Stand by me (Musings on ongoing bullying in healthcare)

Stayed tuned for updates, which are sure to occur.

INTRODUCTION
The idea for the blog was stimulated by news of a celebrated, experienced UK nurse who faced being stuck off after in 2017 she saved a woman's life who was hemorrhaging after losing her baby with a blood transfusion in an ambulance. (Further Reading) But, through no fault if hers, the required prescription for a blood transfusion had not been taken onto the ambulance with the patient. The nurse claims she has been the victim of bullying by senior NHS managers after she saved the life of the woman. She was unable to return to work at the trust's insistence for ten months, and resigned after she lost a disciplinary hearing. She had to find work outside the trust and is now practising elsewhere.

She was a finalist for 2020 Florence Nightingale Nurse of the Year after raising £100,000 to buy iPads for Covid patients isolated from loved ones. Four years later the Nursing and Midwifery Council concluded the nurse undoubtedly acted in the best interests of the patient and has 'no case to answer'. In some ways this case reminds me of the Bawa-Garba case in UK where a pediatric trainee was convicted of gross negligence manslaughter. (Further Reading)

In addition to this case, harassment and bullying of medical students has been in the news in several nations for a few years. And in my province of Alberta, Canada, in 2016 a noose was hung outside a Black Dr's operating room in Grande Prairie. It was reported almost immediately to hospital administrators by startled bystanders. Yet, according to multiple doctors who wrote complaints, nothing was done to discipline the perpetrator, a white surgeon whom colleagues say still held leadership positions after the incident. (Further Reading)

The blog's title derives from a 1961 song by Ben E. King featured in the 1986 move of the same name.

PERSONAL ANECDOTES
The University of Alberta where I once taught has explicit, well defined Employment Equity and Human Rights Definitions and policies on bullying and discrimination. Yet I'm certain both still exist. The guidelines are followed by all faculties, including the Faculty of Medicine & Dentistry. (Further Reading) It covers pretty much every kind of discrimination, whether direct or indirect: any act or omission based on race, religious beliefs, colour, gender, physical disability, mental disability, marital status, age, ancestry, place of origin, family status, source of income, sexual orientation or political belief, when that act or omission results in loss of or limit on opportunities to work or to fully participate in campus life or offends the dignity of the person.

As a patient I've seen bullying by a Dr. against a trainee and at scientific conventions. As a patient the male Dr. presumably wanted the female trainee (intern or resident) to suffer abuse as a rite of passage that would toughen her up. Few likely report it as the Dr. is all powerful and they fear being judged as troublemakers that could affect their career progression.

At Canadian transfusion medicine conferences I've also witnessed bullying, again by a male Dr. (a 'biggie') against a female Dr. who had presented and was taking comments from the audience. She held her own but his comments were dismissive and abusive and it likely cost her much stress. I wondered why at the time and since and, frankly, suspect he'd not have done that to a male colleague in the same way.

As always, comments are most welcome. Would appreciate hearing about discrimination or bullying you've experienced or witnessed, You can do so by name or anonymously.

FOR FUN
Chose this song because we all need to stand by colleagues in any field when they experience bullying, discrimination, harassment of any kind. Sad to report as items in Further Reading report, the incidence of bullying in medicine remains quite high.

• Stand By Me (Ben E. King with stars and clips from the film)

FURTHER READING
Nurse who faced being struck off after she saved a woman's life with a blood transfusion has been cleared by an official inquiry (20 Apr. 2021) | Related:

Employment Tribunal of Leona Harris (18 Oct. 2019) | The complaint of unfair dismissal is not well-founded and is dismissed.

University of Alberta: Employment Equity and Human Rights Definitions

Taylor-Robinson SD, De Sousa Lopes PA, Zdravkov J, Harrison R. A. Personal perspective: is bullying still a problem in medicine? Adv Med Educ Pract. 2021 Feb 10;12:141-5. (Free full text)

Bullying in the workplace (1 Sept. 2020, CMA)  | What bullying in health care looks like, why it persists and how to eliminate it from the culture of medicine.

