by Ilana Yurkiewicz
Bullying doctors are not just unpleasant they are dangerous. Can we change the culture of intimidation in our hospitals?
He comes to the operating room late, greets no one, and berates the nurse for not setting up the stepstools the way he likes. He tells the resident she doesn’t know the anatomy and sighs when she adjusts her grip on a surgical tool. He slaps the hand of the medical student when she reaches for the retractor to pull back skin for a clearer view. The operating room is tense for hours. ‘I need a different clamp,’ he says at one point, ‘this one is too dull.’ ‘I’m on it,’ says the scrub nurse. ‘You’re not,’ he retorts, ‘or else it would already be in my hand.’ All of us adorned in blue scrubs and surgical caps stand on edge, braced against the next wrathful outburst. ‘I want to see the tip of my blades,’ the resident explains, staring intently at the monitors where her laparoscopic instruments have not quite come into view. ‘Just cut,’ the lead surgeon barks at her. By the end of the operation, the intern’s hand shakes as he sutures the wounds closed, to the beat of the running condescending commentary on his halting speed and less-than-perfect stitches.
One doesn’t have to work in a hospital long to experience or observe some form of disrespect. This is hardly a secret. The bullying culture of medicine has been widely written about and portrayed in popular media. In one study, published in 2012 and conducted over the course of 13 years at the David Geffen School of Medicine at the University of California, Los Angeles, more than 50 per cent of medical students across the US said they experienced some form of mistreatment. Behind closed doors, we share advice on whom to hang around and whom to avoid.
At the start of my third year of medical school, when we would finally enter the hospital wards, we had an orientation: ‘Wear a raincoat,’ the doctor standing at the podium advised. I could expect to get rained on.
For the most part, I’ve been pleasantly surprised. The majority of doctors, nurses, and other health care professionals I’ve worked with have been courteous and respectful: strong teachers and compassionate caregivers. I have met colleagues whom I would feel honoured to work alongside in the future and mentors whom I’d want to treat my own family should they become ill. I’ve been amazed by residents who work 24-hour shifts and somehow still have the energy to teach those who do not yet know as much as they do. I both admire them and am grateful for them.
But there is a reason those orientation warnings exist. The surgeon who chides the nurse for her inability to be in two places at once? The nurse who snaps at the medical student for reading the patient’s chart the same moment she wants to write it in? They are a substantial, troubling minority, and they can set the mood for the rest.
Most of my friends in medicine have witnessed flagrant episodes of hospital bullying and have juicy tales to tell. But medical disrespect is usually far less dramatic, dished out in the form of ‘micro-aggressions’: exasperated sighs, a sarcastic tone, the dismissal of alternative ideas. It’s the subtle put-downs about a trainee’s competence that erode confidence; the public shaming for an incorrect answer on rounds; or the denial of simple privileges such as taking a chair or reading a chart. It’s the psychological effect of being called by your rank instead of your name, or having it made clear that your presence is a burden instead of a help. It’s being ignored. It’s other team members looking on when the disrespect occurs, afraid to challenge it and defend those lower on the totem pole. These are the acts that affect our state of mind in small but cumulative ways. This is the stuff that creates a culture.
You learn to deal. This is how it is. That’s the system. It’s ingrained. You excuse bad behaviour with the platitude: ‘That’s just the way (s)he is.’ You appreciate from your elders that it could be much worse – at least they can’t throw scalpels at you anymore. You make allies and whisper in solidarity with those in the trenches alongside you. You train yourself, just as they advised you on your very first day, to wear a raincoat. You start to wear it, and it becomes thicker as your training progresses. You add boots and an umbrella. Then, as you get better and more confident, perhaps you become impatient with the inevitable lack of expertise in the new trainees. Maybe in a few years, you start to rain on others.
We’ve known for years that entering the ranks of medicine means developing a thick skin to criticism and being made to feel small. For a long time there was a mystique that this culture held everyone to high standards, and it was the price we paid for the care we got. What is disturbing is the increasing recognition that bullies are not only bad people to be around – they’re bad doctors, too…
Ilana Yurkiewicz is a third-year student at Harvard Medical School and a blogger for Scientific American. She does bioethics research at Harvard, and her work has appeared in The New England Journal of Medicine. She lives in Boston.