Managing bullying and bad behaviour as a doctor

27 October 2021

Medicine is not immune to bad behaviour. The hierarchical nature of medicine and hospitals can facilitate power imbalances that misuse seniority to intimidate and negatively impact colleagues in the workplace. However, not all bullying involves a senior doctor bullying a less experienced doctor. Bullying can occur between colleagues of equal standing and can occur between different health professionals. AMA Victoria regularly hears from doctors who experience bullying behaviour from nursing or administrative staff.

Legal definition of workplace bullying

A worker is bullied at work if a person or persons repeatedly act unreasonably towards them or a group of workers, and the behaviour creates a risk to health and safety.

There are a few components to this definition:

Bullying can be carried out by one or more persons;
To meet the definition, it must be repeated acts – a one-off act is unlikely to constitute bullying;
The act must be unreasonable and must create a risk to health and safety; and
Bullying can be towards one or more persons in a workplace.

Bullying in the workplace may extend to any situation related to your role, including work-related electronic communication, social functions, or training directly related to your current employment, even if held at another venue.

Unreasonable behaviour can include conduct which is victimising, humiliating, intimidating or threatening, and is determined by the perspective of a reasonable person. Some behaviour might be offensive to one person, but not to another. To determine what constitutes ‘unreasonable’, we need to consider what a reasonable person would think about the behaviour.

It is also really important to consider what behaviour does not constitute bullying. Reasonable and lawful management action, direction and control over work is not bullying. An employer (through your supervisor) is entitled to undertake reasonable and lawful management action, and issue directions and control over work. From a practical perspective, that might be conducting performance reviews, disciplinary meetings, directing you to undertake a certain task within your duties. If that happens, and happens reasonably and lawfully, it does not constitute bullying – even if you might feel uncomfortable about it. For example, performance management by your supervisor if you are not meeting the standard expected of you is not a form of bullying (although it can feel distressing). Always seek independent expert advice from a workplace relations advisor or a lawyer before raising any claims of bullying with your employer.

The obligations of employers with respect to bullying, particularly in risks to health and safety, are set out in the work health and safety legislation. The work health and safety legislation states that employers have a duty to ensure the health and safety of workers, and others, in the workplace. That means that the employer has a duty to:

Ensure that the work environment is one without risk to health and safety. That includes both physical risks and psychological risks;
Provide a safe system of work;
Monitor the health and safety of workers and others; and
Provide appropriate information, training and supervision.

Employers should conduct regular training sessions on bullying and workplace behaviour and ensure that there are systems in place for such behaviour to be reported, recorded and investigated. Every workplace should have workplace bullying policies and procedures that you can access if you are concerned about bullying to find out what steps are involved in reporting the behaviour.

Other bad behaviour

Bad behaviour such as bullying can also occur outside a workplace (for example, in relation to a college training program), but this may not be covered by the legislation relating to workplace safety if it does not involve your employer or other employees at your workplace. If your training college is involved, seek out their policy and procedures for managing bullying and bad behaviour and find out how to lodge a complaint. Seek legal advice to understand your options for addressing the situation.

Harassment and discrimination, whether based on gender, sexual preference or race are equally unacceptable but unfortunately may or may not fit the criteria for workplace bullying. Likewise, incivility, physical violence and general conflict or a dispute can be hazardous as a patient safety risk, but may not be considered bullying either. It is important to talk over the adverse behaviour you may be experiencing or observing with an expert workplace relations advisor or a lawyer to gain clarity about the nature of the behaviour and the most appropriate course of action. Seek out your workplace’s policies and procedures for dealing with these behaviours and find out what steps can be taken to report this behaviour.

Taking action

In any situation where you observe bad behaviour, it is valuable to keep a record of the incidents, what happened, who was involved as well as the names of any witnesses. This will be important if you proceed with making a report. Documenting the behaviour also helps to assess if there is a pattern of repeated behaviour. Keeping a record is also valuable if there is a delay in the matter being addressed or if you need to report an incident later. Do not rely on your memory. A contemporaneous record may be valuable evidence if you decide to take action at a later time.