Medicine's bigotry and bullying problem (Oped in Canada's Macleans magazine, 8 July 2020)

Colenbrander L, Causer L, Haire B. 'If you can't make it, you're not tough enough to do medicine': a qualitative study of Sydney-based medical students' experiences of bullying and harassment in clinical settings. BMC Med Educ. 2020 Mar 24;20(1):86. (Free full text)

Australia: Culture of bullying, harassment and discrimination in medicine still widespread, survey suggests (9 Feb. 2020)

The Bawa-Garba case should usher in a fairer culture in healthcare (9 May 2019)

Musings on bullying in health care

Stay tuned: Revisions are likely to occur

Today, the last day in February, is #pinkshirtday in Canada, a day to stand up to and prevent bullying of any kind. Taking a stand against bullying with pink shirts began in 2007, when on his first day of school, a student wore a school pink polo shirt and bullies called him a homosexual for wearing pink and threatened to beat him up. Two other students decided enough was enough and began a 'sea of pink' campaign.

Earlier this month a biomedical scientist (aka clinical or medical laboratory scientist, medical laboratory technologist) working as a senior manager in the Haematology and Blood Transfusion department of a hospital in Dumfries, Scotland was suspended for 18 months after a campaign of bullying abuse, creating a 'culture of fear' in the workplace for over five years (Further Reading).

The full transcript of the UK Health and Care Professions Tribunal Service hearing of the Registrant's case is online (Further Reading). The Allegation, Finding, Order, Notes are well worth reading.

ALLEGATIONS
Just a few of the many allegations made against the Registrant:

• Said to colleagues in the blood bank, 'Am I talking a foreign language?! Or am I working with a bunch of  f*cking thickos?!'

• Referred to a colleague's flat shoes as 'lesbo' shoes.

• Sent a text message to a colleague describing another  colleague as '‘a f*kin lying *rse wipe sh*te'.

• Asked a colleague to sign off his competency log despite the fact she had not witnessed his competencies. 

• In the presence of another colleague 
• Referred to a colleague as a 'b*tch' ;
• Threatened to slash a colleague's tyres; 
• Referred to having a 'hit list' of people he would pay back. 

DELIBERATIONS
The Registrant did not attend the hearing despite five months notice and instead submitted a written response to the allegations. Some he denied and a few he sloughed off a merely banter. All but one allegation was found to be proven. The witnesses were found to be credible.

The issue was whether the proven charges of serious professional misconduct, including dishonesty, and creating a “culture of fear” were enough to be stricken off the Registrar or if some other sanction should be applied. Be aware that the purpose of a sanction is not to punish, but to protect members of the public and to safeguard the public interest.

The factors considered by the panel as mitigating factors are fascinating and informative. One that struck me in particular:

• The Registrant’s increased workload appeared to increase his stress levels and cause a deterioration in his workplace behaviour.

Increased workload is a reality for clinical labs everywhere these days and has been for decades. Under the umbrella of cost effectiveness and cliches like 'working smarter, not harder', staff have long been expected to do more with less. Does it create stress? Of course, but I'm unsure that's a valid mitigating factor for abusing staff.

In Canada, CSMLS's CEO Christine Nielsen has said that 35% of society members report feeling stressed or burned out on a weekly basis while on the job (Further Reading). Educating new staff becomes difficult as finding clinical placements in short-staffed laboratories becomes increasingly onerous. The situation is complicated by an aging workforce and is likely to get worse before improving. 

The news item reveals the hearing's outcome, an 18 month suspension. To me this case is an ideal candidate for teaching professionalism to students in all health disciplines. If you are like me, you've experienced and witnessed bullying and unprofessionalism at work.

Sad but it happens in health care more often than we like to admit. And how often do we do something about it, given those bullying are usually in positions of authority?

As always, comments are most welcome. We have some - see below.
FURTHER READING

Dumfriesshire scientist suspended for 18 months for bullying staff (13 Feb. 2018)

UK Health and Care Professions Tribunal Service hearing (Jan. 29-Feb. 2, 2018) | See Allegation, Finding, Order, Notes

Medical lab technologists across Canada feeling the pressure of high job vacancies (15 Feb. 2018)

Stand by me (Musings on bullying by heath professionals)

Last updated: 22 Nov. 2018 (Updated links)

Bullying has always occurred in the schoolyard and workplace. Lately much news has focused on bullying in schools and cyber-bullying that sometimes leads to suicides by young people.

