EP 23: Workplace Bullying in Medicine

Episode Description:
On this week’s episode of the Hope4Med podcast, we are joined by Dr. Adam Harrison, a family physician, qualified attorney at law, ex-medical director, and certified life leadership and executive coach. Dr. Harrison shares his experiences with bullying as a medical student and junior doctor. We discuss the toxic culture of bullying and “pimping” of physicians in training, how leadership plays a role, and ways we can promote change for the future generation of physicians.

Connect with our guest, Dr. Harrison
Email: dr.adam@coachingmentoringdoctors.com
Facebook: https://www.facebook.com/coachingmentoringdoctors
YouTube: https://www.youtube.com/c/DrAdamPhysicianCoach

Transcript:
[00:00:00] Dr. JB: For us, by us, and just for us. This is Hope4Med, med.

[00:00:06] Hi everyone, welcome back to the Hope4Med podcast. I am Dr. JB, your host, and today’s featured guest is Dr. Adam Harrison. Dr. Harrison is a family physician, qualified attorney at law, ex-medical director, and now certified life leadership and executive coach. Welcome, Dr. Harrison.

[00:00:30] Dr. Harrison: Thank you so much for having me, Dr. JB. That, that sounds really good when you read it out, it’s more impressive than I think it is. Thank you so much. Thanks for having me.

[00:00:42] Dr. JB: Yeah. I mean, this is actually really impressive, you should definitely give yourself some credit. Not only are you a physician, you’re also a lawyer, and you also have leadership experience that now you’re sharing with others through life leadership and executive coaching.

[00:00:58] Dr. Harrison: Yeah, yeah, yeah. I mean, I haven’t practiced in law, but I’m a qualified lawyer just, just to kind of like keep it real. I have the experience, yeah, it’s good, it’s quite wide-reaching and it comes in quite useful sometimes, so, yeah.

[00:01:13] Dr. JB: All right, so Dr. Harrison, start from the beginning. Well, actually, where are you right now?

[00:01:19] Dr. Harrison: I’m currently in a city called Nottingham in England, in the UK. You will know, so I recently lived in New Zealand because we had a conversation when I was there.

[00:01:28] Dr. JB: Yes. Yes, you’re a world traveler.

[00:01:31] Dr. Harrison: Yeah, yeah. During the pandemic, I’m very, very honored to be able to travel at the moment. Yeah, so we got home to the UK about two and a half weeks ago, after six months in New Zealand and 18 months in Australia, so yeah, back home in the bosom of the family.

[00:01:47] Dr. JB: Yeah. So, you did all of your training in the UK?

[00:01:52] Dr. Harrison: Absolutely. Yep. Yeah. I qualified in medicine in the year 2000 and we didn’t leave for Australia until 2019, so yeah, I’ve trained and practiced and everything in the UK.

[00:02:04] Dr. JB: Okay. So tell me, what made you decide to become a doctor in the first place?

[00:02:07] Dr. Harrison: When I was I guess around 13, I don’t know when most people have the sort of self-awareness about thinking about what they want to do with their lives, I was sort of torn between veterinary medicine and human medicine; and I, I don’t know why, there were no doctors in my family, there were no vets in my family. I was the first to go to university in my family, so I didn’t really have any obvious role models, so I, I guess I was good at science, I enjoyed science and enjoyed being with people, like it’s a bit of a cliche, but I think that’s how a lot of doctors decide they want to do medicine. And then I did some work experience in a local hospital when I was 15 and spent two weeks on a couple of different wards then, and that’s when I really decided that it was medicine rather than veterinary medicine. And then, I’d say age 15, 16, you have to decide what you want to do for your pre-university exams, you get on the conveyor belt and away you go, don’t you?

[00:03:07] Dr. JB: And one thing led to another and here we are.

[00:03:10] Dr. Harrison: Yeah, that’s right. Yeah, a kind of scenic route to where I got to, but it’s been fun, it’s been interesting.

[00:03:19] Dr. JB: And so in terms of your schooling, what was that setup in the UK? I know here in the States, it’s four years of undergrad, then four years of medical school, then three or more years of residency. What was that like for you?

[00:03:36] Dr. Harrison: So, what you guys call high school, we call secondary school. So, you do your advanced level exams where you’re, you’ve really honed it down to sort of three or four subjects you’re going to concentrate on for two years, they are your university entrance exams really. So I did my A levels in the three sciences and then you, if you want to, you go to medical school when you’re 18. I actually had a year out, what we call a gap year here and went did some work in a local school and went traveling, my first lot of traveling, to Hong Kong back in 1993, and yeah, then I started medical school when I was, I was 19 and for me it was a six year course. It can be done in five years in the UK, but you can take an extra year on to study your subjects in a bit more detail, and I was very interested in art subjects as well and I had the opportunity to study history of medicine, so I studied history of medicine for a year in detail and I still maintain that was my favorite year at medical school. So I think it was almost kind of preordained that I was going to leave medicine eventually and do something a bit more kind of social science-y, artistic, which I guess is where the law came in really. So yeah, so I finished medical school in 2000 after six years and then in those days you were a house officer, which is the same as an intern, and then you do your junior doctor years, senior house officer and registrar, which is your residency, and then you can become a consultant, which is the same as an attending. But I originally went down the, well, actually very originally I wanted to be a forensic pathologist, which I think again is where the kind of legal inclinations came in, but you had to do histopathology as a job for about five years before you could get into forensics and I didn’t really enjoy doing the general histopathology so that didn’t really pan out for me.

