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In WSASC, we have been focusing our efforts lately on addressing concerns amongst SAS doctors regarding bullying and harassment. In 2013, the Deputy Chief Medical Officer, Dr Chris Jones, and the SAS Associate Dean, Mr Raj Nirula, undertook a listening exercise which involved visits to hospitals to meet SAS doctors and to find out what was going well and some of the challenges faced by SAS doctors in Wales. Some of the issues which were raised during these listening exercise meetings were very alarming, with reports of bullying and harassment of SAS doctors being a major concern.
As a way of following this up, WSASC decided to undertake a survey during 2014 of SAS doctors who are BMA members in Wales. The survey covered a number of issues such as job planning, appraisals, recognition and support, representation, personal development, working practices, professional development and bullying, harassment and victimisation. A total of 230 responses to the survey were received, 61% of the sample. This was a particularly good response rate and unprecedented for this group of doctors in Wales, or in the UK as a whole.
Bullying, harassment and victimisation was a big theme which arose during the listening exercise and of the respondents to the survey, 48.5% reported that they had experience of bullying, harassment or victimisation in their directorate/department.
BMA Cymru Wales remain committed in addressing any reports of bullying and harassment that are received. Core principles have recently been launched for the NHS in Wales, which were drawn up by Welsh Government, with the full involvement of BMA Cymru Wales. Focus will now shift on ensuring that real, positive change happens and that staff and patients can see and feel the difference, with Cymru Wales actively engaging with partners to make this happen.
In addition, in my role as WSASC Chair, I have reached agreement in Cwm Taf Health Board that a new dignity at work course will be introduced for all doctors and that this will form part of the required training that all doctors must undertake.
A SAS Charter for Wales has also been agreed with Welsh Government and NHS Wales. This will be launched shortly. It demonstrates a commitment to supporting and developing the role of the SAS doctor as a highly valued and vital part of the medical work force in Wales, and includes zero tolerance to the bullying, harassment and victimisation of SAS doctors.
WSASC will endeavor to ensure that these initiatives are implemented and have the desired effect in the months to come.
If you have any comments or want to get in touch about any of these issues, please email [email protected]
Dr Ram Kumar is chair of the Welsh staff and associate specialists committee (WSASC)
Bullying takes many forms; it is usually easy to spot, though rarely easy to deal with. It is part of the culture of all organisations, even our beloved NHS.
Bullying is much harder to deal with when it masquerades as something else. When I was a junior doctor, it masqueraded as training. I wish to share and reflect on my experiences at the hands of one particular "Trainer".
One evening on-call, I needed to site a central line on one of our patients. The neck was short, the anatomy difficult, and I succeeded in accidentally puncturing the carotid artery. This was in the days before we had ultrasound. I contacted my Senior Registrar (remember those?) to ask for assistance; he refused to come in from home, and told me to leave it till the morning. The patient suffered no harm, other than having to receive all his medication through a pair of peripheral lines.
On the ward round the following morning, I confessed my inability to site a central line and admitted to puncturing the carotid. "You have come out of this badly" came my Trainer's reply in front of everyone. The Senior Registrar, not wishing to jeopardise his consultant appointment, stayed silent.
At another ward round, I pointed out that one of our patients had been prescribed the same antibiotics for over three weeks, and was clearly not getting any better. I suggested that it was time for a review of the patient's antibiotic therapy. "Do not make me angry" exploded my Trainer, "You're just here to make sure the patients are properly ventilated. You've got a real attitude problem".
Another patient had had pioneering surgery for a procedure which in those days carried a very high mortality. When the patient's inevitable decline began, it was I, the most junior member of the team, who got the blame. "You should have followed the protocols, they're over there on that shelf" railed my Trainer, again in front of the assembled ward round, his finger pointing angrily to a set of box files on a shelf. A few days later the surgeons admitted that they had not drawn up any such protocols.
I was on call one weekend at a peripheral hospital, and was faced with a particularly challenging clinical situation, one for which there was no textbook answer (pre-Google days). I telephoned the on-call consultant for advice; he told me what to do, and I saved someone's life.
Thinking that this was a case worthy of discussion, I presented it at one of our departmental meetings. My Trainer asked me, "Why did you do that?" I pointed out the unusual circumstances of the case, and replied that I had asked a consultant for advice and followed his instructions. My Trainer replied, in front of everyone else, "At the trials of Nazi war criminals at Nuremberg, they asked the soldiers to explain why they did what they did. They, like you, said they were just following orders. You're just like a war criminal, you're no better than they are".
No-one in that room came to my rescue. No-one spoke up for me. I couldn't speak because I was shaking. Every other trainee in that room went on to become a successful consultant. My reputation and credibility in tatters, I didn't.
I have spent many years reflecting on this, trying to make sense of it all. I have finally realised and accepted that bullies are incredibly insecure, feeling threatened by the most innocuous of comments. The above events took place over twenty years ago. As a profession, have we moved on since then?
Bullying is subjective and I hated my supervision every hour of it. I have to see my supervisor every hour a week part of my training and before I go, I was really in a position that I do not want to go in at all. I took my annual leaves on those days so that I can avoid it. Because once I sat down with that person in a quiet room, that consultant will talk down, look down like a racist person. My consultant told the FY1 doctor that FY1 should not listen to me since I am no good in this speciality . I tried to escalated to seniors and that consultant is there for 7-8 years in this small unit with 3/4 consultants however, I am someone who is rotating for 6 months, they say you can complain but even my educational supervisor looks hesitating. That is a hard to recruit speciality and i m in my core training. But I am leaving the specialty now altogether with this horrible memories. I will never become a consultant like that person and I vowed I will not look down to my juniors or talk in a way that person did. I have worked in NHS for 3 years now and I have taught by many consultants and I never find anyone that cruel to me. Like the quote says "You will never forget how someone treat you" , I will never forget that person. I hope someone in the future in brave enough to report and complain this person rather than running away from specialty like me.
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