But I wonder if many people realize that lack of respect and bullying happen all the time between supposedly caring health professionals. Such bullying seldom leads to tragedies like suicide but has serious consequences.

Indeed, bullying among physicians, nurses, medical technologists and other health care providers has significant impacts and 'long tails' in terms of intra- and inter-professional cooperation and ultimately patient care.

Granted the vast majority of health professionals do not bully, but enough do to make it common. And it's so endemic, even entrenched, that we have come to accept it as normal. How sick is that? Even more so, because we are health professionals. 

The title of January's blog comes from the wonderful Rob Reiner film of 1986 with the same title (which took its name from the Ben E. King song). (See if you can pick out the Canadian star of 24 at ~ the 1:28 mark.)

The blog has several origins:
1. Last week I briefly chatted with a technologist working in a transfusion service. She reported an incident whereby a physician verbally abused the lab's technical staff and a medical director intervened.


Such abuse was all too common historically, but apparently still occurs in an era where inter-professional team work and respect are promoted.

2. A survey on subject certification for Canadian medical laboratory technologists by the CSMLS found that many technologists with general certification held extremely low opinions of those with subject certification calling them "dead weight" and similar derogatory opinions.
Some respondents were even miffed that those with subject certification were paid the same as them, apparently unaware that most with subject certification invest more time and money in their education than those with general certification.

Having subject certification, the report naturally caught my eye. And I wondered how technologists with general certification who hold such views treat "dead weights" with subject certification. Does workplace bullying occur, however subtle it may be?

While working in a combined transfusion service / blood centre many moons ago, I never experienced bullying, but the lab consisted mainly of technologists with subject certification. 

3. Being the founder and listowner of MEDLAB-L, a multi-disciplinary mailing list for medical laboratory professions at all levels, I am periodically struck by ongoing tensions between lab and nursing staff, suggesting a systemic lack of respect between the two groups.
According to laboratorians, nurses

• Just don't 'get' quality control or anything with numbers (only slightly facetious )

• Cannot be trusted to perform point-of-care laboratory tests without laboratory supervision because they don't understand what can go wrong (legislated in some locales)

Conversely, anecdotes abound on how clinicians (nurses and physicians) think lab staff are anal with their insistence on matching patient identification on blood samples and transfusion requisitions. 

• "What? You need another sample because the sample reads 'Jonathan Smith' and the requisition reads 'Jon A. Smith'?

REQUEST
I ask readers to review a few resources on respect and bullying among health professionals and assess what, if anything, resonates.
1. Do doctors and nurses hate each other?
Medical laboratory technologists - Can you see parallels between physician - technologist relationships, made worse because historically technologists were the troglodytes in the basement?

2. Bullying in the lab: Have you been a victim?
Check the comments beneath the article. Just negative griping?
I've seen physicians regularly bully lab technologists in the transfusion service, and lab technologists in positions of power routinely bully subordinates.

Such bullying takes many forms, e.g.,

• Clinician calls the lab and rants about lab incompetence (often leading to a longer delay in providing the requested blood component).
• Some lab supervisors bully indirectly, i.e., they undermine staff by 'dissing' them to other staff. These supervisors don't comprehend Stephen Covey's common sense dictum that you build trust by being loyal to those who are absent.

3. Doctors, being at the top of the health care pecking order, have a long tradition of bullying nurses, medical technologists, just about anyone.

• Physicians, heal thyself
• Doctors behaving badly? They say it happens all the time

4. Nurse bullying show - "Nurses eat their young" (Dr. Brian Goldman's 'White coat, black art' on CBC)
If nurses eat their young, do some pathologists "eat" their students and newbie colleagues? Definitely yes. Same for medical technologists.

ANECDOTE
Fortunately, I've had incredibly supportive colleagues (medical technologists, nurses, and physicians) throughout my career. I could name these treasured gems but won't in the interest of privacy. They know who they are.

