The president of the Royal Australian College of Surgeons (RACS) has apologised on behalf of surgeons for discrimination, bullying, and sexual harassment [1]. The Australian Medical Association (AMA) has released a position statement on workplace bullying and harassment [2,3]. Despite this, Dr Caroline Tan still does not work in any major public hospitals and I, a final year medical student, am still afraid to report bullying and harassment.

“Suck Sarah*, suck” was what the consultant surgeon who was operating repeatedly instructed me to do with the suction device whilst I was assisting him as a medical student in theatre. After about the twentieth time he said this, the assisting registrar joked “I thought you’d be better at sucking than that Sarah”. Everyone in the theatre laughed aloud and despite feeling increasingly uncomfortable, I joined in. I was trying my best to please my superiors and laughing at their jokes was part of this attempt. It wasn’t until the casual discussion with my colleagues that evening that I realised how degrading and inappropriate these comments were. My uncomfortable feelings weren’t just part of being a medical student surrounded by intimidating seniors, but rather, were the result of sexual harassment. The very fact that I assumed what occurred was normal is testament to the fact that bullying and harassment is entrenched in the culture of medicine and its hierarchy. I never reported the incident, and none of my colleagues ever encouraged me to do so.

My story raises the issue of commonplace occurrences in medicine. Sydney surgeon, Dr Gabrielle McMullin, publically said Dr Caroline Tan’s career was ruined by a sexual harassment case that she won against her fellow neurosurgeon in 2008, and that she would have been better off giving him ‘a blow job’ [4]. Dr McMullin’s controversial comments attracted unprecedented media attention and were successful in exposing a silent epidemic of bullying and harassment in medicine.

Bullying is defined as repeated unreasonable behaviour that creates a risk to health and safety. Harassment is unwanted, unwelcome, or uninvited behaviour that makes a person feel humiliated, intimidated, or offended [5]. According to the AMA, medical students, doctors in training, female colleagues, and international medical graduates are the most common victims of bullying and harassment in the medical profession [2]. Up to 50% of doctors, doctors in training, and international medical graduates have been bullied or harassed, and the most common perpetrators are senior doctors [5-7]. This problem has persisted for many years because hospitals and professional associations have failed to act, discouraged change, and have thereby fostered a culture of bullying [8].

The sequelae of workplace bullying and harassment in medicine are serious. The continued erosion of confidence, skills, and initiative creates negative attitudes among medical staff. It directly leads to reduced employee physical and psychological health that manifests as anxiety and depression. This leads to diminishing performance, reduced quality of patient care, and subsequently deteriorating patient safety [9].

Most large medical organisations including the AMA and RACS have responded to the issue and identified bullying and harassment in medicine as a priority area for change. The AMA, on 9^th March 2016, released ‘Setting the standard’, a strategy to overcome bullying, discrimination, and harassment in the medical profession [2]. The RACS Expert Advisory Group (EAG) has published its final report on the extent of discrimination, bullying, and sexual harassment in the practice of surgery [5]. However, despite these efforts and the extensive coverage in the media, bullying and harassment still occur and victims such as myself are still afraid to speak up. Barriers to victims making claims include the perception that nothing would change, not wanting to be seen as a trouble-maker, the seniority of the bully, fear of impact on future job prospects, and uncertainty over how cases would be managed and future policies implemented [5].

Efforts need to focus on ground-level interventions. Importantly, new policies from the AMA, RACS, and other leading organisations need to work towards creating safer and more effective complaints processes that people such as myself are more willing to use. A system that ensures we will not be punished as Dr Caroline Tan was. All members of the medical workforce need to normalise a zero-tolerance attitude to bullying and harassment so that it can be cultivated and adopted into the culture of medicine. Only then may the change be organic and not just another unread policy used by medical associations as medicolegal protection.

* A pseudonym has been used to protect the author’s privacy.

References

[1] RACS Media Release. RACS apologises for discrimination, bullying and sexual harassment. Canberra:RACS;2015 [cited 2016 Mar]. Available from: http://www.surgeons.org/news/racs-apologises/.

[2] Australian Medical Association. AMA position statement: workplace bullying and harassment. Canberra:AMA;2015. Available from: https://ama.com.au/position-statement/workplace-bullying-and-harassment.

[3] Australian Medical Association. Setting the standard, AMA Victoria’s summit. Canberra:AMA;2016 Mar. Available from: http://amavic.com.au/icms_docs/237873_Setting_the_Standardpdf

[4] Medew J. Surgeon Caroline Tan breaks silence over sexual harassment in hospitals. The Age [Internet]. 2015 Mar 12 [cited 2016 May]; Victoria. Available from: http://www.theage.com.au/victoria/surgeon-caroline-tan-breaks-silence-over-sexual-harassment-in-hospitals-20150312-141hfi.html.

[5] Expert Advisory Group. Survey of all college fellows, trainees and international medical graduates to find out the scope of discrimination, bullying and sexual harassment, 2015. Canberra:RACS;2015 Sep [cited 2016 Mar]. Available from: http://www.surgeons.org/media/22086656/EAG-Report-to-RACS-FINAL-28-September-2015-.pdf.

[6] Rutherford A, Rissel C. A survey of workplace bullying in a health sector organisation. Aust Health Rev. 2004;28(1):65-72.

[7] Fnais N et al. Harassment and discrimination in medical training: a systematic review and meta-analysis. Acad Med. 2014;89(5):817-27.

[8] Watters DA, Hillis DJ. Discrimination, bullying and sexual harassment: where next for medical leadership? Surgeon. 2015;2015(001).

[9] Rosenstein AH. The quality and economic impact of disruptive behaviors on clinical outcomes of patient care. Am J Med Qual. 2011;26(5):372-9.