THE BLOG

Undermining Trainees - How Senior Doctors Still Set a Poor Example

15/08/2013 21:24 BST | Updated 15/10/2013 10:12 BST
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The 1950's British comedy Doctor in the House centres on a group of students progressing through medical school. One of the dominating characters at its reins is chief surgeon Sir Lancelott Spratt whose sole purpose is to demonstrate the classic berating style commonly utilised by many a senior clinician.

So how much of this is true in today's practice? Well as a NHS worker myself, I can probably recall one episode of such treatment. However, I have been witness to several more.

One such occurrence took place following a night shift when the team in question had spent more than 12 hours managing a continuous barrage of unwell patients. One of whom was an Indian lady who spoke little english but was noted to have high blood pressure. During the assessment with the consultant the admitting junior doctor commented how the patient kept pointing to her head and grimacing. Concerned about a possible intra cerebral bleed, the doctor had ordered an urgent CT head scan. Unfortunately she was lambasted for having done so, informed she was 'daft' and that her ability was best suited to general practice as opposed to hospital medicine. Surprising to all of us was the consultant in question was in fact a stroke physician and so ordering a CT head in such circumstances seemed second nature.

Another episode took place during an afternoon on call. My colleague at the time, who was certainly more experienced than me having trained longer in the field of acute medicine, was battling through a busy day. His bleep was non-stop and continued to sound as the consultant arrived to start the ward round. It was in fact my colleague's last day with the team as he was due to start another job at a major teaching hospital the next morning. Following the end of the ward round, the consultant turned to him and straight faced said, 'I would like to thank you for all your hard work these past months, if you need a reference for McDonald's I'd be happy to help,' before turning his back and leaving the ward. The consultant at the time happened to be one of the programme directors for junior trainees at that hospital.

A third example I witnessed occurred during a high dependency shift. The patient being assessed was suffering from significant heart failure and needed intravenous medication to help improve his breathing. The consultant had asked one of my team members to prescribe this and assess his response later in the day. As in-patient jobs were rapidly piling up, the team's senior registrar stated that he would do this in order to save time. As the afternoon approached the patient was reviewed and it soon became apparent that the medication had not been prescribed. Thankfully the patient was stable and felt better regardless. But the registrar was quick to comment how he held my colleague personally responsible for not issuing the prescription when asked. Quite a bizarre turn around we all felt.

A further event took place during an ITU shift when a patient with severe sepsis was being reviewed. My colleague, who I might add, is now an international authority in internal medicine, was asked to detail his understanding of the Kreb's cycle, something he could barely recall from his undergraduate days. Even I myself questioned the relevance of this with regards to our current management of the patient. He gave a brief summary which did not at all meet the expectations of the consultant who at this point felt obliged to inform him that he would never progress in medicine and struggle to find a permanent job in the future. How misguided she was.

As for me, well my experience became clear during an episode of gastroenteritis, which left me being unable to go to work for two days, the only time I have been absent since starting in 2007. Having notified my team well in advance, I still received a phone call from the lead of the medical admissions unit demanding I came to work regardless as it was particularly busy that day - and, 'that unless I was intubated and ventilated and needing an ITU bed myself I was well enough to work.'

The Guardian last year reported a story of a newly qualified doctor detailing their personal experience of hospital pursuits.

Unfortunately such an experience is still common place. In fact according to the NHS Employers Bullying and Harassment guidance of 2006, only 54 per cent of staff actually reported such incidents which fell under the bullying and harassment umbrella.

Unbridled examples of bullying and harassment exist and as per the Advisory, Conciliation and Arbitration Service (ACAS) may include:

Bullying by exclusion - which may take the form of social isolation and/or exclusion from meetings.

The deliberate withholding of information with the intention of affecting a colleagues performance.

Unfair and destructive criticism.

Intimidating behaviour.

Verbal abuse and spreading of unfounded rumours.

Humiliation or ridicule.

Setting of unrealistic targets which are unreasonable and/or changed with limited notice or consultation.

A study published in the BMJ recently by Carter and colleagues aimed to examine the prevalence and impact of bullying behaviours between staff in the NHS, and to explore the barriers to reporting bullying. Results demonstrated that 20% of staff reported having been bullied by other staff to some degree and 43% reported having witnessed bullying in the last six months.

It is without question that bullying and harassment in the NHS is still ever prevalent which can no doubt have a direct effect on trainee performance and ultimately patient care. Despite continued encouragement to whistle blow, NHS workers lack tumultuous zeal due to concerns as to whether a particular adverse situation may improve or whether they themselves may suffer for doing so. The government must appreciate such concerns and take concrete steps to make the reporting of such incidents feasible without repercussions in order to protect the very cornucopia our workforce relies on.

It is often typical to try and excuse such behaviour, claiming that those responsible may be insecure, mad devils with dull spirits or had themselves suffered the same experiences previously. However such perverse complacency is far from justified. It was Desmond Tutu who once said, 'If you are neutral in situations of injustice, you have chosen the side of the oppressor. If an elephant has its foot on the tail of a mouse, and you say that you are neutral, the mouse will not appreciate your neutrality.'