Sharon Batt claims that punishing victims won’t change medicine’s pervasive culture of bullying.
Last year, a Nova Scotia Supreme Court jury awarded Halifax cardiologist Dr. Gabrielle Horne $1.4 million in a civil lawsuit for damage to her career in what the president of her medical staff association described as “a classic case of workplace bullying.” In sum, a junior female investigator won major research grants and senior male colleagues wanted their names on her research papers. When she refused, her clinical privileges were revoked, blocking her ability to conduct her research — for 15 years and counting.
A large body of evidence suggests that bullying is deeply entrenched in medical culture. In a 2012 survey conducted by the Resident Doctors of Canada, 73% of residents said they were exposed to behaviour during their training that made them feel diminished. Examples include surgeons throwing medical instruments at trainees who make mistakes, yelling, instructors berating trainees in front of staff and patients for a less-than-perfect consult, pressure to disobey restrictions on working hours, and sleazy comments.
Reports from the U.K., Pakistan, and Japan echo similar stories and bullying rates. In Australia, a male student was asked to remove his pants in front of other students for a demonstration and did so because he feared the consequences of saying “no.” He thought the request must have had a good medical reason, but he later realized it was about power and completely unnecessary. A panel at the Canadian Medical Association’s annual meeting in August noted that bullying of trainees tends to target the most vulnerable, such as marginalized populations, and women who take maternity leave.
Bullying in medicine is nothing new. In a position paper over two decades ago, the Canadian Association of Interns and Residents described the pervasiveness and varieties of bullying and set out principles for complaints procedures. Medical schools across the country have since put resources in place to address abuse, while medical students and residents sponsor awareness activities to change the culture. In the U.S., the AMA Journal of Ethics devoted an entire issue to bullying and harassment in medical education in 2014. Unfortunately, avenues for recourse are underused, in part because victims fear retaliation.
One critic counters bullying is human nature. Some claim that “good intimidation” strategies can motivate doctors-in-training to perform under stress and attain high standards. Others point to costs in loss of confidence, depression, even suicide. In a 1992 article, American physician Adriane Fugh-Berman cites other counterproductive consequences of training-by-terror: learning to lie to cover up lapses rather than admitting error, winging your way through difficult procedures rather than asking for help, and mimicking abusive strategies as you move up the ladder.
Bullying in medicine continues beyond the educational setting to administration and research. Two physicians resigned in July as chairs of large medical districts in Ontario, citing “an immense amount of bullying and intimidation” because they challenged the Ontario Medical Association on its lack of financial transparency. In a 1990s workplace dispute, Dr. Gideon Koren of Toronto’s Hospital for Sick Children anonymously sent poison pen letters to former research colleague Dr. Nancy Olivieri, calling her and four of her supporters, “a group of pigs.” Despite condemning his behaviour, SickKids deemed Koren such a valuable employee, the hospital gave him the lightest of reprimands — only to be embroiled today in another furor over Koren’s discredited Motherisk lab.
In a book published this year, obstetrician-gynecologist Ronald Jones details a patriarchal, abusive hospital culture that, he concludes, created the conditions for an infamous research scandal in Auckland, New Zealand. Dubbed the “unfortunate experiment,” the project resulted in women with a treatable pre-cancerous lesion developing cervical cancer. Some died. Jones, recently retired, practiced from 1973 at the National Women’s Hospital where the research took place. He and two colleagues blew the whistle but were continually undermined when senior physicians implicated in the scandal used intimidation to assert their authority.
Back in Nova Scotia, what seemed like a win for Dr. Horne has instead prolonged her 15-year struggle to re-establish her research career. The Nova Scotia Health Authority, which is responsible for paying the $1.4 million fine, disputes the jury’s verdict that it acted “with malice and bad faith” and has appealed the amount of the award. The provincial government declined calls to step in and the case goes to the provincial Court of Appeal this month.
Recent high-profile cases have focused the public’s attention on the gendered power abuse prevalent in male-dominated workplaces. In this moment of societal self-reflection, agencies elsewhere are confronting the deleterious impact of bullying in all its forms on women’s career advancement. Nova Scotia’s Health Authority should accept that Gabrielle Horne suffered grievous harm to her career and pay her the damages the jury awarded. That would send a message to the medical community and beyond that the province is serious about tackling medicine’s bullying problem.
Conflict of Interest Disclosure: Sharon Batt is on the steering committee of the Visiting Professor in Medical Citizenship project, which Dr. Horne heads.