Ending the silence

by Keith Cooper

Whether in the form of sly comments or physical abuse, bullying affects thousands of NHS doctors. They should not have to suffer in silence, BMA reports.

Location: UK
Published: Monday 17 September 2018

You would think bullies were everywhere in the NHS from the number of reports, inquiries and newspaper headlines of late.

‘Staff at the famous Whittington Hospital “left broken wrecks” by bullies,’ was an August offering from The Sun.

Bullying – and its close associate harassment – are now taken seriously by most hospitals, officials and politicians. Bad behaviour begets bad care is one mantra to endure from the well-known inquiry into the ‘terrible’ suffering of patients at Stafford Hospital in 2013.

However, isn’t some toughening up ‘all in the game’ in the rough and tumble of medicine, as one doctor told us?

You can’t make a good GP, surgeon, or emergency medicine consultant, to name but three, by pussyfooting around with feedback. When lives are on the line, or lost, at the end of a stressful shift, can the loss of a rag really be treated as bullying?

And what is it exactly? When do tough words in training or from a colleague or boss on a work day turn into harassment? What to do when you’re the accused?

According to scores of doctors who shared their experiences with the BMA this year, it takes many forms – from the almost imperceptible to the downright violent.

‘When intelligent people are involved, it can be subtle,’ one psychiatry trainee says. ‘My own experience was of underhand comments, questioning in an interrogatory manner. Made to answer questions again and again. Then taking pleasure in telling me I was wrong.’

One female GP, reflecting on her training, recalls being ‘pinned to a wall by the throat by an emergency medicine consultant’. She took too long to review a patient, apparently.

After reporting it, she was told ‘not to make trouble, it might affect my references’. She moved to a different hospital, her self-confidence destroyed, she says.

A specialty trainee 2 was told to ‘F*** off’ by a registrar in a room full of witnesses. They said nothing. ‘No one stepped in to say this was inappropriate,’ the trainee adds.

A GP partner was ‘cornered and shouted at’ by a colleague, ‘ridiculed and humiliated in front of trainees’, then ‘frozen out’ by other partners in her practice. ‘I dreaded work daily,’ the account says.

 

Angry outbursts

Several felt bullied by being ‘undermined’ or ‘micromanaged’ by colleagues. ‘It was very wearing,’ one respondent says. Another, a male consultant, was ‘undermined and marginalised’ by a more senior academic colleague. ‘This culminated in me having a role removed without consultation,’ he adds.

As many doctors felt bullied by false accusations as undermining behaviours. ‘During his angry outburst he made grossly fictitious claims about a letter I had written,’ one surgeon wrote. ‘As he got angrier, I became calmer until it ended with a threat to my career.’

One female trainee felt sexually harassed by ‘constant comments’ from a consultant about the length of her legs.

‘He told me he wished he was having an affair. It felt like he was trying to put out feelers.’ Another called her into his room to sit in a chair close to his own. ‘You couldn’t sit in it without your legs touching his.’

I don’t remember the exact point things started going downhill but it must have been early on. He began calling me into his office, on a daily basis, for some perceived misdemeanour or other. The daily beratings increased in severity to the point where I’d break down and cry. He asked me three times: ‘Do you think I am bullying you?’ I felt pressured, I said, no.

GP trainee, BMA The Doctor (April 2018)

Trainees with disabilities felt bullied when ‘reasonable adjustments’ for work were not honoured. Some were seen as a weak link.

‘My trainers and now some colleagues don’t seem to understand the limitations of my disability or what reasonable adjustments mean,’ one says. ‘My working conditions had extra protections, due to my disability,’ says another. ‘But other senior house officers were obstructive, accusing me of not pulling my weight.’

These reported behaviours affected professional and personal lives to varying degrees. Many felt isolated, forced to take sick leave, for which some felt punished. Trainees switched specialty. Others quit or felt trapped. ‘I could take action but you just get a sorry note. I have to work with these colleagues for the rest of my career,’ one female surgeon says.

Several struggle to recover. ‘I had no one to turn to,’ one GP said. ‘My mental health started to deteriorate and my family relationships were suffering. I “chose” to resign.’ One trainee felt bullied by their educational supervisor for a year but ‘stupidly persevered, thinking eventually it will pass’.

‘It costs me a lot of sleepless nights, stress, mental and physical health problems.’

 

Inclusion matters

Hostility from colleagues, lack of compassion and isolation hit doctors particularly hard. So says Caroline Elton, an occupational psychologist whose book, Also Human: The Inner Lives of Doctors, draws on her career supporting thousands of people.

‘The antidote to professional pressures for doctors is a sense of belonging, having colleagues you can talk to and respect you,’ she says. ‘Isolation from that, then, is particularly toxic.’

So, bullying is a problem for doctors, it seems. It’s no respecter of grade or gender, you told us. It seems to hit all branches of practice and specialties. The Doctor heard from doctors in England, Scotland, Wales and Northern Ireland.

