The recent examination of discrimination, bullying, and sexual harassment in the medical profession has created a watershed moment for the sector.
Apology over ‘toxic culture’ among surgeons
After a survey finds nearly half of all surgeons have experienced discrimination, bullying or sexual harassment, RACS President apologises for the ‘devastating impact’ on surgeons and trainees.
We are forced to ask ourselves: how, in a profession so dedicated to the nurturing and healing of others, have we allowed the proliferation of a culture so damaging to ourselves?
But with the unequivocal findings from the recent Royal Australasian College of Surgeons’ report into discrimination we seem ready to acknowledge that our current policies are impotent and reported incidents are few – not because we’ve achieved any behavioural utopia – but due to the disempowerment and fear of staff.
As a female cardiac surgeon, I have had to adapt to this environment, but I have left behind friends and colleagues who couldn’t. At times I have been ashamed of my inability to change the climate outside my operating room.
So the sense of relief and appreciation I feel at this development is enormous.
The medical profession has long granted itself behavioural exemptions when addressing bullying and discrimination due to the life and death nature of our work, while at the same time demanding a workforce resilient to the forces of our culture.
Most shamefully we have propagated a culture where bullies have been both prized and bred. One of my past colleagues called it “Darwinism at work”; weeding out those not strong enough to survive.
This must not become our legacy.
Our most manipulative bullies are those who hide behind declarations of doing it “for the patient”. This implies that anyone who speaks out against such behaviour undermines a noble intent.
This cowardice infuriates me.
The data shows what I know, as a clinician, to be true: that discrimination, bullying, and sexual harassment are directly linked to impaired patient safety, raised error rates and an increase in patient complaints.
No one has ever been able to explain to me how my operating theatre team would function better in a time-critical emergency when united only by intimidation and a paralysing fear of speaking up. How can patients not suffer in such an environment?
But in the face of such deep-seated complexity, how do we move beyond the sins of the past?
Firstly, we must reject the notion that discrimination, bullying, and sexual harassment is perpetrated only by male doctors in white coats and accept that bullies span employment groups, ages, seniority and genders.
In a recent Medical Journal of Australia study, 146 medical students identified nurses and midwives as the most likely to engage in “teaching by humiliation”.
Any effort to address discrimination, bullying, and sexual harassment must include all groups with no organisational corners ignored.
We must also recognise that in most health organisations, serious bullying or discrimination is perpetrated by only 2 to 3 per cent of people. Problems become amplified when they are key people of influence.
The majority of staff model behaviours that are focused on patient wellbeing and founded in integrity. Many of these people have been angered and wounded by their tacit labelling as bullies in the media. We cannot alienate this group as their leadership will be the key to any cultural evolution.
And any discussions are unavoidably interwoven with those of gender, discrimination and sexual harassment, with women twice as likely to experience all forms of discrimination, bullying, and sexual harassment.
My career has been defined by my gender and the assumptions of others.
There were days when my being a female surgeon was nothing more than an amusing conversation starter. At other times it became a pivotal part of my career trajectory and I was forced back into the gender trenches alone.
We must design discrimination, bullying, and sexual harassment reporting, accountability and communication strategies that are accessible and intuitive to our most vulnerable frontline employees.
We must grant a safe voice to all, thereby addressing reporting barriers such as fear of retribution, a lack of confidentiality and the feeling that “nothing ever changes”.
Anonymous reporting addresses some of these concerns and has been used with success internationally across health, law enforcement and education.
Standing up to the perpetrators might risk adverse publicity; it may require difficult decisions and confronting conversations, but there are far greater risks in apathy.
Finally, any plan must include external bodies such as colleges, other hospitals and regulatory agencies. We must remove the need for distressed complainants to duplicate their reporting and will allow hospitals to share information.
We currently have a fragmented and weakened industry unable to effectively protect staff and patients.
We can no longer harbour the people who seek to harm us. They are our open secrets, the people we quietly warn others against.
We can no longer surrender our staff and patients to the will of a disruptive few.
Healthcare must begin to value and reward behaviour as we do clinical, academic or administrative achievements. Only then, will we accumulate leaders who live our values.
There can be no more excuses.
Dr Victoria Atkinson is general manager of clinical governance at St Vincent’s Health Australia.