[00:05:35] And so I thought, well, what else do I like? I liked surgery and I guess, yeah, that was the part of histopathology that I enjoyed the most, which is doing PMs and things, so I thought it kind of, kind of makes sense, it’s kind of surgical and I enjoyed that so I did some surgical training for a few years and then decided that I didn’t enjoy working with a lot of consultant surgeons who were quite challenging personalities, some of them; I felt quite bullied at times over the years in almost every surgical job that I did. You moved around every six months, so you, you’d do six months of orthopedic surgery, six months of cardiothoracic, six months of general surgery, whatever your rotation was, and I seemed to fall foul of some unpleasant character in every one of those jobs that I did so I just thought do I really want to be their immediate colleague in about seven years time? No. So I thought, well, what can I do that’s still within medicine, that gives me that autonomy? And for me it was family medicine, so I trained as a family physician and yeah, did that for a few years, but that kind of legal itch kept coming back that I needed to scratch and so I ended up working for an advisory company that helps doctors with medicolegal problems. And it was then that I thought this is great, but every time it gets interesting, every time the cases get interesting, you have to hand them over to the lawyers. And I being a bit of a completer finisher, like a lot of doctors are, I was like, I want to be on that side of things, finishing it off, sorting out, concluding things, rather than handing it over. So I thought, well, I’ll just train to be a lawyer then. I didn’t really think anything of it. I was just like, yep, I’m interested in it. I’ll do it. So I did that, but then by the time I qualified as a lawyer, I was called to the bar in 2014, we had our first child who was very young then and there were financial commitments and trainee lawyer on a very low salary and having to travel a lot didn’t really fit in with being a young father of a young child, not a young father– I was not a young father, I was 38– but it didn’t kind of… Now my wife was an, is an oral and maxillofacial surgeon so she’s got a very committed career pathway and it was like, well, if she’s doing that and I’m off in various courts all over the land, how’s that going to work from a childcare perspective and so on? So I was like, you know what, I will go back into clinical practice and see if I can use my qualifications some other way. So I just thought, well, the natural thing really was, I was very interested in medical regulation and medical discipline, so like, I think you in the states, you have state medical boards, am I right?

[00:08:27] Dr. JB: Yes.

[00:08:28] Dr. Harrison: So each of the different– yeah? So you’ll each, the doctors that work in Texas are registered with the Texas state medical board and that kind of thing, is that right?

[00:08:36] Dr. JB: That’s correct.

[00:08:37] Dr. Harrison: So in, in the UK, it’s a much smaller country, there’s one medical board, it’s called the general medical council, the GMC, that regulates all the doctors. And when I worked for that medicolegal advisory company, I used to look after doctors who’d been referred to the regulator and were facing disciplinary tribunals and going through those processes, and I thought actually, you know what, I really, really am interested in that, so I applied for kind of medical director roles that had those sorts of responsibilities where you were kind of involved in things where doctors had done things that perhaps they shouldn’t have done or had practiced in a kind of a malpractice type way or something like that. And that’s what really interested me, so I did that. And then it was while I was a medical director that I underwent some life coaching myself or leadership coaching myself. And at that time I was just working a bit of clinical practice, about about six hours a week, something like that, and I wasn’t, I wasn’t really feeling like I was enjoying patient-facing work and was quite happy with that, just doing a little bit to kind of keep my hand in and keep my credibility as a practitioner so I could do all these other roles, and I just thought, I really enjoyed that coaching and I, I feel like the things that these guys are doing are having so much more impact on client’s lives than I’m having in all my patients’ lives. And I just saw, I suppose, a bigger picture thinking, well, in five years time, am I going to feel like I’m having more of an impact on the world as a, if I were a coach, than if I’d carry on in medicine? And that’s what really kind of clinched it for me, I just thought, yeah, I, I need to be coaching, and I need to be coaching doctors, and I need to be having some kind of influence on the future of medical leadership, because I’d been on the receiving end of some really awful medical leadership, so that’s kind of how it evolved really. As I say, very, very scenic, so cool with this route, but it’s all the different little, little strands of my career I think led me to this point, and so I can see things from different angles. So I, I do think about the legal aspect, even when I’m coaching people who’ve been bullied and stuff, and although I’m not up to date legally, I still feel like I can advise in a, a semi sensible way.

[00:11:04] Dr. JB: Yes. Quite the scenic road to where you are today. So I do have a couple of questions and it’s going to take us back to earlier in the discussion and then we’ll make our way back to where we are right now. So when you were talking about your experiences and how you had thought forensics then changed your mind and thought surgery then said not so much, et cetera, I was trying to get a good sense of just how things work in the UK in terms of the residency setup. And so at the age of 18, or 19 because you took a year off, you started your six-year medical training, and then you finish, and I think the intern year was equivalent to like a house officer and different levels, seemed like it was like a four year kind of set up, but then I wasn’t really sure. And each time you changed your mind, did you end up having to start back as a house officer in the new specialty that you’re interested in? Could you talk about that a little bit more?

[00:12:17] Dr. Harrison: Yeah, sure. So, it’s slightly different now because the, the house officers year has been replaced by what they call foundation years, so you have two foundation years now, foundation year one and foundation year two, so FY1 and FY2, but the principles are the same. So that being a house officer or a foundation doctor, that’s just to get your full registration with the general medical council because you start off qualifying as a doctor for medical school, but then because you haven’t really been let loose on the ward with real people and having real responsibility, they’re a bit understandably wary of allowing you to be a fully registered doctor who can do anything, who can prescribe anything, so they, they have you under some sort of loosely under supervision for 12 months where you’re provisionally registered, but once you’ve done that, you’ve done it, and it’s usually like for me, it was six months of medicine, general medicine, and six months of general surgery. So I would do, I did like three months of gastroenterology, three months of respiratory medicine, three months of urology, and three months of general, so colorectal and hepato, pancreatic, biliary surgery, so that was my 12 months as a house officer, and, and that is once you’ve done that, it’s in the bank, you’ve got the credit for it and you can then use that to go into anything. So you, if you say I went off to do pathology training and with a lot of these specialties, again, it’s a bit longer in, in the UK, so you’re a senior house officer for a certain number of years, and then you do an exam, like an exit exam from your junior training, so like member of the Royal College of Surgeons or Members of the Royal College of Pathologists or something like that, and then you’re a registrar for usually about four or five years. So your, your junior doctor period in the UK can be 10 years until you’re the equivalent of an attending, and I think that’s probably about double than in America, am I right? Unless you add in a fellowship and things like that.

[00:14:15] Dr. JB: No, you’re correct.

[00:14:16] Dr. Harrison: Yeah. So the supervision period as a junior doctor is, is an awful lot longer in the UK before they give you that all kinds of like powerful title of consultant that everyone works really, really hard for. I mean, in some, some specialties they’re so competitive, you even have to do a PhD along the way as well, so it can take 13 years to even get to the consultant level. But, but kind of going back to your question in terms of the, kind of like the junior doctor training period, you don’t have to do the house officer year again, but you have to– so when I went from pathology to surgery, I then just have to start as a first year senior house officer in surgery, rather than having to go back to being a, a junior house officer. So every time you start a new discipline, you can’t really count the credits from something else, you have to go back and do the core training. Does that make sense?

