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Blog Post as Bully Pulpit: We Need to Talk About Bullying in Medicine

When I think of bullying, I typically imagine schoolyard behavior amongst elementary and middle school aged kids. At the forefront of my mind are the stereotypical incidents you see on television and in the movies:  taking someone’s lunch money, not letting the new guy play basketball, or making jokes at someone else’s expense. Unfortunately, bullying extends a lot farther beyond that and frequently comes up in the medical field. Many medical students and resident physicians are showing up to work eager to learn and help their patients – yet also fearful about interacting with certain colleagues. Maybe it’s a senior resident humiliating you with difficult “pimp” questions in the operating room or an attending physician berating you for an assessment and plan – but if we’re being honest, I think a lot of us can admit to having been in these shoes.

My first bullying experience came as a 3rd year medical student on my surgery clerkship.

At this point in time, I was fairly confident that I wanted to do my residency in general surgery so I was extremely eager to come in, learn, and show everyone how hard I was willing to work. Unfortunately, it didn’t take too long for a senior resident to begin beating that desire out of me. At first, it started with extra work. Since I had made it known that I was interested in surgery, he instructed me to show up at 4 am each day in order to round on every patient on our service – not just the 4-5 I was following. When I actually did that, he berated me as being a gunner in front of the entire team. When I decided not to do it the following day, he called me lazy and worthless. Presenting patients on rounds wasn’t any better as he would consistently dissect my every word and thought in front of anyone willing to listen. If an attending spoke up and praised something I did, it would make it that much worse behind the scenes. I repeatedly stayed well past the other students, was forced to go on food runs for the rest of the team, routinely missed my day off, and was often times subjected to a q2 or q3 day call schedule instead of the standard q4 schedule the rest of my peers were on. Still, nothing caused my blood pressure to spike more than realizing I would have to go to the OR with him on any given day. His two strategies were to assign me to an attending who refused to allow medical students to participate in the case – or to send me to a case where students were allowed to have significant involvement, only to make me watch one of my peers do the work instead.

After four weeks of constant humiliation and embarrassment, when it came time to meet with him for my evaluation I had resigned myself to receiving something terrible. You can imagine my surprise when this resident gave me a great evaluation and praised my ability to “work through adversity.”  As it turns out, he wasn’t being mean to me – he was just doing me a favor and toughening me up for my future career as a surgeon. As messed up as that might sound – the worst part is that I actually believed it to be true.

While my experience was enough to convince me to not go in to general surgery, it did shape who I was when I began my intern year in Internal Medicine.

Looking back now, I’m embarrassed to say that I quickly became the same bully that I hated working underneath. Just like he probably did, I rationalized this behavior and considered it to be something that would strengthen and improve the medical students and co-residents I worked with. I openly laughed at my fellow interns when they struggled with procedures, chastised medical students for making errors, and frequently humiliated a fourth year student that seemed overly eager to please our team. For me, it all came to a head when a co-intern told me that my medical student was crying over something that I had said to him on rounds. Suddenly, I realized that I wasn’t helping anyone become a better doctor – I was just making people as miserable as I had been before.

I wish I could say that after this realization I became some champion or advocate against bullying in the medical profession; unfortunately, I cannot. However, I did make it a mission to start treating each person that I worked with the exact same way that I would want to be treated and to stick up for the people underneath me when I felt like a superior was bullying them.  I don’t think that anything can excuse me for the mistakes I’ve made along the way – but I like to think that my actions now have encouraged a better environment for the people that I work with.

For me, the bigger questions are how do we stop this from happening to others and how do we help when we see bullying going on? 

Personally, I think it starts when we stop normalizing the process. Far too often we attempt to write bullying off as pimping the medical student or as being an old school way of teaching that is necessary to breed mentally and emotionally tough doctors. Let’s honestly ask ourselves – would you rather learn in an environment where you are scared to make a mistake or one where you feel supported and nurtured to grow as a physician? What’s better for our patients – being cared for by physicians that are mentally broken down from the abuse of their peers or being cared for by a medical team that functions like a family? When we do see bullying going on, let’s reach out to the victim and offer them support instead of joining in on the abuse.

Finally – don’t be like me. Throughout my experience being bullied on my surgery clerkship, I gradually came to convince myself that this was a normal part of medical training.

Coming out on the other side of it, I justified that this type of training probably did make me a better doctor. When roles reversed and I became the bully, I justified my actions as tough love and felt like anyone who was broken down by this kind of behavior wasn’t as strong as they needed to be. We need to stop good physicians from embracing this type of behavior as normal and help them see that there are other ways to do things.

We live in a time when an alarmingly large number of physicians are becoming burnt out and leaving the profession while we simultaneously hear of the doctor shortage plaguing our country. We are seeing medical students and medical professionals committing suicide at alarmingly high rates and an increasing number of services exist for the purpose of helping medical professionals escape clinical practice for a more “normal” lifestyle. While bullying is certainly not the sole cause of these problems – it is certainly a serious component that each of us can combat on a daily basis. Fixing the issue doesn’t require becoming some outspoken advocate – just a few kind words and human compassion towards your fellow physician.