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Even doctors suffer from unhealthy work environments

Some of the most sought-after professions can be the most demanding for young people to train in. The medical profession is no exception and current policies within the profession highlight the pitfalls of managing this difficult area.

Unhealth work environmentsJunior doctors entering the profession are highly motivated, highly intelligent and determined to succeed. The rigorous selection criteria for their profession ensures they are nothing but this.

But it is these characteristics which also make them vulnerable.

Such determination to succeed frequently means they are prepared to endure far more than they reasonably should. Junior doctors in New Zealand and Australia are reporting they are working unsafe hours, subject to toxic work environments, subject to sexism and sexual harassment, and the list goes on.

Frequently those subjected to problematic behaviour in the medical profession are reluctant to raise issues. Given the close connections between all those within the profession, junior doctors are justifiably apprehensive about raising any complaint which could damage their reputation and jeopardise their career. During my time in practice, I have encountered this on more than one occasion.

There are many obligations an employer has in these situations. They must provide a safe place of work. They must treat the employee fairly and reasonably and in a way that enhances trust and confidence.

Almost all workplaces and training institutions maintain bullying policies to address these issues, but any policy must have regard to the environment they operate within.

The Royal Australasian College of Surgeons has made “cup of coffee conversations” (CCC) a significant part of their bullying policy.

Under this policy, doctors are encouraged to invite those engaging in bullying behaviour to a cup of coffee. During the cup of coffee, the victim is encouraged to “clearly” and “unambiguously” raise the specific matters which are causing that person distress.

A tall order for someone who is afraid of the reaction they will get.

A cynic might suggest such policies are more likely to protect the perpetrator of such conduct as opposed to the victim.

Rhea Liang is the former deputy chairwoman of the Royal Australasian College of Surgeons’ “operating with respect committee”. In support of the policy, she has said on Twitter: “The whole point of the CCC is to provide an intervention shortly after the event (singular) more rapidly than has usually happened through more formal structures.”

She has also tweeted: “Importantly, the CCC lowers the barriers for reporting. Too many formal structures require disclosure of identity, investigation, statements of fact etc into which existing power differentials and discriminations play. It's too easy for the complainant to be silenced.”

Such goals are commendable. However, they arguably disregard the circumstances of those participating in the system. A trainee doctor and their trainer will never be on equal footing. Many would find it very difficult to initiate and hold such a confrontational conversation.

Emphasising such a policy only reinforces a view that it is the responsibility of victims to address bullying where it occurs. Where behaviour has continued for some time, such a policy might also suggest it was the failure of the victim not to raise the matter sooner that is blameworthy. Such feelings may cause complaints to be buried longer, or not raised at all.

Unfortunately, a recent case suggests dysfunctional relationships within district health boards (DHB) are a fact of life.

In 2019 a junior doctor employed by the Northland DHB brought a host of claims against her employer. One of the claims was that she was bullied.

She said she was often ridiculed, was “ripped into”, blamed for adverse events, given inconsistent instructions, and was threatened.

She claimed that as a result she became ill, lost weight, did not want to attend work, was confused and upset, and lost confidence in her abilities.

Another doctor at the DHB said he understood there was a “dysfunctional relationship” but the junior doctor had not described the behaviour as bullying.

After considering the evidence, the court ultimately held that “context for these dynamics was a high-pressure work environment”.

It found there were “at times significant workplace demands which arose from high patient numbers and the intensity of care required by them. These factors created significant stress for staff, at all levels”.

The court ultimately concluded that at heart the issue was a relationship problem between the two doctors and that communications with each other were completely professional at times and at other times were not.

The court acknowledged the “huge international literature on the topic of bullying of junior doctors by senior doctors, a product of the significant power imbalance that can occur”. However, it ultimately determined that the complexities of what occurred did not qualify as bullying. The court found that the junior doctor’s health was not imperilled.

The current state of play is not satisfactory. Dysfunctional relationships within the workplace cannot be allowed to fester. Regardless of whether issues are bullying, poor communication or personality clashes, such relationships left unresolved will inevitably become issues of health and safety.

Employers cannot rely on the parties involved to sort these issues themselves. Power dynamics at play, and a reluctance to speak up, should always be considered. Where necessary, employers should not be shy to step in and set expectations for all parties and enforce those.

If these lessons cannot be learnt, I fear that talent across all our professions will be lost, and at all our expense.