[00:15:10] Dr. JB: Yes. And so, yes, I think so, I think I got it. So, there’s a house officer, well, now it’s one to two years, but when you were doing it was one year, and then you become a junior house officer, and then you become a senior house officer. So when you transitioned from surgery to family, then you just went back and were a senior house officer for how many years before you’re able to qualify for the exit exam?

[00:15:37] Dr. Harrison: Okay. So this is, I don’t know if this is the same in the States as well, but it’s a bit shorter for family medicine. So you spend about a year in a practice, either in a surgery or clinic, it’s family medicine as a trainee. And usually, for me that was six months at the beginning and then six months at the end, and then in between those two six-month periods, you do two years of hospital jobs that are going to be relevant for family medicine, so things like ED, psychiatry, pediatrics, obstetrics and gynecology, the kind of things that you might see that would be your bread and butter in family medicine. So it’s a three-year residency, if you like, and then you become a fully qualified family physician.

[00:16:23] Dr. JB: Interesting. Okay. Yeah, there’s a lot of similarities between your experience in the U.S. And I’m just, I was just kind of like writing it out and so with the U.S., you’re 18, you go to your undergrad, it’s four years normally, and then you go to medical school and that’s another four years. So, medical school, the first two years are all academics, the last two years are rotations, or clinicals is what we call it, clinicals. And so that’s kind of equivalent to the first two years as a house officer, the first two years of medical school maybe, but except as a house officer, you’re actually on the wards, you’re not sitting learning, right? You’re actually doing things, putting orders in.

[00:17:10] Dr. Harrison: Yeah. So if you, if you take away that year where I did history of medicine, because not everyone does that extra year, so some people graduate from medical school after five years. The first two years are preclinical, so it’s your anatomy, physiology, biochem, pharmacology, all of that stuff, and then the last three years are your clinical years. So that’s where you do all your rotations, your, your surgery, your medicine, your psychiatry, your pediatrics, all of your, all of your clinical rotations, but that is strictly as a, a student observer, and then you have to pass all the core finals, so the, the big exams at the end of your fifth year, and then you get to start doing stuff– but it’s, it’s still very much under quite close scrutiny in your first year as a qualified doctor in the UK.

[00:17:59] Dr. JB: Okay. So yeah, so house officer is very much like intern year as a resident.

[00:18:04] Dr. Harrison: Yes, yeah, I think so. Yeah.

[00:18:06] Dr. JB: Okay. All right, so, you mentioned a couple of times you used the word bullying and that you experienced bullying while you were going through your training. Could you elaborate on that some?

[00:18:17] Dr. Harrison: Yeah, absolutely. Yeah, I can’t promise I’m not going to get a little bit, a little bit emotional about it, some of these were not very nice situations, but I mean, it’s funny because the definition of bullying in the UK, there’s no, there’s no legal definition because it’s not actually an illegal act unless it involves, kind of discrimination against you because you have a protected characteristic, so like gender, age, race, sexuality, disability, whatever the protected characteristic is, and then it becomes harassment. But if it’s not, if it doesn’t seem obviously sexist or misogynistic or racist or something like that, then it’s, it’s bullying and that in itself is not against the law. And so kind of the non-legal definition of bullying is includes that it’s a repeated phenomenon, it’s, it’s something that you experience on a repeated basis, and I think a lot of, a lot of the situations that I found myself in weren’t repeated, but they felt like so personal and extreme or severe, that I did feel like persecuted. I did feel like I was being bullied. And what I, I’ve done a lot of work on this and thought about this a lot and I think that even if you only experience it as a one-off from a particular person, if that person is doing it repeatedly to lots of other people, and so you would say that they are a bully because they’re acting in that way repeatedly, then I think it’s fair enough to say that you have been bullied, even if it’s only been a one-off. So I’ve had situations like, where I’ve been monitored by people. I mean, let’s sort of take a step back. When you, when you are in medical school, you’re not prepared for life on the ward, really. As we’ve just discussed, you go through these rotations as a, as an observer, you interview patients, you examine patients, but you’re not prepared for the reality of actually what it’s like to be a doctor, and you’re not prepared for, for the sort of softer skills, like when you– imagine when you were a first year resident and you literally just the day before you were an intern, and then the next day you’re a resident, and all of a sudden you are, you have some responsibility for supervising the intern. Do you get trained at medical school how to supervise someone?

[00:20:42] Dr. JB: Uh, no.

[00:20:45] Dr. Harrison: No, exactly. So it’s just an expectation that you’re going to do it right or do it well, and I floundered when I had my first job as a senior house officer where I actually had some junior house officers underneath me. I thought I was, I’m in heaven. I have these younger people to kind of do, do the jobs for me and I could go off to the office and catch up on my admin and they could do all the bloods for me and examine that patient for me and things like this, and I, I didn’t realize there was an expectation that I would be kind of properly supervising them. So I, they obviously felt unsupported by me, but I, I didn’t know any different. I hadn’t been taught how to, how to support someone or how to supervise someone.

[00:21:33] Dr. JB: What was it like for you when you were a house officer and your supervisors, like, were they pretty hands off?

[00:21:39] Dr. Harrison: Well, this is it. This is where the whole thing about how medics learn how to be leaders comes in, because I think really, I was just, I was just modeling my behavior as a somewhat hands off senior house officer on what my experiences had been. So I would, so we call them bleeps, you guys call them pagers, you would bleep.

[00:22:00] Dr. JB: You would bleep. I was so happy to get rid of my bleep when I was a resident in emergency medicine, I threw it out the window. No, I don’t think I did, I think I just, I just so happily handed it over.

