When people learn that I pivoted from broadcast journalism to health care, they are rightly surprised: the two fields don’t seem to have a lot in common. But in my experience, they share at least this: both occasionally celebrate a culture of blame, celebrity and an eat-your-young mentality that fosters fear, undermines team work and discourages whistle blowing. In a health care environment, this type of workplace bullying has even been associated with harm to patients.
First and foremost, the vast majority of journalists and health care professionals are good, caring, collaborative people who go into these fields hoping to make the world a better place. But events over the last year at my former employer, the CBC, have me thinking about bullying in the workplace in general. And I don’t think the CBC is unique in its failure to intervene and prevent this type of behavior.
In medical education, we talk about “the hidden curriculum.” It’s not the stuff we’re taught in the lecture theatre, it’s the stuff we learn by watching our superiors in action day after day. As students, whether we are residents or nurses or physician assistants, we are exposed to an array of medical professionals whose behaviours and attitudes we soak up like sponges. And we often model those behaviours as we move from student to practitioner.
Unfortunately, students are sometimes exposed to sarcasm, shouting, dismissiveness and disruptiveness from the very people they’re supposed to emulate. In a 2011 survey of more than 800 physicians in a variety of health care settings, almost 75% reported they had witnessed disruptive behavior within the previous month, which included “degrading comments or insults, refusal to cooperate with others, and speaking loudly, characterized as ‘yelling.’” The chain of bullying can vary depending on the players in each setting, but the hierarchical nature is familiar: senior doctors bully residents, senior nurses bully residents and junior nurses, senior residents bully the junior residents and so on. You think public shaming on social media is bad? Try getting pimped – that’s how we describe being deliberately grilled by your staff physician about things way above your knowledge base. The humiliation is heightened when it happens in a group or in front of the patient.
Disruptive behavior by just one or two members of the health care team sends ripples through the work environment, creating stress, frustration, insecurity and low morale. But the harms extend beyond those wearing the stethoscopes. When surveyed, doctors and nurses say that disruptive behavior by health professionals is strongly linked to adverse events; 71% feel it is linked to medical errors and 27% link it to patient mortality. According to people on the front line, we’re hurting our patients when we bully each other.
Perhaps Jian Gomeshi thought that his tantrums, his sarcasm, his shunning of certain producers was justified because his standards for his radio program were high, and he put the quality of the program above all else. In fact, this is how bullies in health care justify their behavior. Their usual defense is that they are the Erin Brockovitches of superior patient care, loudly “outing” ineptitude to force change on a stagnant system. Sometimes, “these physicians become folk heroes to younger physicians who envy their fortitude in confronting the power of the bureaucracy.”
So while the CBC ordered a full-scale independent investigation of l’affaire Ghomeshi, what are health science programs and hospitals doing to identify and prevent disruptive behavior among health care workers?
We know that medical schools are making ethics, communication and team building part of the official, not just the hidden curriculum. This is welcome. And the hospitals I’ve worked in have clear policies against abusive and unwelcome behavior. But so did the CBC. I worry that health care workers who have little seniority and rank further down the power-pecking-order may feel too vulnerable to come forward in a formal complaints process, which is how many of Mr. Ghomeshi’s coworkers apparently felt. The report for the CBC contains nine recommendations to better protect employees, including an anonymous hotline, frequent workplace surveys and an ombudsperson who would oversee respect in the workplace. These ideas could be adopted in hospitals if they aren’t already. When I look back on my career in the media I see that the “host” culture sometimes put egos ahead of journalism. Let’s all make a commitment that in health care, no behviour will be tolerated that doesn’t put patients first.
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Oh how I welcome your article! I recently forwarded the CBC report on the Ghomeshi case to the head of our HR. For four years I have been bullied in a small team of technologists and when I went to HR, early on, they told me, I have to file a formal complaint. One of the findings of the Ghomeshi report (page 40) is that CBC relied on “formal complaints” and managers did not know how to behave when informal complaints were lodged. I feel this is the big problem with our HR departments in hospitals. When an employee, like myself, shows up on 4 to 5 occasions, speaking about bullying in a department, why is there no investigation? When a manager (like mine) hears complaints about bullying, on a “daily basis” why is the manager not investigating? In my hospital, management routinely ignores behavior received about bullying. I hope all hospitals study the Ghomeshi report and use some of the recommendations to limit bullying in hospitals. It is RAMPANT! Anonymous, RN, Toronto Hospital.
