Bullying In Medicine: Just Say No

The internationally award-winning documentary film, Bully, tells the story of four kids who were victims of bullying in their respective schools. Tyler Long, who committed suicide because of the unrelenting physical and mental abuse he endured each day in school, was one of the kids whose stories was shared in the making of the film.  A short trailer for the film follows.

While filmmaker Lee Hirsch focused on school age children, physician and author Pauline Chen MD recently wrote about the bullying that goes on in medical schools in the NYTimes Well blog (see The Bullying Culture of Medical School.) Bullies, and the pain they inflict upon others, does not stop in middle school, and according to Chen:

…For 30 years, medical educators have known that becoming a doctor requires more than an endless array of standardized exams, long hours on the wards and years spent in training. For many medical students, verbal and physical harassment and intimidation are part of the exhausting process, too…early studies found that abuse of medical students was most pronounced in the third year of medical school, when students began working one on one or in small teams with senior physicians and residents in the hospital. The first surveys found that as many as 85 percent of students felt they had been abused during their third year…

Lucian Leape MD published two papers this past July in Academic Medicine on the disrespectful behavior that continues to occur in medicine, further confirming Chen’s assertions. A Culture of Respect, Part 1: The Nature and Causes of Disrespectful Behavior by Physicians, and A Culture of Respect, Part 2: Creating a Culture of Respect both address this problem, and share that patients, as well as medical professionals, suffer when bullies are allowed to reign. Lucian says:

Students and residents suffer from disrespectful treatment. “Education by humiliation” had long been a tradition in medical education and still persists. Patients suffer when physicians do not listen, show disdain for their questions, or fail to explain alternative approaches and fully involve them in the decision-making process…

We have talked often in this blog about creating high reliability organizations (HROs) in healthcare. Other high risk industries do not tolerate bullying like healthcare does. Why is that? Does healthcare lack the strong leadership needed to eliminate it? Bullying does not belong in healthcare period, or anywhere else in learning cultures for that matter. While it is allowed to persist in any given health system, it will be almost impossible to achieve high reliability.


One Comment on “Bullying In Medicine: Just Say No”

  1. Shannon,
    Thanks for your post – I am sorry to hear about your medical error. It is an amazing personal story and one I can appreciate more than many. At the age of 15, our youngest daughter was diagnosed with an aortic dissection. Her pediatrician thought she had a higher blood pressures in her right arm compared to her left arm. When young, that clinical finding could signal an aortic coarctation so the pediatrician to be on the safe side wanted to do a chest scan. I still remember when my wife called me terrified that Friday afternoon telling me the radiologist told her our daughter had an aortic dissection and needed surgery ASAP. He had already call the cardiac surgeon who was coming in to see her. Being a cardiac anesthesiologist myself who is part of the team that repairs aortic dissections, I knew the possibility of an otherwise healthy 15 year old girl who didnt have Marfans syndrome to present with a sudden aortic dissection (no chest pain also) was so rare it would be reportable in the literature. However, the doctors there were not thinking like that. I told my wife to get her scans and have her immediately transferred to another hospital in the area where I knew the CT surgeon and CT anesthesiologist. I called to let them know she was coming. On arrival, they met her in the ED and admitted her to the ICU (which scared my daughter badly). The team there took one look at the scans and said what was being interpreted as a dissection was really artifact and nothing more. Just to make sure, they repeated the scan which was totally normal. She was discharged the next morning with both my wife and I staying with her that night in the hospital.
    I still have her scans and the official reading of the films from the first hospital and radiologist…we never had anyone follow up with us either from the first hospital to see if my daughter was ok after we transferred her. You would think they would have wanted to know what happened…and to learn.
    My daughter is now 24 now and thankfully still healthy – sometimes too healthy 🙂 We were one of the fortunate families because my career gave me the knowledge to sense or know something was not right – we need to get to a point where everyone feels that way somehow.

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