[00:22:15] Dr. Harrison: Yeah, they are. They’re quite stress-inducing, aren’t they? That’s what, that’s what I found. But when, when we bleeped our senior house officer, it was always like, oh, they’re, say in surgery, or they’re in theater, they’re operating, we can’t disturb them. And so you just felt like, oh, okay, who do I turn to for advice then? Go to the next grade, the registrar, like a senior resident, oh no, they’re in clinic, they’re busy, or they’re on call, they can’t, they can’t help you though, whatever, there was always something. It was like, okay, I’ll just– what good interns and house officers do is seek out an experienced nurse and sort of say, what do I do in this situation? So yeah, there was very, very poor supervision from my seniors, who were also junior doctors themselves, let’s not forget. But they were, they were training in a specialty, so they have to put in the hours, like, I know why the hours are so long in the states for junior doctors, in things like surgery you’ve got to get so many procedures under your belt and so many hours of operating and, and whatever, and actually you guys have only got four-year residencies to do it in, so it’s like, well, I don’t have time to do anything else other than come to work and operate, essentially, because in four years’ time, I need to be an attending, so I need to be competent. So, yeah, I think there was this, they were busy doing their thing and they were too busy to help out the most junior members of the team, and I guess that’s all I knew. And so I, honestly though I was. I feel like if they had asked me things, I would have been helpful. I was helpful, but I wasn’t proactive.

[00:23:47] And I think I, I forgot what it was like, I think they needed their, metaphorically, they needed their hands holding a bit more than, than I did for them, so then they then reported me to the, to the consultant and I remember being called into the consultant’s office and there were three consultants I worked for and the three of them were sitting there and I was on the other side of the table and they had this list of about, I don’t know, 20 transgressions or something that they felt I had committed. And it was just like, it was just like a character assassination. I just sat there and they just listed them off, and you did this and you didn’t do this, and this happened, and this was dangerous, and this patient could have, could have come to harm and, and all of this. And I just, I was, I was oblivious to the fact that I’d done anything. It was a complete bolt from the blue. And I, I was just so– you know, nothing, as far as I know, I was pretty diligent in my role and I would go around the patients myself, and I knew that no patients had come to harm or died or anything because of anything that I had done, so it was like, well, where’s this coming from? No one’s complained about me, no patients complained about me, no one’s been harmed, no nurses have complained about me, so I don’t, I don’t understand where all this is coming from. And so it was like, literally just being called to a kangaroo court trial and being read a list of charges, and I just thought, why me? Where’s all this coming from? And it was so shocking and so upsetting. I just sat there and I was like, I felt really, I felt really got out. I felt really intimidated. There was this huge power mismatch between me as a very junior trainee and these three consultants, and there were three of them or one of me, and it was just, just a deeply unpleasant experience, and I just sat there and tears were just rolling down my face. And one of the consultants who was the, he was the, I got on the best with him anyway, and he was like just, just take a moment out and take care, take a breath, and he kind of calmed the other two down a little, but it was, that was one that I, talking to you about it now, I can still relive those feelings. And there were, there were multiple kinds of things like that. There was, when I worked on trauma and orthopedics, I had an incident where I was the only junior. We didn’t, we didn’t have any junior house officers and so I was the most junior. I was on-call, I was covering ED and I was covering the wards, and there were three, I think, three acute trauma wards, each with about, 30, 30 to 40 patients in, and the nurse, the nurses needed to do an ECG, I think you guys call them EKG. Is that right?

[00:26:32] Dr. JB: That’s correct. Well, they’re ECGs also, but go ahead.

[00:26:35] Dr. Harrison: Oh, okay. Okay. So they bleeped me and I was in ED, I was in the middle of clerking a patient or whatever, admitting a patient or reducing a colleague’s fracture or something rather, and they were like, “we need you to come up and do an ECG on this patient.” I was like, look, I’m right in the thick of it, I’m snowed under, I can’t, I can’t come now. “Well, you need to come.” And I was like are there any nurses on the ward that are trained to do ECG? “Oh no, we haven’t got any on our ward.” Can you just ask in these three trauma wards, they’re all next door to each other, I was like, can you just go into the other wards and ask if there’s anyone who is trained to do ECG? ” Oh no, we’ve already tried that, there isn’t anyone.” Please, can you just ask again, cause I can’t, I can’t come? Anyway. Part of it, part of the reason I was sort of trying to defer that is that certainly in med school, in the UK in those days, you weren’t trained as a doctor how to do ECGs because the nurses always did them. So I had to, I had to sort of confess in the end when she said, “look, there isn’t anyone, you need to come and do it.” I said, I don’t know how to do an ECG. And she said, “I find it astonishing that you don’t know how to do an ECG.” This is like the nurse in charge. I was like, well, there it is. Anyway the next, the next morning, my boss, consultant pelvic trauma surgeon who had a bit of a, a God complex I think, he came, he came along and we affectionately call him Genghis Khan, that was the kind of person that he was, and he basically took me aside and he just, he just tore into me and he’s like, we don’t give a damn about you guys, you guys come and go, every four months or six months, we get a new, a new batch of you lot, but you can’t go round upsetting my nurses, we can’t afford to lose any of the nurses on these wards and whatever. I was like, I didn’t upset anyone, I just said I can’t do an ECG. And then he, I mean, he made me feel about an inch tall, and again left me feeling really upset and distracted by all of that.

[00:28:35] And, and there’s one more really obvious example I can, I can recall, which was when I was doing cardiothoracics and a new cardiac surgeon had started in the department and he comes from another hospital where the anticoagulation regimen for their valve patients, valve replacement patients, were different to what we did in our unit and he wanted it doing his way. But the day that he explained to all the juniors how he wanted his anticoagulation writing up, I wasn’t in, I was on a day off or something. So I was in the preoperative assessment clinic, seeing his, his future operative patients and taking the histories and everything and writing up the drug charts, as you, as you go, so that when they come into hospital, the drug chart is already written. So operated on the patient and the next day, the nurses had dutifully given the medications as per the drug charts and first day post-op, he goes, sees the patient, there’s about 10 of us following him, various junior doctors, senior nurses, et cetera. He talks to the patient and he looks at the drug chart and he’s, he starts to, starting to look really quite angry, and he’s like, who wrote up this warfarin? And this is in the days before, um, [riverbanks abandon] in drugs like this, and we all had to look at the drug chart and I said, oh yeah, that’s my writing, I saw the patient in the preoperative assessment clinic and yeah, I wrote up that anticoagulation. And he’s like, this is not how I want it doing, I told you I want it doing like this, and he was literally just bawling out in the, in the middle of the ward, there were four patient beds around, it was in front of the patients, it was in front of all my colleagues, the nursing staff, and he just kept shouting at me and no one, no one intervened, no one said anything at all, it was a proper bystander effect. Everyone was just watching me being murdered on the ward. That’s just a few examples I can think of, but they just make you feel, so worthless and they just shatter your confidence. And I think the biggest thing is when you have an interaction like that, you just can’t, you can’t focus on anything else sometime afterwards, hours afterwards. So yeah. There are more, but yeah, I won’t go into them all.