When NHS staff were last asked, in 2017, one in four said they had felt bullied or harassed by colleagues. Expect more if you’re disabled, from a black or minority ethnic background, lesbian, gay or bisexual, the official figures say.

Earlier this year, the BMA surveyed thousands of members to inform its Caring, supportive, collaborative project, which aims to develop a positive vision for a better healthcare system.

Two-fifths said that bullying, undermining or harassment was a problem in their places of work.

Through consulting with members, including through a number of events, the BMA is working on practical solutions to address the problems in funding, culture and workforce which do not excuse bullying behaviours, but may sometimes help exacerbate them.

Although it can seem intractably difficult, there are also actions which those who feel themselves bullied can take.

BMA members can call an employment adviser. It’s best to call at the first inkling that you’re being bullied, says head of member employment relations, Jill O’Regan, who oversees the service. ‘Sometimes people do come to us when it’s a bit late, and it’s much harder to resolve things.’

If you feel you are being bullied pick up the phone. A specialty doctor did just that and was glad she did. She told the BMA: ‘I want to sincerely thank you for your help and your support at a particularly difficult time… you had helped me gain an objective perspective when I felt really helpless.’

This is supported by guidance from the employment advisory and conciliation service ACAS, which says there’s a better chance of sorting things out and preventing bullying spreading if it is dealt with early.

Evidence gathering is ‘key’, Ms O’Regan adds. ‘Without witnesses, it can be one person’s word against another’s.’

Doctors are advised to keep diaries of incidents and they need to be talked through the process of raising concerns through official channels and they need to be supported through any inquiries, commissioned by their employers.

As a union, advisers support doctors accused of bullying too. In such cases, Ms O’Regan says there are strict ‘security walls’ raised and different advisers for each side.

In England, doctors can flag harassment, anonymously if they wish, with ‘freedom to speak up guardians’, of which there are hundreds and at least one in each hospital trust. Jamie Read, an ST5 in geriatric medicine at University Hospitals

Plymouth NHS Trust, was the first junior doctor to be appointed to the role. The National Guardian’s Office, which oversees him, is keen for more trainees to sign up.

‘Bullying and harassment has been a big finding across all of the guardians,’ Dr Read says. ‘Some people say, “I think I am being bullied, undermined or harassed”. Others don’t use the “bullying label” but through conversations it looks like that is what’s being described.’

It tends to be undermining rather than shouting or aggressive behaviour, he adds. ‘It’s about people being told they’re not good enough, snide comments in rooms full of people. That nothing you ever do is good enough. There’s nothing you can do about it, even if you work really hard.’

Trainees felt undermined by senior doctors, including those in charge of their training, according to the experiences some shared. More than 140 reported ‘belittling or humiliating’ behaviour to the GMC last year.

 

It starts with consultants treating you as though you’re an irrelevance. The clinical director told me they simply do not have time to teach us. We have no teaching and are looked down on.

Specialty trainee, BMA The Doctor (April 2018)

Such behaviour is ‘absolutely not acceptable’, says Health Education England’s GP dean for the eastern region Vijay Nayar.

‘These allegations are followed up and investigated.’ He said feedback to trainees should be given in a respectful way which is sensitive to their needs.

If relationships broke down, GP trainees could seek help from their programme directors, associate deans or heads of school.

 

A ‘tradition’ which must end

So help is there to address immediate concerns. For the longer term, the BMA is leading a campaign to change the culture of medicine and is holding a conference in November.

‘I don’t believe that bullying and harassment is all in the game of the medical profession, as some still do,’ says BMA representative body chair Anthea Mowat, who is leading the campaign. ‘You’ve told us you want an end to it. We won’t stop until it does.

You’ve probably heard quite a lot about bullying already. How bad it is for patient care. About being strong and speaking up. Here’s a leaflet, there’s a phone line. Let’s tick that box and move on.

But I want the BMA’s anti-bullying campaign we’ve begun to be different. We need to start a conversation with everyone, including the bullies. We need to end the silence. To not stop until everyone knows where to find help and feels safe to do so. We need to help those who harass us to change. Some of us might have to admit that we’ve been bullies too.

We know there’s a problem. We’ve listened to your experiences of being isolated, frozen out and marginalised by colleagues. Those feelings of being trapped, forced to work alongside your aggressors; how it harms your career, your health, your home life. The false accusations. In cold, hard facts, one in five doctors are bullied or harassed in the NHS.

As a staff, associate specialist and specialty doctor, I was regularly informed of my ‘junior’ status by a colleague. Into my anaesthetic room he’d come, twiddle the controls on my perfectly balanced machine. Nothing said. Just changed it, then walked away. I was so stunned.

We must do something about the bullies, too. Some don’t recognise their patterns of behaviour and the damaging effects they have. They might be horrified, they might not. Or what if it’s out of character? Is there trouble at home? Even doctors get ill, of course. We must think of the future, of changing the culture. About how we treat and train the next generation. How to put paid to the unproud tradition of training by humiliation, which some still pass on. We need to find role models for doctors and team leaders, an alternative to belittling power plays.'