Table of Contents
Introduction
Remember when you were in middle school? Who are some of the major plot characters that come to your mind? Your favorite class teacher, best friends with whom you ran around during recess, your first childhood love possibly, and of course, the famous “bully” in class or school goes without saying into the list owing to the enormous impact they’ve had on us. No matter how old we become, we still remember them very clearly – the psychological impact is very strong, as you can see; holding onto those memories still or if it was pretty bad, trying our best to avoid or delete them. Bullying is a very common thing we experience in school, especially in middle and primary schools. You would think that something this childish and immature would be gone by the time you enter the world of adults, yes? Well, unfortunately, a big no. Bullying doesn’t end there; it is prevalent in colleges, universities, and in workplaces too!
What is even more surprising is that bullying is present in the highly esteemed medical profession as well- bullying of students during their clinical years at the university and during their trainee/ internship period when they are new to the workforce.
What is Bullying?
Bullying is any act done to hurt or harm another person. The act can be words or actions or any other behavior, which ultimately makes the victim feel ridiculed, threatened, intimidated. This will affect the victim’s dignity and his/her wellbeing in several aspects- mentally, physically, socially, emotionally, and ethically.
There is an immense amount of psychology involved in the behavior of a bully. Some things to consider here are the fact that most bullies lack prosocial behavior. Prosocial behavior is any act that done with the intention of benefiting another person, such as helping, sharing, etc. The ability to empathize plays a key role here. Bullies, therefore, lack empathy; they do not know how to consider another person’s feelings and lack good intentions, for the most part, you could say. Another concept is the bully-victim dance; the behavior of the bully and the victim will affect one another with repeated actions over time; thus, the feeling of power in the bully and the meek victimization of the other person. Most of these are relatable to school children, and of course, to any other bullying scenario.
How Common is Bullying in the Medical Profession?
A study done in 2006 in the US shows about 85% of medical trainee students being harassed. An Australian study, revised in 2015, states that more than 50% of medical trainee students are bullied. This goes to show that the prevalence percentage is very high.
What Exactly Constitutes Bullying in the Medical Profession?
This may be a little difficult to answer sometimes by some people because there is a fine line between what may or may not be bullying in the medical profession. The margins are blurred, you could say; it depends on individual perceptions. But what is not difficult for any person to realize is that there are certain basic humane care and kindnesses that we are all entitled to.
Trainees can be subjected to a variety of abusive behaviors, including sexual harassment, which is especially targeted at female trainees. Trainees are treated with aggression, hostility, rudeness, and disrespect. They are humiliated and criticized in front of their own colleagues and patients when they lack some knowledge about a certain matter or cannot perform a clinical procedure. It very seriously breaches work ethics and morale. Pimping in medicine is where the clinician fires questions at his trainees; sometimes, it may be beyond the trainee’s knowledge level, and then they are shamed. Trainees are treated with passive-aggressiveness or sarcasm. They are discriminated against or excluded based on specific social criteria. Trainees are loaded with a lot of work, sometimes even beyond their capacity and without being given any decent breaks.
Why is Bullying Prevalent in the Medical Profession?
You would wonder why bullying is so predominant in such a highly ranked noble profession. It is almost as if bullying is part and parcel of the medical system at present; you could say it has been institutionalized. You see – one of the main features of the medical profession is the hierarchy inherent in the system. Your seniority is decided based on the exams and the higher studies that you complete. In other words, the more educational qualifications that you have, the higher your place in the hierarchy will be. It does not generally depend on your age, gender, or social status (discriminations regarding this, if it exists, is beyond the scope of this article). Medical doctors generally work as a team in hospitals.
The medical doctors at the highest level of the hierarchy, for instance, the consultants, registrars tend to bully the junior-most doctors, i.e., the trainees. This could be due to the idea that learning by humiliation makes you a better doctor someday as perceived by certain so-called professionals, which is a pretty controversial statement. When the people higher up in the system are stressed and depressed due to the intense increased workloads, they take it out on their underlings. Bullying the trainees may also be due to unrealistic self-image of the Heads in the team or stress due to their own personal problems or due to influence by substance abuse.
The thing is, most of the time, these incidents go unreported, partly due to perception differences but mostly due to the fact that these bullies have absolute career control over their trainees. They make it a point to make the trainees as vulnerable and miserable as possible. The trainees need the signature of the heads in the team to sign them off after their specific clinical training. Therefore, most trainees complain only when they have nothing to lose or too late because they also would prefer very much getting their lives and careers in order instead of getting into trouble’ or ‘getting in the wrong books of some people.’ After all medical career is challenging, you work hard for years and would like to see some good result in the end and not want it ruined.
What are the Outcomes of Bullying?
What happens with all of this bullying throughout the time you keep experiencing it as a trainee? For one thing, it will definitely compromise patient care and safety. A trainee who is bullied, harassed, and undermined will not have self-confidence or the strength in spirit to ask for help when needed. It could be a clinical procedure or knowledge about some vital information, which the trainee lacked and was unwilling and afraid to ask, which in turn puts the patient’s life in danger. The trainees will also, in fact, underperform due to the stress and anxiety added by the bullying.
It is a well-known fact, as I mentioned earlier, that life in medical school and its curriculum is one of the toughest challenges a student will face. It breaks down even the kids who are considered gifted and pampered so since childhood. Every single medical student and trainee experiences Imposter Syndrome, sooner or later after they enter the field of medicine. I believe it is inevitable, with you being in your early twenties learning for the first time to deal with the responsibilities of an adult and having to handle the difficult contents in the medical syllabus. Add to this the pressure of being bullied. It certainly gets very challenging to the point that trainees lose even more faith in themselves and their dream of becoming a good enough doctor that they may even get to the point of giving up!
Bullying ultimately turns out to be a vicious cycle. Trainees who are bullied tend to bully their junior doctors when their turn comes. Displacement becomes prevalent in the life of these trainees, be it their personal lives or career-wise. Displacement is when someone redirects their negative emotions to another vulnerable, less threatening recipient. Needless to mention that bullying absolutely breaches the work ethics and morale of the team. There will be serious communication problems in the setup.
How can we Prevent Bullying in the Medical Profession?
It obviously is not something that can be resolved within a day. Zero tolerance to any form of bullying must be emphasized! Be it a major tantrum thrown by a senior person in front of an audience or even a very slight remark thrown surreptitiously at the trainee, it must not be tolerated. It will not be easy, but if everyone collectively contributes the bare minimum, little at a time, it is definitely achievable. A sound reporting system and a support system should be available. The team members should have a comfortable environment with good communication and feedback. A code of conduct should be available on which to act upon. Doctors should have awareness programs and workshops related to these ethical scenarios, with a major emphasis on bullying, to help them train their minds and actions.
Conclusion
Some people regard bullying as something that might be necessary in medical education, ‘to build the minds and bodies of young doctors in order to make them efficient someday.’ I do not think it is true or right. Bullying instead builds people with unresolved psychological trauma, which would make them even more inefficient and incompetent. The bullied lose their love for the medical profession and believe me, medicine is not a field that you can pursue half-heartedly. The medical profession requires immense strength and determination to keep going ahead, which can only be nurtured with a lot of love and support; self-love is key, and then comes love and support from those around you, and that definitely includes your trainer!
References
https://www.psychologytoday.com/us/articles/199509/big-bad-bully
https://www.cma.ca/physician-wellness-hub/content/bullying-in-the-workplace
https://www.sciencedirect.com/science/article/pii/S1743919115012042
https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-02001-y#ref-CR15