Size matters. At least, that seems to be the media’s belief when it comes to analysing social problems. The grimmer the stories, the uglier the experience, the more bodies at the bottom of the cliff, the better.
And last night’s episode of ABC TV’s Four Corners didn’t disappoint, with its expose on bullying among surgeons and the devastating consequences this entrenched practice has for its victims, both in the short and long term.
Despite casting their net wide, the show’s producers found only three medical professionals who haven’t spoken out about this issue before, and only two chose to be identified. Imogen Ibbett and Vyom Sharma have now joined the growing ranks of doctors, such as Dr Caroline Tan and Dr Talia Steed, in breaking the silence around the destruction of careers and health that doctors cause among their own.
But noticing the growing pile of bodies at the bottom of the cliff is only helpful if it triggers the essential questions – who or what is pushing them off and what can be done to stop it?
Not just surgeons
The program notes that this is not just a problem for women, or surgeons or even just the medical profession; it’s a public health issue that demands action. Indeed, women can also be perpetrators as Imogen Ibbett’s allegations against Helen Maroulis clearly demonstrate.
But most significantly, the show highlights the risk bullying, scalpel-throwing surgeons, misogynist physicians, and harassed and cowered trainee doctors pose to the lives of patients.
The problem starts early, in medical school; both local and international research persistently show most medical students experience mistreatment during clinical placements in hospitals.
Our recent – about to be published – research found 74% of Australian medical students experienced mistreatment during clinical placements and even more witnessed it. Similarly, a 2014 US study found 83% of medical students experienced some form of mistreatment during medical training in hospitals.
A large number of students reported use of “pimping”, an aggressive form of questioning based on an abuse of the Socratic teaching method, described in Four Corners, which isused to shame students for their lack of knowledge. Studies have also highlighted negative environments involving belittlement, disrespect and being “constantly ignored and told to disappear.”
Although student reports of mistreatment may be interpreted by some senior staff as just over-sensitivity, research shows students perceive negative events in a similar way to physicians and nurses. Unsurprisingly, under-reporting is common.
Mistreatment of medical students is at odds with the explicit teaching about professionalism in medical training, leaving many confused. But some others become medical teachers who “mete unto others what was perpetrated against them”. The effects of all this “teaching by humiliation” can be profound and enduring.
Medical students’ mental health has been shown to decline throughout medical training. And this can lead to poor self-confidence and burnout, binge drinking, stress and depression, and substance abuse, broken relationships, suicide and early exit from the profession.