The one exception involved a somewhat paternalistic  physician who had a habit of glaring at subordinates menacingly in an effort to bully them into complying with his views. The tactic was comical (See Dilbert example) but it scared the bejeesus out of staff unfortunate enough to experience it, including me.

My incident involved having failed a student on a research project. Being young, I was intimidated and never did that again. I got the message. 
If something similar happened today, who knows? I'd like to think I'd resist being intimidated but you have to pick your battles carefully with those who have the power to make your life miserable.
For some levity, one of my favorite Dilbert cartoons on bulllying.

BOTTOM LINE
What can be done about bullying among health professionals? Given that it's usually practiced by those in positions of power, probably not much. Some would argue, "No big deal. We're strong and can handle it."
Still, it's worth a try, isn't it? Does anyone need to take such crap? Shouldn't we try to stop bullying in all its forms?

Many strategies exist, including

• Bullying in the workplace. A handbook for the workplace (Canada)
• Bullying at work (UK)
• Disruptive clinician behavior: a persistent threat to patient safety (USA)
• Preventing workplace bullying. A practice guide for employers (Australia)

MUSINGS
Will reporting bullying be effective, even if a report framework exists? It's a challenge, especially if only only one brave soul does the 'blowing'. Whistle blowers are typically discounted, gain a reputation as trouble makers, and lose their jobs as soon as conditions allow it to be done surreptitiously under the cover of a surrogate reason.

Usually, persistent abuse on the part of one individual to another stops only when many (almost all) subordinates rebel. Systemic abuse by powerful health professionals to another group lower on the pecking order continues relatively unabated despite extensive education.

Of course, it's individuals who bully. Colleagues who see bullying may offer a sympathetic ear but typically do little to stop it, mainly because they cannot see how to help. 

Does it matter? Unfortunately, workplace bullying leads to many consequences, including 

• increased absences
• decreased productivity
• mental health issues
• job dissatisfaction
• increased job turnover

On a personal level, it can devastate those experiencing it. Many learn to cope (albeit at a price), but some do not.
I encourage you to identify the bullying (minor, moderate, severe), whether intra- or inter-disciplinary, that routinely occurs in your transfusion service or blood centre. Then do something. 

If prevention and complaint resolution processes on bullying don't exist, develop them. If existing policies are ineffective, improve them. Don't be content with lip service - make the system, especially its leaders, walk the talk.

CBS has a donor slogan, "Blood, it's in you to give." The last part is the key - It's in you to give. You can make a difference.
As Margaret Lawrence said,

Know that although in the eternal scheme of things you are small, you are also unique and irreplaceable, as are all your fellow humans everywhere in the world.

In the worst cases, there's always hope of retribution, although this successful example is no doubt complicated by race:

• Former NHS manager awarded £1m in racial discrimination case - Elliot Browne subjected to 'systematic bullying and harassment' (9 Jan. 2012)

FOR FUN
What music comes to mind?

• 'Stand by me" by Ben. E. King ( Support colleagues who experience bullying. It could be you next.)

As always, the views are mine alone. Comments are most welcome BUT, due to excessive spam, please e-mail me personally or use the address in the newsletter notice. 

Addendum (23 Feb. 2012): 

• Report confirms Alberta physicians bullied and muzzled
• Analysis / political ramifications

Further Reading
Nice series on physician and nursing relationships with the laboratory (full free text on PubMed Central):
1. Butterly JR, Horowitz RE. Controversies in laboratory medicine: a series from the Institute for Quality in Laboratory Medicine. MedGenMed. 2006; 8(1): 47. 
Two parts, each with responses:

• Top 5 issues that irritate physicians about the laboratory  
• Top 5 issues that irritate the laboratory about physicians

2. Kurec A, Wyche KL. Institute for Quality in Laboratory Medicine Series - Controversies in laboratory medicine: nursing and the laboratory: relationship issues that affect quality care. MedGenMed. 2006 Aug 30;8(3):52.
Three parts:

• 5 nursing concerns as viewed by the laboratory
• 5 nursing concerns as viewed by [nursing] 
• Beyond the complaints: working together to improve laboratory testing and services

Updated 14 Jan. / 17 Jan.  / 24 Jan. 2012 / 23 Feb. 2012