Wednesday, May 27, 2015

Bullying Culture in Surgery - Has Nothing Changed?

The airing of the Four Corners report on an entrenched culture of bullying of surgical trainees and medical students has for the very first time pushed this matter into the public spotlight.  The obvious reason for the suppression of this ugly behavior is the enormous power imbalance that exists between perpetrators and victims.  Medical students, and particularly surgical trainees, are unwilling to come forward as their career progression is totally at the mercy of those who have significant influence over the results of their progress reports.

I hear the argument from a number of my colleagues who say that everybody is getting too soft and that they dread the ability of these ‘mollycoddled children’ to handle the stress of dealing with catastrophic bleeding at 3 am in the morning. I totally reject this assertion as justification that an intimidating bullying culture has a role to play.  I am not aware of any evidence that a non-confrontational approach to training will impacts upon the ability to perform following the completion of training.  When we look at the commercial airline industry, it is the meticulous training that prepares pilots for a variety of catastrophic events.  Being yelled at, publicly humiliated and often being left wondering what it was that was done wrong (because one could not dare ask what it was that was done wrong as one should know) is not training. 

It is bullying and harassment and nothing more.

I was on the receiving end of bullying during my training, particular at the hands of a cardiac surgeon, well before I started training in urological surgery.  At that time I felt that he had total and absolute control over my career.  However, it was far more often that I observed my junior colleagues being on the receiving end abuse and harassement. What worries me is that many of my colleagues who were bullied and harassed as junior doctors, do not reflect back as this having been the case.  This is how the cycle of bullying continues. Their interpretation of bullying has been reset by their experience to become a norm of surgical training.  They too go on to repeat the behavior experienced during their formative years as surgeons.  The words of Dr Vyom Sharma are chilling but demonstrate great clarity in the problems we face: –

"In one moment I could just see how this all happens. Someone bullied him, he bullied someone else, and now it's my turn."

The stories on Four Corners make me worry and wonder if it really could be a case of where “Nothing has changed”.

Maybe I should provide some context of how things were different when I was training.  I was absolutely everything that was atypical and confrontational to the surgical establishment when I wished to undertake surgery as a career in the late 1980's. 

I was Asian, went to a public high school and at that time, hated rugby. 

I was definitely not “one of the boys”. Tearoom discussions were often lonely as I had no ability or real interest to discuss the results of the last weekends’ private school rugby game or who should play fly half for the upcoming Bledisloe Cup.  Apart from clinical matters, I had very little in common with my surgical seniors.  My colleagues who fitted the perfect surgical role model would regularly get the pat on the back for being a ‘good bloke’ and were rewarded with more opportunities to try their hand at surgery. The diversity of surgical trainees and subsequently trained surgeons has changed enormous since then due to surgical training programs being taken out of the hands of individual hospitals and therefore the hands of a very few powerful individuals.  Centralised selection for surgical training was a very positive step forward although for general surgery it was introduced after my time.  I remember having little support base as none of the surgeons were really my ‘mates’ but I was fortunate to have sufficient numbers of surgeons who saw that I had talent and were prepared to put their reputations on the line to help me achieve my career aim.  I always remember this as a reminder that there was also a lot of good in many of the surgeons who mentored me as a junior doctor and it was not all bad.


(Note for those outside of Sydney - back in the 1980's Rubgy Union was a game that was almost exclusively played in elite private schools. Public schools and non-elite private schools tended to play Rugby League.  Back then, the vast vast majority of surgeons had been educated in the private school system apart from a handful from exclusive selective public schools)


  1. Insightful, and sad. The rigid hierarchy perpetuates this form of "education," and ultimately patient "care." One expect more from fortunate regions such as Australia where there may be trasnparency and accountability, partly because it is "fortunate." The cases from Eastern Europe would make you swoon. One solution is greater inclusiveness, that is, more female surgeons.

  2. Much of what we see in Australia is built upon entitlement. In my training days, factors that favorited a trouble free training idid indeed include a love of rugby and having a privileged private school background - being Caucasian was icing on the cake. Having a said that, the converse was not necessarily an indicator of risk of bullying. Most got bullies although many without even realizing it.

  3. Yep. When they deny bullying has been much of a big deal, you can see why the problem is perpetuated.

  4. To think that the power imbalance and bullying ceases after we finish our training is simply being in denial. Younger surgeons are in the same position although most choose to ignore it. Bullying takes sophisticated paths. It is about stopping your accreditation process in a private Hospital, corridor reputation attacks, planned M&Ms witch hunts...This is when it really affects your career, not because someone yelled abuse at you because your vertical mattress looks untidy...The problem does not stop, why should it? we live in denial and do nothing about it

  5. Is this my imagination or not? It seems that most who are bullied are either Asian, Indian or women?

    1. It is not rocket science buddy, they are minorities...and should be protected...your tone and comment is worrying and it seems you are just trying to dismiss a real problem. People like you should not be surgeons. There was a really interesting article in the New York Post about a bloke in college explaining his technique to rape drunken freshmen. The most interesting part was that he thought it was "part of the college experience". You probably think that treating Asians, women and Indians badly is part of the surgical experience. Like I said you are a disgrace to surgeons.

    2. Thanks Anon. I'm not sure if Mick is a surgeon or not - for all we know, may be not at all. You do however raise a good point in that those who are 'minorities' in surgery tend to be those who are most vulnerable to bullying.

  6. Thank you for sharing Henry. I think you nailed it nicely.