How widespread is bullying in our profession?
Concerns about bullying within the medical and dental professions are not new. In 2002, the British Medical Association surveyed junior doctors with regard to their experiences of bullying and almost 50% of the sample group reported being bullied in the previous year. The size of the group (594 doctors) was small, making it difficult to extrapolate these figures to the medical profession in general, but suggested that bullying was indeed a problem. Other studies have drawn similar conclusions.
In 2014, the GMC National Training Survey explored the issue of bullying amongst trainees in the UK. 8% of junior doctors reported experiencing some form of bullying or undermining, and surgery was ranked the second worst in this field, behind obstetrics and gynaecology. In 2015, the President of the Royal Australasian College of Surgeons (RACS) issued a public apology for the extent of bullying behaviour that had been found in surgical workplaces across Australia and New Zealand. Up to 50% of surgeons had been subjected to bullying and this led to the launch of their campaign ‘Let's Operate with Respect'.
In 2016, the Royal College of Obstetrics and Gynaecology published the results of their survey into bullying amongst consultants. Up to 44% of the respondents described persistent bullying and a third of those labelled it as severe. They too reacted to both this and the GMC Survey by providing their members and fellows with initiatives to tackle bullying. These included an online bullying toolkit and regional bullying guardians, who were outside of the training hierarchy .
RCSEd conducted its own membership survey in 2014, which was reported in the popular press. This survey demonstrated that 60% of surgical trainees testified to having been bullied in the workplace, yet nearly all described having observed it. But, interestingly, this survey identified that it wasn’t just a trainee issue; 34% of all the Members and Fellows that responded reported being bullied.
RCSEd set up a group in 2014 to ascertain the extent of undermining and bullying in UK surgical practice. The group identified a significant problem throughout all stages and grades within surgery, and the College released the following statement:
“The College has a zero tolerance approach to bullying, undermining and harassment and categorically condemns this in all circumstances.”
The work that has been done as part of this campaign follows on from the work of this group.
We don’t just need to be nice to each other – bullying affects our patients
As mentioned in The Facts and the Law, undermining and bullying is of considerable concern when it comes to patient safety. At the inquiries into the mortalities at both Mid Staffordshire NHS and Morecombe Bay NHS Trusts, a breakdown of team working was identified as part of the cause. There is a mountain of evidence to show the detrimental effect that bullying and undermining has on team performance, not just in the surgical arena, but in all walks of life.
Our workplace can be stressful. Treating others with the respect they deserve not only makes it a better, more supportive environment, it fosters good relationships between members of the team, and ultimately this leads to better patient care.
Views of other organisations
The General Medical Council provides a clear view on bullying, stating that doctors should not bully colleagues, and should treat them with respect. Those in positions of responsibility should create a positive working environment where bullying, harassment and discrimination do not exist. Read more on their website.
Other links to the GMC website which refer to bullying in the workplace:
The General Dental Council also provide a document called Standards for the Dental Team. In this document, section 6 is entitled working with colleagues in a way that is in patients’ best interests. There is explicit advice that bullying between any members of the dental team is unacceptable.
The Association of Surgeons in Training (ASiT) produced a consensus statement on undermining and bullying and surgical training in 2013. In addition to summarising the literature, ASiT provided recommendations on how an individual can report bullying, and summarises the mechanisms which should be in place to support affected individuals and investigate alleged incidents of bullying.
In 2015, the President of RACS, Professor David Watters, issued a public apology for the level of bullying, harassment and sexual discrimination that had been identified in surgical practice in Australia and New Zealand. This led to the launch of their “Let's Operate with Respect’ campaign. RCSEd is very grateful to RACS for their collaboration and we have taken a huge amount of inspiration from their campaign.
The 2014 GMC survey identified obstetrics trainees as being exposed to the highest rate of bullying amongst all specialties(7). They subsequently commissioned a study to explore how prevalent it was amongst the consultant workforce(12). The results demonstrated high levels of disruptive behavior throughout all grades within the specialty, and the College launched a web-based toolkit to tackle the problem. This provides advice and information for staff at all levels, and it provides guidance for individuals, departments and institutions. Again, we have been working with RCOG and would like to thank them for their support and help with the concept and content of our campaign.
The Royal College of Nurses offers advise to all who work in the nursing profession, outlined against the Nursing and Midwifery Council Code of Practice. They have developed a Bullying and Harassment Resource page which offers help for those who require help for related issues in the workplace.