By Steven Perlman, DDS, MScD, DHL (hon)

“If they don't like you for being yourself, be yourself even more.”

-Taylor Swift

Thinking about this month’s theme of “Don’t be a bully”, we are all aware of the current crisis and alarming rise of bullying children and adults with disabilities. Bullying has also been a problem within our healthcare system for decades, but only in the past few years has this phenomenon been acknowledged as a very serious problem.

One issue has been the lack of consensus defining just what bullying means. The American Medical Association (AMA) policy defines workplace bullying as “repeated, emotionally, physically abusive, disrespectful, disruptive, inappropriate, insulting, intimidating, or threatening behavior targeted at a specific individual or a group of individuals that manifests from a real or perceived power imbalance and is often, but not always, intended to control, embarrass, undermine, threaten, or otherwise harm the target. Individual, organizational, and health system factors may contribute to the overall workplace climate or culture that allows unprofessional behavior, such as bullying, to persist.”

Another associated factor is that acts of rudeness and civility have reportedly risen to crisis levels in medicine. It is a particular problem in the American workplace where three out of four employees report rudeness on their job at least once a week.

Civility is an essential part of a social contract, a “benevolent awareness, a sense of respect for oneself and others. It seems that simply, people have forgotten how to be nice.”

What is it about healthcare that makes it so susceptible to rudeness and bullying? We are here to take care of people, yet we forget to take care of ourselves. Research has shown that rude behavior spreads like a virus.

Nurse bullying is probably the most documented and is such a systemic and pervasive problem that it is almost considered to be a rite of passage. It is so common that nurses in the profession call it “eating their young.”

Nursing journals and articles report that:

* Up to 34% of nurses leave the profession because of bullying.

* 60% of nurse managers, directors, and executives experience workplace bullying.

* 26% of those considered the bullying to be severe.

* 78% of nursing students experience bullying in nursing schools

* 60% of nurses quit within six months of their first job due to the behavior of their co-workers.

* Bullying impacts their job satisfaction more than salary.

In 2021, the Joint Commission reported that in the healthcare setting, 44% of nursing staff members reported being bullied. The most common healthcare settings, where bullying is prevalent are behavioral health units, emergency departments, and intensive care units.

In long-term care settings, bullying occurs more frequently during evening and night hours. Targets of bullying were typically under 40 years old, female physicians, unmarried female employees with less education and had children at home. Bullying in the healthcare workplace is more common than sexual harassment and initiated by both men and women.

Medical students, residents, and physicians are a special population when it comes to bullying. Studies have shown that medical students experience mistreatment during their education at twice the rate of students in other fields. Prevalence ranges from 30-95%.

A 2022 Medscape survey of the 1,500 physicians found that more than 80% said they had witnessed bullying and harassment by other doctors, the offenders being primarily males in their 40s. Bullying is associated with medical burnout.

The old methodology of physician culture is for the mentors to traditionally abuse trainees at every level. “Tear you down to build you up” was pervasive. The star system in medicine tolerates bad behavior by rainmakers. The power gradient in medicine often prevents reporting. Racial and ethnic minorities experience bullying more frequently than white participants.

“Let us all reflect during ‘Don’t be a Bully’ month and strive to create a healthier workplace, a nurturing relationship with our students and colleagues, and respect the fact that people want a sense of feeling valued and respected. ”

Years ago, I had a patient who I began treating when the child was three years old. She had Down syndrome, was legally blind, was g-tube fed, and had severe behavioral issue. Born with the tetralogy of Fallot, post-surgically, she developed a chronic infection in her leg, resulting in a significant difference in her limb lengths. She was ambulatory with the use of a walker and was under the care of a leading children’s orthopedist at a top ranked children’s hospital.

When the patient was 12, the orthopedic surgeon recommended to her parents that an amputation was necessary, and a prosthesis would be made so she could be ambulatory. Her parents would not give consent to the procedure and procrastinated at frequent recall visits. The orthopedist at each visit would reenforce his recommendation, always claiming he was a world expert and the amputation was unavoidable.

Her parents sought a second opinion at John Hopkins Hospital where their expert would only agree with the primary physician and told the parents he was an authority who he would not challenge. Depressed after this encounter, the parents came to me and asked for my advice.

Reaching out to my AADMD Colleagues, we referred them to an orthopedist in Florida who specializes in limb lengthening. The family flew down for the consultation and were met by a caring, empathetic physician who looked beyond the child’s disabilities and saw a leg that he could fix. The procedure was successful, both legs are equal length, and her mobility is completely normal.

I spent the next several years trying to convince her parents to tell their story, how they were bullied relentlessly for not listening to the advice of the “world’s expert”. Their response has always been that it was such a traumatic time in their lives, and they were so close to being bullied into a decision by a physician whose ego was challenged.

Let us all reflect during “Don’t be a Bully” month and strive to create a healthier workplace, a nurturing relationship with our students and colleagues, and respect the fact that people want a sense of feeling valued and respected.

PAOH President’s Message: ‘Don’t Be a Bully!’

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