Disruptive behaviour by doctors and nurses requires good communication and thoughtful intervention. The reality is the behaviour could be indicative of psychological harm, and healing is needed. Patient safety could be affected if the health and safety of healthcare professionals is not managed appropriately.
If a patient is harmed by a doctor who has suffered psychological harm and developed a mental health problem, for example – depression, anxiety, insomnia, psychosis, substance abuse – the doctor becomes the patient and his health and reputation is protected by the College of Physicians and Surgeons. The harmed patient (or family member of a deceased loved one), is not considered a patient. This person is defined as the “Complainant”.
The RN Investigator for the College has no Nurse/Client relationship, no duty of care towards the Complainant, and therefore further negligence and abuse by the RN Investigator doesn’t matter. The College of Nurses’ philosophy – “One is one too many” concerning abuse doesn’t apply. No amount of neglected and abused “complainants” would be “too many”.
I can see how patients and families could suffer great harm by doctors and nurses suffering from a mental illness. The truth doesn’t matter. These patients and families don’t matter. Protecting the status quo and the reputation of the doctor matters, and no amount of money is too much for the Canadian Medical Protective Association, formed over 100 years ago by Canadian doctors. https://www.cmpa-acpm.ca/our-history I imagine nurses are well protected too.
There are “victim services” for victims of crime. http://www.thespec.com/news-story/5567267-gratitude-for-role-of-victim-services-comes-through/ However, there are no “victim services” for victims of doctors and nurses with any kind of mental health problem, from mild depression to severe drug induced psychosis and psychopathy. There is no crime. There is no repentance. There is no justice.
Our healthcare is all a game to Canadian lawyers, and doctors and nurses are often forced to play along. Patients are not part of the team, and for some healthcare professionals, this could cause a mental health problem. More research on this cycle of abuse is needed.
Hi Janice,
Thanks for your comments. I don’t think many doctors would agree that they are treated like a patient when they are abusive. Many find investigations by the College to be very unsettling and intrusive – which is not to say the College should take a lighter touch approach, simply to say, from what I’ve heard, the Colleges tend to take its role seriously.
That said, I think it’s interesting that you point out the term ‘complainant’ could denote certain unfair attributes. I wonder if there is a more neutral word you suggest?
Finally, isn’t it ideal that any health worker who has a mental health or addiction issue is offered help rather than be punished? If a person has been rude or unfair to other health workers or patients, this help could involve getting the person to understand how their behaviour has affected others and apologies. Where behaviour crosses the line into harassment and abuse, than indeed, repercussions are necessary.
Please stop using the word client when referring to patients.
Patients are not clients.
The roles are different. The expectations are different.
Using the word client to describe a patient makes patient care into a commodity or a corporate relationship. If this is a corporate relationship, the leader is not the patient. The leader is not even the doctor. It’s the businessman.
Please stop using that term.
My daughter had returned to medical school after her brain tumor surgery. Amazing the meanness sarcasm and dismissiveness with which her attending physicians treated her disability. The psychiatrist insisted that on higher rotation with him she watch electroconvulsive therapy. Her presentation of her illness was with the seizure. On the day that she had her first MRI post treatment he could not understand why she needed the morning off. The cardiovascular surgeon she was studying under was demeaning when she couldn’t stand for hours holding a retractor for surgery because her back hurt. The G.I. surgeon now no longer at Med Center whose name I have conveniently forgotten routinely made her cry insulting her in the OR.
Medical school and medical training is dysfunctional. The dysfunction continues from one generation of physicians to another.
I work on the inside and agree. When I do shifts on CCU, I tremble to call the cardiologists on night duty. They (not all of them – some of them) have a reputation amongst nurses of being rude, condescending and unfriendly. When short staffed nurses need to call doctors, at night, because they are conveniently “not on site” it is difficult to save a crashing patient’s life if the doctor is rude. And yes, junior nurses will call the MD for things that might not be as crucial as saving someone’s life, but due to the way the system is organized, the nurse becomes intimidated if she makes an unnecessary call. The power differential between doctors and nurses is still the area where a lot of abuse is occurring. Doctor’s are often more knowledgeable, but why is it so scary to ask a “stupid question”? Sometimes nurses need to learn by starting at the beginning. There is nothing built into the system that allows me to say, “Don’t talk to me in that tone”. I need skin on my teeth to do so. In one of my visits to the head of HR in our hospital, I was told by the senior HR guy, that he once had a “seasoned, hard core nurse” tell him to f’off? I was floored. Does that mean I have to become “hard core” and start swearing at people to tell them my piece of mind? Anonymous, RN, Toronto hospital.