[00:30:53] Dr. JB: Wow. I’m sorry for your experiences.

[00:30:57] Dr. Harrison: Yeah. Thank you. I just, I think it’s just par for the course. It was certainly par for the course then, and as far as I can see– and I kind of semi-look and semi-participate in Facebook groups where junior doctors are kind of giving their stories and scenarios and asking for advice– and as far as I can see, it’s still very, very rife now, and the doctors I’ve spoken to in the states, I’ve coached some doctors in the states, and it seems it’s still a very big problem in the states as well. And I know with my wife having worked in Australia and New Zealand sites, it’s a very, very big problem there as well.

[00:31:32] Dr. JB: You know, you describe it as bullying, the word that I would use for that experience, that we tend to use in the states is, is pimping. And are you familiar with pimping? Do you think that that is similar to what you defined as bullying or is there a difference?

[00:31:50] Dr. Harrison: Actually, we don’t use that term, I mean, a pimp is something else.

[00:31:54] Dr. JB: Yeah, no, yes. Yes. Yes, a pimp is– yes, it’s also something else.

[00:32:02] Dr. Harrison: That’s the only context in which I know that term, please enlighten me, I’m here to learn as well.

[00:32:11] Dr. JB: It’s called you got bleeped, is that what it’s called, the pager? So, page, bleep, bullying, pimping. But yeah, so, in terms of these experiences, be it as a trainee, like a medical student, residents, fellow, where you just get berated and you’re left feeling less than, less than human. And ” could you not know this?” And “you’re so dumb,” and all these things that really make you question yourself, question your intellect, question whether you should be pursuing this career path in the first place, want to run into a closet and cry. Yeah, so those were all the things that we, the word that we used to describe that in the U.S. is pimp and being pimped. And there’s, there’s levels of being pimped, there’s gentle pimping, like pushing back a little bit to see how much you know, and what you do know versus what you don’t know, but then if you, if you go beyond that and you start tearing into the person, their character, who they are, that’s extreme and it seems like it’s, it’s very similar around the world.

[00:33:28] Dr. Harrison: Yeah. Yeah, I’d agree with that, yeah.

[00:33:30] Dr. JB: And so your experience with the bullying is what made you decide to be in leadership?

[00:33:37] Dr. Harrison: Yes. I mean, I have been on the receiving end of quite a lot of what I would consider to be poor leadership and certainly through the lens of my knowledge and expertise now about leadership through my leadership coaching training. Yeah, I would, I would consider retrospectively to be, to have been very, very poor leadership indeed. And I’ve worked in the medical leadership roles where, and again, my very first medical leadership role, I’m sure I wasn’t a very good leader, I wasn’t a very good role model, I wasn’t a good example of a leader because I wasn’t appointed to that role because of any leadership skills that I might have. There might’ve been some leadership potential that they saw in me, but it was more for my, my legal expertise then because it was like assistant medical director for regulation and disciplines, so it was like, oh, this guy has done law as well as medicine and he worked for one of the indemnity organizations or the advisory organization, so he, he’s the right guy for the job. But I hadn’t had any leadership training during all of my clinical jobs, so I, after a few months, I had some feedback from my medical director, my immediate line manager, and he was like, “so people have been saying that you’re, you’re not as, as visible or as accessible as you could be, and you shouldn’t perhaps get involved in these kind of these email debates with people,” and things like this, and it was just basic basic stuff. I was completely clueless and it was, for me, it was, it was a good education. It was a very steep learning curve, but it was a good warning shot across the bows because it was like, actually, yeah, no, I’ll take it on the chin, that’s fair enough. But then when I became what I considered to be a slightly better leader, and still by no means the finished product, I started to see what I was then considering myself to be poor leadership from clinicians and non-clinicians in the organization. So I I’ve been on the receiving end of bad leadership, I had probably been a perpetrator of bad leadership for a short time, and then I saw it from that leadership angle as well, so the organization, sort of like a systemic organizational level, how it was leading the– it was for a family, the family physicians in the in the region, and they were not kind of leading family practice in a, in a good way, as far as I could tell.

[00:36:11] And then I, when we were in Australia, I was tutoring some indigenous medical students and one of them had had a truly awful experience on her first ever clinical placement as a third-year medical student. And she had been, she’d been on a medical team with a consultant who was notorious for being just being an unpleasant person essentially, and he had said to her right away, take a history from and examine the patient, you’ve got seven minutes. This is her first ever clinical attachment. He’s like you’ve got seven minutes, come back, present your findings to us. There were about 11 or 12 people there that he wanted her to present in front of, so a really daunting and intimidating situation. And then just to add that extra kind of like frisson of excitement for her, he was like, and we’re all going to mark you, and we’re all going to tell you what mark we’re giving you an out of 10.

[00:37:13] Dr. JB: Wow.

[00:37:15] Dr. Harrison: So she goes to see the patient and like all good medical students, she asks a nice open question and so the patient proceeds to talk for about five of the seven minutes that she’s gone. So it’s easy enough to elicit the history of the presenting complaint that it sounds like it’s a chest infection, sounds like it’s a pneumonia, and so she goes for the money, she listens to the chest and she doesn’t get a lot of anything else done. She goes back and she presents, and the interesting thing is that no one called this guy out, no one. They, they just did exactly what he said. He was, he was a bully, I’m not going to say he was a pimp.

[00:37:55] Dr. JB: If he was in the U.S., he would be called a pimp.

