When a Sydney vascular surgeon, Gabrielle McMullin, warned last March that parts of the medical profession were tainted by a toxic culture of bullying and harassment, the reaction was not, as might be expected, universal condemnation. Some surgeons criticised Dr McMullin, and the then president of the Royal Australasian College of Surgeons described her comments as "appalling" – no surprise there.
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To its credit, however, the college later apologised and published an action plan pledging to "reshape the culture of surgery on foundations of collaboration and respect". Other "stakeholders" initiated their surveys to determine the extent of the problem, with the promise that appropriate remedial measures would be undertaken.
One such group, the Australian Medical Association (ACT) recently released the findings of a survey of interns, registrars and registered medical officers working in and around Canberra. Conducted over two weeks in November, it found that half of the junior doctors reported being bullied over the previous 12 months, with about 4 per cent saying they had been sexually harassed in that time. Sixty-three per cent of respondents said they felt unable to raise concerns about this or other bullying forms of bulling, such as being pressured into working unpaid overtime.
The AMA report's findings largely mirror those of a KPMG report into training programs at Canberra Hospital which the ACT government commissioned after the RACS withdrew the hospital's training accreditation for urology services in June. It recommended, among other things, that the hospital compose new statements of culture, hone its communication campaigns, and revise recruitment processes. The AMA has been less prescriptive, however, with ACT president Elizabeth Gallagher suggesting that doctors, medical colleges and the government need to work together to effect lasting change. "This is a big problem that's been going on for many years, and we can't just change a culture overnight. I think we need to [take] baby steps and gradually chip away at the situation".
Bullying in hospitals is indeed extensive and long-standing, despite doctors supposedly being held to higher professional and ethical standards than ordinary professionals. There are a number of factors peculiar to training hospitals that have accentuated this culture.
There is the inherent power imbalance between trainee doctor and supervisor, the celebration of the ethos of survival of the fittest (exemplified by interns working long shifts that would be a considered dangerous elsewhere), and the unquestioning deference that senior doctors or surgeons have historically demanded from interns, nursing staff and administrators. That discrimination, bullying and sexual harassment. should flourish, particularly in the male-dominated fields of surgery, is hardly surprising.
If collaboration between the various parties running hospitals and training doctors is essential to eliminating bullying, there's also a requirement for leadership from the AMA. That's not been readily apparent, so far. For an organisation which labels itself the "most influential membership organisation representing registered medical practitioners and medical students in Australia", this failure to advocate a zero tolerance for bullying (in the manner, say, of former chief of army David Morrison) is glaring.
