Thursday, January 12, 2012

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'?
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.
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.

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.

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
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:
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): 
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