[00:38:00] Dr. Harrison: So yeah, so they all kind of like give her, give her a mark for her presentation and on the ward, it’s not even in a side room, yeah it’s just on the ward, in the open, and no one just kind of stands up for her and speaks out. And I think it was, it was then that I just thought, okay, this is just horrific. She phoned me for advice, she was in tears, and I, I was powerless, I was just a, a casual tutor for the university. I had no authority within the hospital there in Darwin. So all I could do was be a sympathetic ear and try and give her some sort of some pointers, but yeah, I just though this has, this got to stop. I need to, I need to do something about this, or I need to do my bit any way, it may be a drop in the ocean but if I can help one person, then I, then I’ve done something good. And I was training to be a coach and I was like to use my powers for good, the leadership coaching was really, really helpful because it’s given me a good foundation as to what kind of good leadership is and how to coach leaders who are perhaps going a bit awry, but it’s given me that insight into what more toxic leadership is and now I’m kind of applying those principles to help medical students, doctors, kind of target some perpetrators, organizations, because we know that whole organizations can have that as part of their DNA almost.

[00:39:27] Dr. JB: Listening to you talk brought back a memory that I had when I was, I believe maybe in medical school, maybe it was in the OR, and I just remember I think I just got really berated, I don’t know what, I don’t remember all the details, I guess I tried to block that out a little bit, but I just remember being in the OR and the surgeon just making me feel very, very tiny. Tiny, tiny, tiny, tiny. And I felt so bad, and I remember, I think I went and had like Chinese food and it had one of those fortune cookies, and it said in the fortune cookie, which you know, the fortune cookies don’t mean a lot, that message doesn’t really mean that much, but on that particular day after I felt less than human leaving that OR, it said we were all learners. And I saved that because I think that that is something that we forget as we go through this process, because in medicine what’s the, what’s the motto? It’s see one, do one, teach one.

[00:40:31] Dr. Harrison: Yeah.

[00:40:33] Dr. JB: And so, essentially you emulate the behaviors of your seniors, that’s how you kind of learn. So you, you get taught, but then you also learn through their actions and their behaviors and you kind of like watch your leaders and how they do things, and then you kind of create your own way of you’re going to do it, but you’re kind of still emulating all of those seniors. And we forget the way we felt when we were those learners who didn’t know anything. You don’t know anything as a learner, but that’s to be expected because you are a learner and it’s ridiculous for people to make you feel small because you know nothing, because you’re not supposed to know anything. So the questions that get asked should be asked not to make you feel like you’re dumb or like you’re an idiot, but just to get a gauge for where they need to start teaching. Do you know your ABC’s? If you don’t know your ABCs, guess what? We’re starting with A. Not “oh, you should have known your ABCs by now.” No. You don’t know it? Fine, okay, so let’s start from the beginning.

[00:41:39] Dr. Harrison: Yeah. Yeah. True. You are, you are where you are so you just have to go from there. No point in trying to make someone regret that they don’t, that they don’t know what you think they should know. As my wife always says, and I think my wife is my wisest counsel. She’s like, well, if you knew, if you knew it all already, you wouldn’t be here, you wouldn’t be a trainee, you’d be, you’d be the consultant. You’d be the, you’d be the attending. So it’s, it’s a nonsense, isn’t it, to expect people to know at all?

[00:42:06] Dr. JB: But that’s what we do. And then we become the consultants or the attendings, and now we have these learners working with us and we treat them the way we’re treated and we forget how horrible we felt or we think, “oh, it’s a rite of passage,” but it doesn’t have to be a rite of passage.

[00:42:22] Dr. Harrison: I mean, there are lots of things that we did in the past that we now look back on and are disgusted by. So we’ve, we’ve evolved and we’ve learned, so why, why can’t we do that in, in medicine? But I mean, what you said before about, about modeling, emulating, this is an absolute textbook example, I think. Again, I had one of the indigenous students I was teaching was doing a surgical job. She was a final year medical student and one of the, the residents and I think this particular surgeon was a registrar, so a fairly senior resident, said to her “oy, girl, medical student, don’t take blood from this patient.” And she was recounting this episode to me and I was like, wow. Some– I don’t want to say that all surgeons, it’s always surgeons, a lot of my examples, a lot of my examples tend to be, I’m sorry to any surgeons listening that I might be offending– but I was like, wow, some surgeons have a bit of a reputation, but he sounds like he was a bit of a piece of work. And she said, “oh no, it wasn’t, it wasn’t a he, it was a she.” And it was a female surgeon who had said this to a female medical student or a girl medical student, I was like, wow, you’ve just blown my mind. That’s just taken it to another level. And my, my rationale for why that female trainee behaved in that way is that certainly in Australia, female trainees that are in surgery are in the big minority, and she’s looking at the consultant that she’s working for, or the consultants that she’s worked for over the years, and she wants to become them. She wants to get to be where they are, and as also sadly is the way in Australia, they’re mostly white male consultants. So she’s like I have to behave in the way that I’ve seen them behave to get to where they are. And it’s just, there’s just this gulf in between what she did and what she could have done that I can only explain by huge lack of insight and self-awareness and a real lack of emotional intelligence. And, and again, these, these are things that can be worked on, and these are important things. These are– I mean, emotional intelligence, so essential for doctors to have, you must have, like me, met many a doctor who you think is emotionally very unintelligent.

[00:44:46] That’s the politically correct way of describing them.

[00:44:51] But I mean, that’s just one example of a skill of a skill that can be worked on and developed that there’s no time given to that in the, in the curriculum, in the syllabus, just like leadership. It’s just, it’s that sort of squeeze the curriculum full of anatomy and physiology and biochemistry and get all your clinical attachments done. Yeah, the rest, the rest of it is fine, you can learn it on the job. It’ll be fine. It’ll be fine.

[00:45:14] Dr. JB: And then you find yourself in situations like you found yourself in when you got your, at your first leadership position. Oh, he’s a doctor, he’s a lawyer, yep, good. And no training for, what are my expectations in this leadership role? How am I, like, what do I do? How, how do I act as a leader? Where is that formal training? And it’s not there. Somehow, you must have somehow got it through your training in becoming a physician, just like somehow you must have acquired these skills of like financial management. You know what I mean? And, and it’s not taught.

