Protecting Yourself, Protecting Your Colleagues
Self-Reflection
How to Maintain Healthy Working Behaviour
When you are exposed to bullying or abusive behaviour at work there will be established pathways within your hospital and Health Board for you to report the bullying activity with an aim to bringing some resolution of the conflict.
It is also unfortunate that many of these pathways may lead to long delays in the bullying or abusive behaviours being addressed or that you may not feel safe or empowered to report the bullying and abusive behaviours.
In these circumstances it may be helpful to consider some of your options to help protect yourself from the detrimental effects of being bullied and abused in your workplace.
Below are outlined some options that you may be able to instigate yourself to preserve and promote the wellbeing of yourself (to mitigate negative effects on your colleagues, your family and your patients) during the investigative phase of your bullying complaint.
The advice below is appropriate for all grades of surgeon (trainee, SAS, Consultant) that are being bullied in the workplace and it is helpful to keep a personal contemporaneous diary of all episodes and consequences of bullying that you are exposed to.
Informal Peer Support Group
Usually you will not be the only person to have been bullied by a perpetrator. An informal peer support group can include those friends or colleagues who have also been bullied, or know about the bullying individuals/department that you are experiencing but can also include colleagues or friends who are not in your department, specialty or hospital. What is important is that you are all comfortable to talk openly within your group and that member’s respect the confidentiality of what is revealed. It can be useful to meet outside the workplace. It can be beneficial to know the location of a central 24-hours fast-food restaurant where informal meetings can occur outside of office hours and at short-notice in a ‘crisis’ moment. The basic benefit of an informal peer support group may be just to hear others reassure you that the bullying activity ‘is not your fault’.
Formal Support Group
Every Health Board will have an Occupational Health Department. If you are feeling unwell, stressed, anxious or depressed by bullying at work then you should self-refer yourself to your hospital’s Occupational Health Department. By self-referring you can retain your confidentiality right of the Occupational Health department not to share your clinic attendances and outcomes with your departmental management team. However, if you are requested to attend Occupational Health by your clinical leaders or management team then Occupational Health may be obligated to keep the referring managers informed of your attendances and outcomes.
Outside of the workplace you can seek help from your GP if you feel that your mental or physical health is being impaired by the bullying at work. Your trade union (e.g. the BMA) will have counsellors and staff to support and represent you at meetings with your employer about the bullying activity that you are experiencing.
What You Can Do
Speak up. If you see someone being bullied, harassed or undermined then speak to the perpetrator and challenge their behaviour. If you do not feel comfortable doing this on your own, then ask a colleague to accompany you, or speak to their line manager. DON’T leave it – challenge it before it becomes a recurring problem.
Report it. If speaking to the bully has not changed their behaviour and it becomes and on-going problem then report it to their line manager. In extreme circumstances you might wish to speak to the GMC. See our section on the facts and the law.
Document every incidence and interaction. Keep a record of every encounter you have, write down what was said, and try and keep to the facts. This can be used as evidence if needed.
Employment Tribunal. As a last resort you may wish to consider taking things further. Read about how to go about this here.
Reflect on your own practice. Have you ever been rude to the referring GP or A&E doctor? Has someone tested your patience in theatre today? Were you short with the clinic staff because you were overbooked? We often think about clinical cases when we go home, but how often do we think about how our actions affected others? Could you be perceived as a bully?
Take our online e-module. This emodule guides you through the facts, identifies the problem and suggests ways of managing our own behaviour in order to change the surgical culture. CPD accredited. RCSEd online account holders can access the emodule by logging in with your RCSEd account here. Non-RCSEd online account holders will first need to register to create an online RCSEd account here. Once you have registered, you can then log in to complete the emodule with your new RCSEd account here.
Go on our professional development course. We are currently developing a bespoke course designed for surgeons and dentists, showing us how to get the best out of our professional relationships. To register your interest in this course please email education@rcsed.ac.uk
Schwartz rounds. Ask your organisation if you can set up a monthly Schwartz round. These are group meetings for all staff where the emotional and social aspects of working in healthcare are discussed. For more information and to find out how to register please contact the Point of Care Foundation.
Present at your hospital. We want you to spread the word that disruptive behaviour is not acceptable. We have two presentations available; a ten minute and a thirty minute version for you to present at grand rounds or departmental meetings in your own hospitals. Guidance notes are attached at the end of each slide.
Print out a poster. We have posters made to put up in the workplace. These are available to download in portrait or landscape.
Other Avenues for Help
Sometimes you may need to source help from an external agency. The following links may be useful:
- The BMA offer a wealth of help on their website, that covers a variety of topics, e.g. bereavement, addiction, counselling and wellbeing.
- Doctors’ Support Network
- The Royal College of Nursing provides advice and support to members who may be experiencing bullying and harassment in the workplace and can be contacted on 0345 772 6100.
- The Royal Medical Benevolent Fund – Health and Wellbeing section.
- The Samaritans offer a safe place for you to talk any time you like, in your own way – about whatever’s getting to you.
- Counselling Directory is a confidential service that encourages those in need to seek help.
Managing Criticism
Receiving criticism from our colleagues can be one of the most difficult aspects of practising medicine. It threatens confidence, can lead to feelings of shame and regret, and can disrupt doctor-patient and doctor-doctor relationships. In many cases, however, the criticism may be well-intentioned and designed to optimise patient care, and so all doctors should strive to manage personal criticism effectively. When delivered by effective communicators, negative feedback can be a very useful educational opportunity.
Avoid ‘Knee-Jerk’ Responses
It is often tempting to try and offer an immediate defence when receiving criticism. This can be represented by anger, denial and rejection or by making comments that you later regret. Try to avoid making an immediate defence and take time consider the criticism that has been made.
If, on reflection, you feel the criticism may be justified and / or well-intentioned:
Ask for Honesty and Comprehensive Details
It is important to remember that doctors may also find it difficult to give criticism, but may feel obliged to do so in order to protect patients. Accordingly they may feel reticent and may only offer brief details of their concern. Invite them to give as much detail as possible and be in full possession of the facts before considering a response. Effective learning is only likely if the feedback is comprehensive, intelligible and trusted.
Turn the Discussion into a Learning Opportunity
Establish how you could do things differently in future. Set learning objectives to help you achieve the necessary changes to your practice. Revisit the situation with your clinical supervisor once you feel you have learnt from the criticism and take the opportunity to demonstrate that you are able to manage negative feedback in a mature and useful fashion.
Thank Your Critic
Thanking the person that criticises you may be instinctively difficult, but will show them that you are serious about self-improvement and optimising patient care, rather than becoming defensive and rejecting their well-intentioned advice.
Reflective Writing
Self-reflection is now a requirement of most training programmes and is stated as one of the GMC’s Duties of a Doctor. This usually takes the form of written reflective pieces submitted to online portfolios. Ensure that you follow the Academy of Medical Royal College’s guidance on entering information into ePortfolios.1
If, on reflection, you feel the criticism is unjustified and / or ill-intentioned:
Discuss with a Trusted Colleague
A neutral third party may offer a different view of the criticism, and may disagree that it was unjustified and / or ill-intentioned. They could suggest ways in which the advice could be used productively. If they agree that the criticism is unfair or has been inappropriately delivered (i.e. in a way designed to undermine or intimidate) then consider a discussion with a senior colleague such as an educational or clinical supervisor, and refer to RCSEd advice.
References
- AoMRC. Guidance for entering information onto ePortfolios (2016). Last accessed 7th January 2018 at http://www.aomrc.org.uk/publications/reports-guidance/academy-guidance-e-portfolios/
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