Why do we need to talk about bullying in healthcare?

During our undergraduate degrees, our educational foundation is underpinned by a desire to improve the health and wellbeing of others. We strive to develop our knowledge and skills and push ourselves to the limits in order to achieve this. The very idea that we need to address bullying in the healthcare setting is an oxymoron. There is an overwhelming amount of evidence that highlights this incongruence - many of our colleagues experience and, by definition, inflict the mental pain of bullying in a culture that, taken at its best, tolerates it and, at its worst, encourages it. 

A quick google scholar search reveals thousands of hits addressing this very issue across the world. Closer to home, the 2022 Medical Training Survey results suggest 34 per cent of doctors in training had experienced bullying and concerningly, 70-75 per cent did not report it. Medicine and medical teaching is an extremely structured hierarchy – based on experience, knowledge and qualifications. From a teaching and learning perspective, the hierarchy seems appropriate. There is so much to learn and so much to know in our professions and we need guidance as we develop our knowledge and skills. However in practice, this is one of the primary causative factors behind bullying in medicine and surgery. The 2015 Royal Australasian College of Surgeons report into discrimination, bullying and sexual harassment in surgical training recognised that “bullying has become normalised as a culturally acceptable behaviour” and “abuse of power and authority is a significant cultural issue”.

The power is held by senior medical officers and colleges who bestow the qualifications and oversee the training that is undertaken in our public hospitals. It is in the best interest of the public and the medical world that bullying is recognised for what it is and eliminated from our hospitals. Most colleges are beginning to address this issue and we recognise and applaud the efforts and achievements to date. We also recognise that this has not yet impacted on the daily experience of Doctors in Training. However, this does no change the unacceptable rates of bullying, harassment and discrimination that we see in a profession that is driven by our commitment to health, wellbeing and kindness towards the vulnerable. Senior medical staff have responsibility to set an example of respectful and professional clinical teaching and practice. This is reflected in junior doctor wellbeing and ultimately, we must remember that junior doctors are a product of how they are treated and taught in their training.

The AMA CDT Wellbeing Special Interest Group (WSIG) has put together these posters to help DITs that feel bullied find a pathway to address their issues. We recognise the fear DITs feel about reporting bullying is real – that currently it may impact on their progression and experience through training due to the hierarchical nature and cultural normalisation of bullying. We also recognise that despite this, we must strive to create pathways for trainees to at least obtain help even if they cannot change what they are currently experiencing. That aspect is up to the colleges and Hospital and Health Services to continue to push for cultural enlightenment that no longer accepts bullying just because the doctors in question have seniority and experience.