Incompetence in communication

THIS IS MY last DIT diary – after three years I don’t think I can claim to be in-touch with issues affecting pre-vocational JMOs any longer. But oh, the many issues I have had. It’s been an amazing journey reflecting on these years and it was very hard to choose an exit message. Fortunately (or perhaps unfortunately), as I struggled for a topic, I was once again subjected to casual workplace bullying. This made my message an easy choice. We’re all tired of being bullied and it can (and must) stop.

On this particular day, I walked into intensive care to hand-over a patient to the on-call registrar. Dr X, Intensive Care Consultant Extraordinaire and Total Aussie Hero boomed at me, “I am the consultant, you tell me about the patients!” The tone was not helpful, nor supported by the ancient protocol of registrar-to-registrar referral. In case there was any confusion about his hostility he employed some eye-rolling and a mocking voice. I had never met this man before. Several doctors and nurses witnessed this exchange. I nodded politely, responded, “of course, if you think so” and restrained myself from asking if he had some kind of axis-two personality disorder or his parents never hugged him. Lest anyone think I’m criticising a specific institution, I’m locuming this year and have worked everywhere from Western Australia, to rural Tasmania, Alice Springs, then back to Sydney again. I can say with confidence this issue remains endemic throughout the country and bullying is still commonplace.

This consultant’s attitude was hardly the worst example of hospital bullying imaginable, nor even the worst I’d seen that week. It did not undermine my relief at the patient getting the treatment she needed, which – as always – is the most important thing. Although we talk a lot about the negative mental health impacts of bullying, we talk less about how it can become so routine it just gets boring and makes otherwise enjoyable jobs tedious. This interaction was in the ‘nauseatingly boring/counter-productive’ category. I didn’t cry or feel depressed, though perhaps if I’d had a worse day I might have. He just made me feel beyond exhausted from dealing with the constant background radiation of low-grade hostility whilst trying to care for patients.

Just because difficult interactions are common doesn’t mean they should be considered normal. Bullying is an egregious form of incompetence in communication – a technique that we have decided is somehow cancelled out by clinical competence, even though an angry handover is just as confusing as a poor one. I don’t care if you’re the cleverest intensivist this side of the MacDonnell Ranges, if you can’t communicate without belittling subordinates you’re unqualified in a key professional domain. With each passing year when people condescend, block, yell, snap, gossip, intimidate I become increasingly frustrated with this unnecessary workplace burden. I’ve started to see it for what it is, doctors manifesting stress and over-work with anachronistic behaviour that is counter-productive.

We can change. I am not perfect – two or three years ago I was well known as “a bit cranky” – but I’ve evolved through my training to realise the cranky persona came out at times when I wasn’t really coping with the job. I think very carefully now about how I speak to juniors and I remember that shaming people is not a recognised form of performance-management. There will always be tough moments in which we snap or speak sharply because medicine is a high-pressure job, but that is not the same as systematically blocking or demeaning people. If you are an intern, what I want to pass on is that it doesn’t matter if the bully is the head of surgery or an irate medical registrar; you have every right to respond to aggression or abuse with, “it is not appropriate for you to speak to me like that”. One day, when we’re old, we’ll tell the new generation of medicos that we used to get bullied. It will seem just as bizarre to them as doctors smoking in hospitals seems to us now. People who persist in intimidating and belittling behaviours are being unprofessional and, in an increasingly competitive job market, will find it harder and harder to hold onto their positions.