[00:45:49] Dr. Harrison: I mean, that’s a whole, that’s a whole other podcast. I mean, how many, how many doctors ended up doing self-employed type work, work in the private sector, or if you’re a, certainly in the UK, as a family physician, you know, a lot of doctors own, own their clinics. Business skills that would be so, so useful to be taught at medical school, but we can’t do that because actually if we give them an idea that they could be good at business, or we teach them some skills that could make them good at business, they might end up leaving medicine and we can’t, we can’t have that. We need, we need people on the frontline. Yeah, no, no, absolutely. But yeah, like you were saying, when I was in that first leadership role, it was only then, and by that stage, I was I think qualified as a doctor for 16 years, and it was the first time in my career that I’d felt truly exposed because– and even more so than when I had that situation when I had those junior house officers who were not happy with the way I was supporting or supervising them– because it became really apparent that as, not only as a doctor do people kind of look up to you or look to you for a steer, but then a doctor in leadership, you’re one of the medical directors, they kind of put you on an even higher pedestal, and so everyone is kind of watching you, not in a, in a sort of scrutinizing type way, but it’s like, everything you do is being watched in a way. And I had, I didn’t realize that, and it’s because they’re looking to you for just leadership. They’re looking to you for a steer and it just became like, so crystal clear after that. And when I was, I was responsible for teaching the family medicine block in Darwin, in Australia, and I had these year two students, year two medical students, and most of them were actually graduate students, and most of them had done another degree beforehand, and I gave them a talk on leadership, and in fact, the management asked me to, they said, “you are, you’re a leadership coach and you had leadership positions, please can you give them a talk on leadership?” There’s a, a learning outcome, a whole section of learning outcomes for when they graduate from that medical school that is in title leadership, but in the whole four or five or six years of them being an undergraduate in medicine, they get no leadership teaching. So they’re expected to understand and exhibit certain leadership characteristics, but they’re given no teaching whatsoever. So they were like, “thank God you’re here, you, you’ll probably be the only bit of leadership teaching they ever get, can you do it for us please?” And I was like, hell yeah. You know, I, I relished the opportunity. And I was saying to them, just because you’re second year medical students, you’re actually already in a leadership role because there are people, when you, when you go on the wards, even though you’re just a medical student, quote unquote, then the nursing staff will be looking up to you as the future doctors. You’re on a, you’re on a campus with, with other students, biomedical science students who, some of whom might have tried to get into medical school, but didn’t get the grades or whatever, and they’re looking at you going, oh, wow, they’re a medical student. And so you’ve got with that kind of position, comes responsibility, and this is why you need to know what good leadership skills are now. I wish, I wish I had been exposed to that when I was a junior medical student.

[00:48:57] Dr. JB: Yeah. No, I mean, we’re all leaders, we’re all leaders of our team and getting that formal training, that emotional intelligence training, will go a long way.

[00:49:09] Dr. Harrison: Yeah, absolutely. And I did, even within the leadership talk I did for them, I talked about growth mindset. I talked about emotional intelligence. I talked about Daniel Goldman, the different types of leader and the different leadership, emotional intelligence. But I mean, for me, it’s, I feel so strongly that good leadership teaching, leadership development should be a core subject at medical school. Forget medical school, most people that do a degree at university are by virtue of the fact that they’re going to be more educated people. They’re going to end up in management positions at some point. Every, every student at university should be taught good leadership because if we can show them at that age and stage that there is a good way of being a leader, it should help lessen some of the toxic problems upstream that we’re now seeing in the, in the other workforce. That’s what I think.

[00:50:02] Dr. JB: Dr. Harrison, you are doing such important work and tackling such an important topic, because I don’t know if it’s because people are fearful because the consultant has an amazing reputation, because people just don’t know what to say in the moment, but you find that that happens all the time, where somebody will get bullied in broad daylight, and everybody’s just quiet. And nobody’s there to stand up. I mean, there are people physically there, but nobody does it. Nobody stands up for that person. And so by having conversations like this and being like, no, it’s not okay, remember back to the days when you were in training and when you, you are the one on the receiving end of that, how did that make you feel? Did you like it? If you didn’t like it and you are in the environment where somebody else is getting bullied, stand up for that person. Until that person learns how to stand up for themselves, somebody else needs to stand up for them saying, stop. Enough. It’s not okay. It’s not right.

[00:51:10] Dr. Harrison: I think the, I mean, you’re a hundred, a hundred percent correct. And, and even those bystanders not speaking up, I mean, you, you can, you can sort of see why they don’t, you know, they’re, they’re, they’re fearful for their own future career. You know, if they, if they stand up to the boss, if they speak out against the boss suddenly in a, in a public forum like that, how good is their reference going to look for that for the next job? They are absolutely petrified that if they, if they lend a helping hand that it’s going to harm their career, I think a lot of people will persuade themselves that I know I’m not standing up for that person, but it’s okay, when I, when I get to the consultant or attending level, I’ll be different. That’s how I will make my difference. I will be a good, nice, kind, compassionate boss when I am at the same level of grade as this person who’s being a nasty person. I can then speak out against them. It doesn’t always work though. I mean, I’ve seen consultants bullying other consultants, and even coaching an attending surgeon at the moment who’s been a, an attending for nine years and she still doesn’t feel that she can speak out against some of the other attendings because they’ve been in the hospital longer. And they are in more influential positions and they could make her life difficult. But what you say about, I’ve been through that, I remember that experience, I remember that feeling, and I should speak out because I don’t want anyone else to suffer that same fate and, and have those same feelings that I had. Why is the, why is the consultant or the attending not thinking that, why are they not thinking, “oh, I was, I was put through the ringer when I was an intern or, or a resident, I shouldn’t be being, I shouldn’t being like this to these people.” It’s, there’s, there’s, there’s more to it than, than that. I mean, there’s, there’s other elements that work, I think in terms of narcissism and personality disorders and things like that. I think that that can be a play where there’s just no insight there because just going back to this consultant I told you about who really shamed my student in her first ever clinical attachment, a good, a good friend of ours from Darwin, she was a very senior obstetrician in Pakistan and she’d come over to Australia and married her husband, and she pretty much had to start at the very junior level in the Australian medical system. And she worked for this consultant physician and on her first, on her first day with him on his team, he basically turned around in front of everyone else who was there and said, ” oh God, another, another bloody foreign doctor, why do they send me all the crap? I’m sick of this.” Literally.

