Very few are talking about workplace bullying, yet many are benefitting from it. It acts contrary to the principles of care at the heart of medicine — and we need to do something about it.

How many physicians have wanted to leave medicine because they were subject to horizontal violence or bullying in the workplace? Who has felt undermined, belittled or humiliated when showing up to work on a daily or weekly basis?

Are there those of you who have been used for skills yet have never been acknowledged for your contributions or work? Have you had someone in a position of power act as a gatekeeper in your career path? How many have been subject to some kind of mental, emotional, physical or sexual harassment?

In a profession with the core principle to heal, it is sad, disappointing and sparks anger to know of and experience workplace bullying. It has grown like a festered fungus in health systems already under pressure from decades of under-resourcing and underfunding. This has worsened with the COVID-19 pandemic.

When we contextualize medicine today, it is embedded in capitalism, neoliberalism and patriarchal, colonial thought. Bullying and horizontal violence, therefore, fit aptly as a mechanism to maintain these dominant and exploitative systems. All of them benefit from low worker morale and pave the way open for exploitation. Structural changes are less likely to occur if responsibility is laid upon the worker and their “coping strategies.” Horizontal violence and bullying in medicine are a worldwide phenomenon.

According to a World Health Organization multi-centered study, 67 percent of health care practitioners had experienced verbal abuse in Australia in a year. In a New Zealand study conducted by the Association of Salaried Medical Specialists (ASMS), two-thirds of senior physicians witnessed workplace bullying in action. In this same study, women reported experiencing bullying more than men, and emergency medicine was identified as the field in which most physicians experienced some kind of bullying. Māori and Pacific peoples had higher demands in workload expected of them. The Royal College of Surgeons (RACS) identified that in 2015 almost 50 percent of surgeons in Australia and New Zealand experienced bullying of some kind. In another study, doctors who were bullied were more likely to consider leaving medicine.

Hierarchy often excuses abusive behaviors by claiming they are subjective. However, there has been ample research over three decades around the globe in which researchers have established certain repeated and unreasonable bullying behaviors causing harm to workers in health.

Some of these include:

• belittling
• undermining integrity
• lies being told
• opinions marginalized
• humiliation
• exclusion and isolation
• threats
• sarcasm
• physical attacks
• being shouted at
• intimidation
• giving unachievable tasks and deadlines
• undervaluing contribution or taking credit for work that is not their own
• deliberately, undervaluing and underpaying workers
• harassment and discrimination

A single incident is considered horizontal or lateral violence, and this has been extensively researched in the nursing field.

It is not rocket science: environments that lift up the morale of workers and value workers have positive effects and bullying and horizontal violence have negative effects.

Clinicians have reported decreased mental, emotional and physical health and the adaptation of alcohol and drug use to cope with stress. Anxiety, fatigue and burnout feature high in repercussions. Some experience post-traumatic stress disorder and depression. There have been cases of suicide.

There are also high turnover rates, leaving huge gaps in a system that financially benefits those interested in maintaining high salaries and profits. We should be worried about the quality of care patients and families are receiving from a demoralized clinician. If people are purely interested in economics the economic cost of workplace bullying inclusive of the labor workforce, not only health, is between $6 -36 billion dollars a year in Australia.

There are a multitude of interrelated factors for the alarming incidences of bullying in medicine.

1. Physicians experience high workloads and stress, leading to increased demands. Structural inadequacies including poor staffing levels, long hours and poor resourcing have been identified by the NHS, to contribute to bullying.

2. Competitive nature. A prevalent and insidious need to prove oneself as more competent and better performing than others and the desire to make others appear incompetent to get ahead.

3. Control and power. Let’s face it, there are many in the profession who feel powerful belittling others. This usually occurs in differences of power relations but is not exclusive to it. Those at the top of the tier are more likely to bully those doing the actual clinical work, although it has been identified, lateral violence and bullying can occur amongst colleagues within the same groups and across professions.

4. A rite of passage. Medicine is hierarchical in nature, and “eating the young” is normalized in our field. It is considered part of the training to prove and show one’s worthiness to be there as a student, and this is reinforced in a vicious cycle once qualified.

I know of colleagues who have been drained by the process of laying formal complaints as a means to address workplace bullying on top of already existing workloads. Personal grievances are not easy to do if one already feels disempowered, and many see resignation as a way out. Others do not share their experiences at all, one study showed 70 percent of participants continued to work under abusive conditions.

The medical profession, in the time of COVID-19 and beyond, cannot afford to lose staff due to exploitative and abusive behaviors. As one geriatric consultant shared in my medical student years, “It makes no sense for us to belittle and humiliate you all in our profession because you will just leave. It is to our own detriment in medicine to treat you this way as we lose staff.”

This too is not rocket science. So when will the profession come to its senses?

Maria Peach is a general practitioner in Rarotonga, the South Pacific.

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