Deciding whether to take action is an individual choice. Seek advice from an expert workplace relations advisor or a lawyer. Reporting bad behaviour to an employer is important to protect others but be mindful that going further to pursue legal action for compensation is very stressful. Consider the long term impact on your wellbeing and your personal priorities.

Looking after yourself

If you are experiencing bullying or bad behaviour, the psychological impact can be very damaging. The impact can range from a loss of self-confidence and emotional distress through to trauma and a lasting impact on your mental health.

When you are in the presence of the perpetrator, you are likely to feel very anxious and hypervigilant. This will make it hard to focus on the task at hand, to think clearly and remember information. You may experience amygdala hijack as you move into the flight or fight mode with a racing heart and a sense of panic. Taking some deep, slow breaths can help in the short term. In the longer term, practising mindfulness and activities that help to manage your stress is essential. If there is someone on your team that you trust, confide in them and ask them for support whenever the perpetrator is present.

It is common to feel ashamed or a sense of guilt about the situation and stigma may make it hard to seek help. It is important to reach out to someone you trust and who can support you to seek professional advice. For example, you may call the AMA Victoria Peer Support Service which is confidential and anonymous for an initial discussion to help clarify what you are experiencing before you ring the AMA Victoria Workplace Relations unit for expert advice.

Treat yourself with self-compassion at this time. Remind yourself that you are not to blame. Seek support at work from a trusted colleague. Support your self-worth by focussing on your professional values, outside interests, and friends/family. See your GP to talk about how you are feeling and ask for a referral to see a psychologist if necessary. Take leave if you need to spend time recovering. Do not try to soldier on and bury your emotions by being busy. Take time to identify and acknowledge what you are feeling and use your values to guide you to commit to take the steps needed for recovery.

Assertiveness and standing up to a perpetrator

Good communication between doctors, and indeed all healthcare professionals, is essential to patient care and safety. Bullying and bad behaviour can place patients at risk as it deters clarification of orders or concerns being raised about patient management, or even escalating apparent patient deterioration to a more experienced doctor.

If you observe bullying, incivility or disrespect as a bystander, whether you intervene will depend on your relationship to those involved and if you know the background to the incident. However, it will be helpful to discretely check in with the person who was being treated disrespectfully, let them know you saw the incident and offer your support. If you have a team member who is regularly being treated with disrespect, you may be in a position to call out the behaviour with the perpetrator. This needs to be done in a way which does not cause humiliation to either person or aggravate the situation. You may wish to discuss how to do this with an expert workplace relations advisor or a trusted senior colleague before approaching the perpetrator.

If you have experienced bullying or bad behaviour or if you are easily intimidated, you may need to develop a greater sense of self-efficacy, which is a belief that you are capable of successfully taking action. For example, believing that you can confidently set boundaries in relation to unacceptable behaviour and speak out assertively. It can be helpful to have some coaching to develop a sense of self-efficacy and assertiveness skills. The AMA Victoria Professional Development and Careers Service can provide coaching to assist your development.

It can be helpful to practice some assertive scripts to use, for example:

Raising a concern about patient care: “This is a patient safety issue and I need you to clarify this order.”
Practice escalation: “I am concerned/ uncomfortable about…” to “This is unprofessional/harmful. It has to stop.”
Responding to humiliation, intimidation: “I need a professional explanation here. What exactly is your intention?”
Responding to eye-rolls, making faces, deep sighing: “I’m sensing from your expression that there may be something you wish to say to me. It is OK to speak to me directly.”
Bystander intervention: “Sam is a valuable member of the team and deserves our support. How can we work through this together as a team?”

Bullying and bad behaviour in medicine and in healthcare is never acceptable and should not be tolerated. The culture will only change if this behaviour is challenged. Bad behaviour is a patient safety issue and impacts on patient care. Everyone has a right to be treated fairly and with respect at work.

Kay Dunkley
AMA Victoria Coordinator of Doctor Wellbeing