Bullying Epidemic among Surgeons Harms Patients

• Survey shows 84% of UK doctors have experienced bullying[1]
• A study of plastic surgeons uncovered 94% had encountered unprofessional behaviour including bullying and “poor anger management”
• Surgical trainees THREE TIMES more likely to be bullied than other healthcare professions: trainees tell of ‘living hell’ and even suicide
• Disruptive behaviour direct cause of 67% of adverse events, 71% of medical errors, and 27% of perioperative deaths - issue costs the NHS £13.75 billion annually
• 1 in 6 surgical trainees suffering from Post-Traumatic Stress Disorder (PTSD)[2]
• Britain’s oldest surgical Royal College launches landmark campaign, calls on compulsory training to recognise the signs of , and alert others to, the practice of bullying and undermining – and for bullies to be removed from training

 
In the first UK study of its kind published in its journal The Surgeon, the Royal College of Surgeons of Edinburgh (www.rcsed.ac.uk) has today revealed that a staggering 1 in 6 surgical trainees suffer from Post-Traumatic Stress Disorder (PTSD). Moreover, it is also known that aspiring surgeons are three times more likely to be victims of bullying than anyone else in the NHS[3].

PTSD symptoms of insomnia, anger, poor concentration, hyper-vigilance and exaggerated startle have serious implications for patient safety[4] - as does the endemic culture of undermining and bullying in surgery, as juniors and even senior colleagues become cowed and fear raising concerns when there is a problem or a behaviour should be challenged.

One surgeon describes the bullying he experienced during his training as so severe it led to him considering taking his own life. He witnessed colleagues who left the profession due to bullying and, in one particularly tragic episode, a colleague committed suicide. Another surgeon, a senior consultant who has witnessed bullying throughout his 40-year career, comments:

“Bullying leads to a demoralised workforce, poor morale and gets in the way of communication. Working relationships break down, which jeopardises the care of patients. In extreme cases, surgeons’ practices go unchallenged, which is what we have seen with the disgraceful Ian Paterson case.”

In addition to the human cost, it has been estimated that this issue costs the NHS £13.75billion annually, and healthcare professionals have attributed disruptive behaviour in the perioperative area alone to 67% of adverse events, 71% of medical errors, and 27% of perioperative deaths[5].

Disgraced (and now convicted) plastic surgeon Ian Paterson was described by colleagues as an ‘arrogant bully’ whom colleagues feared to challenge. In fact, a study from 2015 in the Annals of Plastic Surgery revealed a staggering 94% of surgeons have observed unprofessional behaviour [6] among colleagues,and in the College’s own membership survey, nearly 40% of respondents reported they had been victims of such behaviour, with the same amount reporting that they had witnessed it[7].

Through their latest initiative, the Royal College of Surgeons of Edinburgh has reinforced its continued commitment to changing the culture of healthcare to eradicate such behaviour, ensuring patient safety remains at the forefront of healthcare delivery. The College has now launched an Undermining and Bullying initiative, Let’s Remove It, to encourage healthcare professionals speak up and stamp out bullying.

The College is campaigning for the General Medical Council to introduce compulsory training on bullying including medical education (CPD) credits for all Foundation year doctors and processes introduced, so individuals who bully and undermine have their training responsibilities removed. As part of the campaign, the College has developed the following resources:

• A new digital resource full of factual and legal information, with links to literature, case studies and e-learning tools. The hub provides support for people who are being bullied and strategies so surgeons are able to reflect on their own behaviour to make sure that they are not part of the problem
• Posters and presentations for all hospitals
• A performance workshop ‘How to survive and thrive as a surgeon’ which will include work on team behaviour and how to build and support successful, effective teams

RCSEd President and consultant general and colorectal surgeon Professor Michael Lavelle-Jones says:

“The sentencing of surgeon Ian Paterson has once again raised the issue of bullying and undermining in healthcare, and highlighted the terrible consequences that this behaviour can have for patients.

“The College has a zero tolerance approach to bullying, undermining and harassment and categorically condemns this is in all circumstances. But we want to do more. We want to change the culture of healthcare to ensure that this kind of behaviour becomes so unacceptable it can no longer go on. We want to offer support to those who have been bullied, and to get people to reflect on their own behaviour and take ownership of the fact that this is everyone’s problem. As professionals, we have a duty to protect our patients from damaging and unnecessary treatments, and, as professionals, we have a right to be protected from being bullies and undermined.”