Why is bullying still a problem in medicine?

Dr Ciaran Crowe is an ST6 doctor in obstetrics and gynaecology and a Clinical Fellow at the GMC. Here, he talks about bullying in the healthcare system and what we can all do to tackle unacceptable behaviour.

I’m sad to say the recent state of medical education and practice report shows that bullying and undermining are still rife in our healthcare settings.

In 2014, out of a sample of 150 calls made by doctors to the GMC’s confidential helpline, nearly one in five were about serious problems in working relationships [PDF] between doctors. Three-quarters of these were linked to bullying or undermining in various forms.

Infographic - National Training Survey 2014 found 8% of doctors in training had been bullied

The National Training Survey 2014 found 8% of doctors in training had been bullied at work

The state of medical education and practice report also draws attention to the 2014 NHS England staff survey, which found that almost one in four staff said they experienced harassment, bullying or abuse from their manager or other colleagues.

I know this is a major problem because I have been on the receiving end. It is an isolated and stressful place that no doubt affected my mental wellbeing and ability to do the best job I could for my patients and colleagues.

Bullying and undermining in my specialty

I am even more saddened to say that when it comes to bullying and undermining, my own specialty – obstetrics and gynaecology – consistently outperforms the other medical specialties.

In the GMC’s National training survey 2014 [PDF], obstetrics and gynaecology was given the lowest score for offering a supportive working environment and for instances of undermining.

This may surprise the public and other doctors given that we are part of one of the happiest occasions in life: the birth of a baby.

Triggers for bullying in healthcare settings

So what goes wrong? What are the causes of bullying and undermining in healthcare environments?

Certainly balancing service needs with training and education in an ever more pressurized working environment has not helped. A squeezed service faced with a shortage of midwives and large workforce gaps of obstetricians around the country is one contributing factor. Combine this with increased patient needs (older mothers, obesity and a diabetes epidemic) and suddenly the stress barometer is into the red.

I believe poor communication between staff and poor leadership at various levels of the healthcare system can also lead to problems among doctors and between doctors and other healthcare professionals.

I believe poor communication between staff and poor leadership at various levels of the healthcare system can also lead to problems among doctors and between doctors and other healthcare professionals.

According to The state of medical education and practice, the GMC’s quality assurance team found problems with bullying and undermining at six of the 23 sites that required enhanced monitoring in 2014. In many of these cases, the report says consultants were not aware doctors in training felt undermined by their actions.

Infographic of who has been bullying doctors in training

The National Training Survey 2014 explored who had been bullying doctors in training

Good practice already exists

Last year, I spent time in Sweden where I saw supportive working environments, low maternal morbidity and mortality figures and almost no reports of bullying and undermining.

When I asked doctors in Sweden what they attribute this to, they unanimously said ‘team working.’ They have breakfast together before the clinical shift begins to encourage discussion about what they can learn from past clinical outcomes as well as any personal concerns. This sets the team up for the day. Everyone knows what resources they’re working with. And, on a wider note, it ensures joint decision making and cohesive team working.

Doctors in Sweden have breakfast together before the clinical shift begins to encourage discussion about what they can learn from past clinical outcomes as well as any personal concerns. This sets the team up for the day.

In the UK, Southmead maternity department in Bristol has outstanding patient safety figures. Their research attributes this to effective team working: a flattened hierarchy, empowering staff to lead and joint decision making. This culture begins during simulation training and is integrated into daily practice.

Stamping out unacceptable behaviour

The most effective way to eradicate bullying is to challenge it early on. Ideally, this behaviour should be managed locally. Sometimes encouraging both parties to talk about why this behaviour has occurred is all it takes to resolve the situation and prevent it from being repeated.

The most effective way to eradicate bullying is to challenge it early on.

The GMC already takes concerns about bullying and undermining seriously and acts on them using evidence from the National trainee survey, the confidential helpline, and an online reporting tool to tackle this behaviour.

Through a new single set of standards Promoting excellence: standards for medical education and training and the duty of candour work with the NMC, the GMC wants to make sure doctors feel supported to report behaviour which puts patient safety at risk. This includes bullying and undermining.

The Academy of Medical Royal Colleges (AoMRC) has also agreed that creating supportive learning environments is a top priority. I’d like to see the undermining toolkit developed by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) adapted for use across all Royal Colleges. It recommends ways to make departments welcoming to all team members: for example, through daily team huddles and ‘about the team’ noticeboards.

‘Resilience training’ is seen by many in education as key to creating a supportive working environment.

Resilience training’ is seen by many in education as key to creating a supportive working environment. We will always have good days and bad, poor clinical outcomes and difference of opinion within the team. Our natural resilience is a combination of personal characteristics and learned skills. We need to explore these personal traits more when recruiting doctors to a speciality and to teach these skills throughout medical education.

Greater openness will help empower healthcare professionals to shift the culture balance so that bullying and undermining at times of stress are never acceptable.

Have you read this year’s state of medical education and practice report? Tell us how we can make it even more useful next year by completing our short survey.

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Dr Alys Cole-King explains why doctors under pressure need resilience, not mental toughness

Peter Lees from FMLM writes about how positive leadership can empower change

2 responses to “Why is bullying still a problem in medicine?

  1. If GMC is used by bullies, there is no escape for the doctor. Usually the seniors/ other staff make unsubstantiated complaints to GMC. And GMC goes back and asks the same people about the complaint they made. If the current type of investigation of believing the complaint and disbelieving the doctor, treating the doctor as culprit untill proven continue, there will be no end to the bullying experienced. As the GMC itself is being used as an instrument of bullying and control.

  2. I know a story of a Senior Reg in Obstetrics being bullied in a gynaecology theatre – The male consultant apparently bullying the female registrar . No one else wanted to challenge him – he had done hundreds of the procedure he was bullying and undermining the registrar during and it was her first time doing the procedure – A brave nurse reported it to the clinical lead who addressed it . The registrar compared her bad experience to another case where she (registrar) was facilitated to learn & gain knowledge . It takes everyone to speak out to bullies – the standard we walk past or see is the standard we accept – all NHS and private staff should be taught

    1.how to deal with bullying
    2. How to not be a bully
    3. How challenge thèse that bully others and support those who are bullied

    We are all responsable in stamping out bullying no matter whether we are nurses , midwives , porters , HR managers , Team leaders , non- clinical staff , health care assistants , junior doctors or consultants – let’s start today

    http://wp.me/p4C9Z1-8Z

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