doctors have poorer mental health than non-doctors. But surely the way we treat each other is one reason.
Five years after that landmark study, it seems that many doctors still treat each other like crap.
My own experience is not unusual. I know of a student who had their knowledge compared to that of a child, later turning away so no-one saw their tears.
I've seen a senior doctor berate a fellow trainee for not performing a manoeuvre properly, barking "get out of the way". I finally understood why the trainee always looked kind of broken.
I saw firsthand a senior doctor rip a junior team member to shreds in a group phone chat, for all to read and see.
Once I did not find something fast enough in a new storeroom, the doctor stomped in front of me and snatched the item. "You're going to be eaten alive on the wards," he said.
I've lost track of the eye rolling when a question isn't answered correctly. And we've all become immune to "What do they even teach you these days?!"
A colleague failed to hear a heart murmur when examining a patient — it was a noisy ED and something easily missed by novice ears. The supervisor took a different approach and implied the student had lied and not actually done the examination, wondering aloud if they could be trusted.
The days of doctors throwing scalpels and swearing at those around them have mostly gone (I hope), but their attacks continue. These insults to our self-esteem and performance accumulate, insidiously.
I've been through radiotherapy, chemotherapy and cancer surgery, so I know pain.
But this was a new type of injury — one that ate away at my sense of self. I even started to excuse the bully — perhaps they were correct and this was the kind of treatment I deserved?
Change will benefit doctors… and their patients
As students we rotate through teams every four to six weeks, so I've left the bully behind. But doctors in training don't have that luxury.
Doctors should reflect on and develop their interpersonal skills just like they do any other part of their work.
Just like mastering a new procedure or understanding new drug dosing, doctors should be encouraged to evaluate and practise their teaching, leadership and mentoring skills.
It's common for medical students to dream of a better future, when our generation is running the system. But I bet every cohort before us has longed for the same.
One problem is that we aren't taught how to be good workers and team members.
Doctors are thrust into positions full of status and power — but where are the courses at medical school on leadership, team management, mentorship and peer support?
Unless we start to address these skills, I'm afraid the cycle of mean and unhappy senior doctors moulding mean and unhappy junior doctors will continue.
While I am out of the shadow of this bully now, the statistics show that I will likely see or be the target of unacceptable doctor behaviour again. I was able to cope this time, and feel stronger for it, but a part of me continues to dwell on the way the bully made me feel.
As well as discussing my experience with colleagues, I flagged it with senior doctors who hold positions to affect change.
Discussing this behaviour and reporting it when necessary is the only way to bring about change — the kind of change that is good for doctors and good for patients.
If you're a medical student or doctor, and observe or are the subject of unacceptable behaviour, there are many support services available to help you work through the issue and decide on the best course of action. Here's what helped me:
Document the episodes in writing. Include the who, what, where, when and why. I did this and tried to describe the sequence of events, but also my feelings and responses. This helps if you decide to report the behaviour later, and helps process any immediate distress.
Check your facility's workplace bullying policy so you're across how people are expected to behave and what it says to do if you feel bullied.
Chat it through with a colleague or mentor. This will help you remember that there are people on your team and that you're not alone. They may also have advice on what to do next.
Given the attention this issue is now receiving, there are loads of support services you can contact for advice. You could start with your supervisor, director of education or human resource department.
If that doesn't feel like a good first step, you can reach out to an employee assistance program (EAP), Medical Benevolent Association or workplace health and safety authority in your state. Many health departments have anti-bullying support services. People with expertise in these issues can also be contacted via medical insurers, the Doctor's Health Advisory Service, Lifeline or beyondblue.
So, we can wait for the system to change, or we can be that system change.
Ben Bravery is a final-year medical student, who was diagnosed with bowel cancer at 28 and survived. His experience inspired him to change careers from zoology and science communication, to medicine.