Bullying in the ED

Authors: Dan Darbyshire / Editor: Liz Herrieven, Charlotte Davies / Codes: SLO12, SLO7, SLO8, SLO9 / Published: 07/12/2021

Bullying is something that an unacceptably high number of healthcare workers will experience. Despite priding itself in being a friendly specialty with a flattened hierarchy, those working in emergency medicine, too, report experiencing bullying.

Whilst harassment is unlawful under the Equality Act 2010, bullying is more of a grey area. However, as healthcare professionals, it is clearly a behaviour that contravenes our duty to “do no harm”. This is not to say that there are not legal consequences of bullying, indeed legal claims for the harms suffered from bullying — either in terms of mental ill health or constructive dismissal — can be difficult for employers to defend and very costly.

The gov.uk website provides examples of bullying or harassing behaviours including:

  • spreading malicious rumours
  • unfair treatment
  • picking on or regularly undermining someone
  • denying someone’s training or promotion opportunities

The same source helps us define what makes something harassment and that’s essentially when the behaviour is related to one of the characteristics protected under the Equality Act 2010:

  • age
  • sex
  • disability
  • gender reassignment
  • marriage and civil partnership
  • pregnancy and maternity
  • race
  • religion or belief
  • sexual orientation

The Anti-Bullying Alliance, a UK based charity, has its own definition:

Which can also be reviewed in a helpful video.

So now we know what bullying is, the question is why should you care? Bullying isn’t an emergency medicine problem is it?

The last three EMTA Surveys dispel any notions that the emergency department might be immune from bullying. Indeed the first of the surveys to look at bullying was conducted shortly after similar work from the British Orthopaedic Trainee Association and the levels reported by emergency medicine trainees were worse.

The most recent version of the EMTA survey from 2020 showed that in the last 4 weeks one in ten trainees had felt bullied and a similar number had witnessed such behaviour. Extrapolate that across an academic year and the scale of the problem starts to become apparent and the free-text responses start to make sense.

“It’s endemic in my trust”

“Widespread and accepted practice”

“No point in raising it”

The NHS staff survey suggests that bullying is a problem throughout the NHS with some estimates suggesting that the financial impact of bullying (combined with harassment) is greater than that of clinical error.

What can we do about bullying? It is worth thinking about how you would respond if (when?) you were to witness it. The aforementioned Antibullying Alliance have free on-line CPD including a session on responding to bullying. Each NHS Trust has a Freedom to Speak Up Guardian, who may be your first point of call if you need advice about bullying. For trainees, your Clinical or Educational Supervisor may also be a good point of call, so long as they are not the person bullying you. Each Trust also has a policy explaining the procedure to follow should you feel you are being bullied or harassed. The name may vary, but the pathways are often similar. Depending on the severity of the behaviour, there will be informal or formal routes to follow to try to resolve the issue.

Something that is a bit of a taboo is the notion that you might be the bully. Maybe you have been accused of bullying behaviours. If this is the case it is definitely not something you should ignore, and asking the question of yourself does not mean there is substance to the allegation. The national bullying helpline has a helpful guide to this.

But what about at a departmental or cultural level? What is it about the emergency department that means that emergency medicine trainees repeatedly report high levels of bullying? To be honest it is not totally clear. To start to try and understand this, and more importantly to take ownership of and improve the problem, RCEM instigated an anti-bullying task and finish group.

The first thing we need to do is to recognise that we have a problem with bullying in emergency medicine and start having difficult conversations in each and every department about how, not if, it manifests where you are. The anti-bullying group commissioned a video as part of a campaign entitled RespectED to try and help to encourage these conversations. Do take a couple of minutes to watch it and share it with your colleagues.

Editor’s Note: Bullying is one of those difficult topics where the label is attributed by the recipient, whether according to a definition or not. I’ve seen it a few times where negative feedback has been given to a doctor, and they’ve responded with a bullying allegation which is difficult for everyone and is why educationalists ask for regular and detailed documentation of such feedback. But bullying does exist, and hopefully this blog has provided you with some discussion and consideration points. 

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4 Comments

  1. Dr. RaviRaja Muddana says:

    Good catch

  2. Mr Philip John Currie says:

    A good start on a difficult subject.

  3. Mr Kayode A O Adeboye says:

    Difficult subject but important. The workplace is difficult enough.

  4. Dr Catherine A Motwani says:

    A brief but very thought-provoking article. I feel it is one we should all read from time to time as we reflect on our own practice and behaviour, as well as what may well be happening to colleagues around us and what we can and should do about it.

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