Bullying in Medical School…and Everywhere Else

Posted on August 15, 2012

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Earlier this week, I read a short report about bullying in medical school. According to a report in Academic Medicine, and a recent New York Times article, which based its story on some UCLA School of Medicine findings, 60% of 3rd year medical residents experienced bullying, defined as “verbal, physical or power abuse” or being “belittled, yelled at and threatened.”

UCLA determined that, despite efforts since 1995 to eradicate bullying, results have been disappointing. A national culture in medical education was cited as a major reason for the persistent negative behavior. Although I am no doctor, I am not really sure why this is newsworthy.

Anyone who has spent time in school, joined a club, held a job, or played a sport has likely faced bullying.  And in the work place, it still exists.  Just this week, the WSJ had an article on bosses who yell.  Here is what I have observed:

1. Bullying is cultural.  When something is cultural, it is very difficult to change. Companies struggle with changing culture. Architecture school had its own sadistic traditions (all-nighters, intensely critical design reviews) and I imagine any rigorous preparatory program has aspects participants wish were more humane—but it will take time to change: years, generations even.  I have to admit, though, it helped prepare me for ‘the real world’ (see #5 below).

2. You say “bully”, I say “tough love”.  One person’s forceful disagreement is another person’s verbal abuse. I have lived, worked and played through it. Sometimes bullying is a matter of perspective, and those who are sensitive, or used to being coddled and appeased, or overly eager to get ahead (read: Gen Y) may not appreciate concepts like chain of command, seniority and rank, which can be misinterpreted as bullying.  I bullied my younger brother and he turned out ok; we’re great friends.  In fact, I tend to think I deserve some credit for hardening him up.

3. Bullying is everywhere, so deal with it.  Job (trade, professional, government, non-profit), education, military, sports, family…it is a part of life.  Bullying can be disheartening, but should ultimately be a motivating force. I worked as a corporate mover one summer (filing cabinets, bankers boxes, furniture) and was taunted by a veteran driver who leaned against the truck and smoked the whole time; it motivated me to get my college degree.  While in architecture school, I was told by an administrator I would never be an architect so I should choose a less rigorous research concentration; he was the first person I thought of when I became licensed.  I had issues with a former boss, where I ended up the recipient of some bullying; I chalked it up to generational differences, and worked harder to get promoted. 

4. There are things far worse than bullying.  As unpalatable as bullying is, it likely a temporary nuisance that can be proactively minimized. No one should be subjected to an environment with even more hideous crimes than bullying.  I would take bullying any day over a superior with unethical behavior (lying, cheating, passing others’ work off as his own), chauvinistic attitudes, blackmail or manipulative tendencies, constant harassment or abuse. Early on in my architecture career, it was not uncommon for interns to be mistakenly (or purposefully) salaried and not paid overtime.  Some of my friends felt bullied; I thought it worse:  stealing.

5. Aspects of bullying can be beneficial.  Newbies cannot expect the most lucrative shifts, choicest projects, best assignments, or newest tools. Hierarchy:  that’s the way the world works. Yet properly done, enforcing watered down bullying techniques can lead to more effective learning that benefits the individual with perspective and improved skills. Some benefits:  passing on of valuable lessons learned, respect, teamwork / camaraderie, power and leadership, mentorship or apprenticeship, and meaningful initiation into a group.  None of these things can be fully imparted without the gravity of a little fire-and-brimstone, however it is delivered.

Now, there is no reason to tolerate abuse, especially while paying to learn. Of the above definitions of bullying, I find the physical abuse part most troublesome.  Still, bullying has been present in all phases of my life.  I am not sure why doctors, who tend to have their own less-than-favorable, collective reputation, should be any different.  Get tough and cope, or do something else.

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