Bullying and harassment: can we solve the problem?

The prevalence of sexual harassment and bullying in medicine has recently been highlighted in the media. This matter is not, of course, restricted to medicine. However, in medicine, harassment and bullying appear to be most evident among very hierarchical, male-dominated specialities such as surgery.

Although the focus of the complaint alluded to above was the Royal Australasian College of Surgeons (RACS), all colleges, and their specialist societies, must respond to these allegations. In Australia, these colleges and societies are responsible for postgraduate training of medical specialists. They produce a highly-trained, fit-for-purpose doctor based on a sound clinical curriculum and appropriate skills training.

The Colleges already have codes of conduct and a limited capacity to counsel, censor and discipline Fellows, but these have not worked and a new approach is required. First, they must seek information to determine the extent of the problem, understand the perspective of those who have been harassed or bullied, and consider what options are available to solve the problem. The RACS has commissioned an expert panel to, in effect, perform a root-cause analysis of the problem, and make recommendations on how to solve it. In response to the panel’s findings, new empowered policies and new educational models must be developed.

Lucey and Souba have suggested a shift away from classical educational paradigms based on a “carrot and stick” philosophy of education, and a move to such strategies as rewarding good behaviour, reinforcing rules, providing role models and removing those who falter.1 The authors asserted that rules and regulations alone do not change behaviour. They argue that, while an employer can counsel, censor, reprimand or even dismiss offending clinicians, the problem can only be solved if the individuals concerned recognise that their behaviour is inappropriate and then determine to change that behaviour.1 In cases of bullying or harassment, they must see such behaviour as not in keeping with their personal expectations. For many older clinicians, this will be difficult. Behaviour that made them successful is being challenged and is no longer legitimate. Further, many clinicians will accept the rules of professionalism but behave differently or deny their behaviour is inappropriate. Lucey and Souba identified five teachable skills: self-awareness and self-control, situational awareness, alternative strategy development, crisis communication and peer coaching.1 These skills could provide the foundation of educational interventions. They could be incorporated into new educational programs. The colleges are ideally placed to undertake this role as the larger colleges have excellent educational resources and an excellent track record of educational innovation.

Such interventions could begin at medical school. Students learn not just by observation of poor behaviour, but also by observing examples of good behaviour which are far more powerful.2 This approach is also relevant to trainees.

The Sydney surgeon who made claims about sexual harassment has already publicly expressed doubts that the RACS’s expert panel will make a difference.3 Cynicism that a lasting solution can be found is understandable. Repeatedly in history, when confronted by questions of professionalism, the profession has responded with well meaning codes of conduct, but these have done little to solve the problem. Sometimes a catalyst is needed to change embedded behaviour, and perhaps this is it. The response so far by the RACS is commendable, but it will need to act transparently on the expert panel’s recommendations and not shrink from difficult decisions.