[00:53:55] Dr. JB: Wow.

[00:53:55] Dr. Harrison: Okay.

[00:53:55] Dr. JB: Wow.

[00:53:57] Dr. Harrison: The, the, the ironic twist being this guy was an international medical graduate himself. He had joined the, yeah, he had joined the Australian system as a junior having come across from India and then it’s like, okay, so is it then because he’s a misogynist? Because he’s a man and she’s a woman. Or is it, is there some racial discrimination element this cause he’s originally from India and she’s from Pakistan? It’s like all that, these sort of more subtle reasons for explaining behaving like that, but it seems like he, he didn’t, he didn’t reserve his bad attitude for any anyone in particular. He was quite happy to be unpleasant to everyone. So, some of them, they kind of, they, they breach the glass ceiling and then they pull the ladder up behind them and close the trap door. And yeah, if they ever used that excuse, it’s character–, I went through, it is character building. I’m like, sorry, mate, by this, by the time we’re at that stage of our life, we have enough character. We don’t need any more character building. Thanks very much.

[00:55:04] Dr. JB: You know, but that’s the excuse has been being used for ages and now we need to stop. It’s not, it’s we are training the future generation of healthcare professionals. One day we, the current healthcare professionals, are going to retire, we’re going to get sick, and we’re going to need to be taken care of by the future generation. So what kind of doctors and nurses and other healthcare professionals do we want taking care of us?

[00:55:37] Dr. Harrison: Yeah, that’s a really good point.

[00:55:40] Dr. JB: So, on that note, Dr. Harrison, if my listener want to get in touch with you, how could they do so?

[00:55:51] Dr. Harrison: Well, email, my business email address is just doctor dr.adam@coachingmentoringdoctors, one word, dot com. So dr.adam@coachingmentoringdoctors.com, it’s all lowercase. I’m in LinkedIn as Dr. Adam Harrison, that’s probably my favorite social media platform. I have a Facebook page, which is, Dr. Adam Harrison coaching mentoring doctors, and a YouTube channel, which is really, really quite proud of it’s, I’ve got videos of being interviewed, interviewing other people, it’s talking about far reaching things from wellbeing and mindset to bullying and leadership and stuff, so there’s something for everyone there. That’s just Dr. Adam Physician-Coach. So yeah, if any of what I’ve said has resonated or sparked an interest then please, reach out and we can start a conversation. It would be great. I love connecting with people and increasing my network.

[00:56:50] Dr. JB: Dr. Harrison, this was great. It was great having you here on our show and we are nearing the end. And so in closing, do you have any words of advice you would like to leave my listener?

[00:57:02] Dr. Harrison: Yeah. I mean I’m honestly, somebody at the moment, my passion is my, the expertise on developing in bullying or pimping, and I have a couple, a couple of points. So I’ve, I’ve just kind of created this mantra, it’s an affirmation really, for people who feel like they are being targeted by someone or, not to use the term victim, I know not everyone likes that term, but if they feel they’re a victim of bullying, I would say, it’s not your fault, you’re not alone, and you have no reason to feel ashamed. And the thing is, it’s, if you are on the receiving end of an almost irrational hatred or victimization, then it can’t be your fault. You’re certainly not alone. There was a study in JAMA a long time ago, it was in 1990, it followed a cohort of medical students through to attending, and just trying to remember the figures off the top of my head, but I think when they were students, that the cohort said that 46% of them felt like they’d been bullied, so almost half of them. By the time that same group of medical students and then doctors became attendings, that had gone up to 78%. So almost 80%. So when you’re walking through the hospital, if you feeling that you’re bullied and you say you were an attending because it happens to attendings, believe me, for every you know if you’re one of ten and there’s another nine that you pass, there’s another seven of those nine that have been bullied or are being bullied. So you’re very, very much not alone. And you have no, no reason to feel ashamed and this is, this is one of the things that really holds people back when, when we’re bullied, it makes you feel weak and no one, no doctor wants to admit any weakness, cause it’s a, it’s a, it’s a chink in the armor of, of our perfection, isn’t it? We’re all perfectionists. We can’t possibly be, be seen to the outside world as being weak. So, you know, because that’s, that’s shameful, isn’t it? But you shouldn’t feel ashamed. You really, really shouldn’t feel ashamed. So that’s my mantra.

[00:59:03] And then the, the only other, the only other point is, and this is a bit of an ideal really, I would love to see a time where organizations themselves admitted that they had bullying problems and actually embraced the paradigm that is much better for everyone in the organization or the company, including patients or shareholders, if they were open to initiating a kindness and leadership program, because the detriment that that comes out or pimping or bullying, it’s just, it’s not just to the individual. We know that the individuals will suffer psychological and physical illnesses as a result of being bullied, the organization itself will suffer massively. There was a, a study, by Christine, I think Christine Pearson that was published in the Harvard Business Review in 2013, that surveyed 800 managers and employees in 17 industries who were on the receiving end of just instability, so not, not frank bullying, but just kind of rude or discourteous behavior, and 48% who said they’d been on the receiving end of instability decrease their work effort, 78% said their commitment to the organization declined, and 25% admitted to taking out their frustrations on clients. So in health care, our customers and clients are our patients with a lot, a lot at stake. Just taking myself back, and you’ll have been on the receiving end of it as well I’m sure, you’ve just had a, a bawling out from your, your attending or whatever in front of everyone and you’re angry, you’re feeling miserable, you’re distracted, and then you take all of that with you to your next patient interaction. How, how can you not then risk getting a complaint about your attitude or risk committing some kind of malpractice, and then a lawsuit coming out of it? It’s so scary. Surely it would be better for all organizations and health care institutions included in that to say you, yeah, we appreciate, we appreciate we have a problem and we need to work on it because it’s just gonna be so much better for everyone. That would be my utopia, from the leadership perspective.

[01:01:13] Dr. JB: Wow. If you can dream it, you can achieve it.

[01:01:16] Dr. Harrison: That’s true. That’s true. You’re right, you’re right.

[01:01:18] Dr. JB: So, here’s to utopia.

[01:01:18] Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic, the greatest podcast ever broadcasted or prerecorded. Come learn some, each one, teach one. I’m done.

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