Bully-Busting Basics
The plight of the target
Bullies often target people who are
talented, popular with clients or patients, and independent
thinkers. They tend to victimize individuals of integrity who
possess a strong sense of values and who have an exploitable
vulnerability. “They don’t match aggression
directed at them with aggression coming back from them,”
says Namie.
Victims may suffer a gamut
of stress-related physical and psychological symptoms, and most
end up paying with their jobs. In a 2003 WBI survey of 1,000
volunteer respondents who were victims of bullying, 37 percent
were terminated involuntarily and 33 percent quit their jobs.
Bullies affect more than
just their targets. They intimidate and manipulate situations
so others observe and start to fear, says Glaser. They collect
people around them who revere them and want to be a part of
their inner circle. Bond says people pick up on bullying
dynamics very quickly. They notice how one person is being
singled out, and this can lead them to shun or snub the
individual, compounding the isolation.
When Max Aguilera-Hellweg,
MD, photojournalist, filmmaker, and the author of The Sacred
Heart: an Atlas of the Body Seen Through Invasive
Surgery, (Bulfinch Press, 1997) was an intern, he tried to
ignore the name-calling and insults of residents. Though it was
not his nature to tolerate abuse, medical school had taught him
speaking out gets you nowhere.
Prior to attending medical
school, Aguilera-Hellweg spent eight years in the operating
room photographing more than 100 surgical procedures for his
book. So he greatly anticipated his third-year surgical
rotation. However, the rotation became a lesson in
intimidation.
Aguilera-Hellweg knew
something wasn’t right on the second day of his rotation
when he expressed to his supervising resident his concern over
a patient who had no family and was about to receive a
diagnosis of AIDS. The resident harshly informed him,
“we’re f***ing surgeons, and if we can’t fix
it, we don’t want to know about it.” After that,
Aguilera-Hellweg recalls, “it proceeded to get worse on a
daily basis.”
For inexplicable reasons,
Aguilera-Hellweg was singled out. He was told he could ask
questions as long as they weren’t stupid ones. One
resident shouted and demanded that Aguilera-Hellweg address her
by her first name while other students were permitted to use
her surname without reproach.
A medical condition,
essential tremor, further contributed to
Aguilera-Hellweg’s vulnerability. He elected to take
medication as prophylaxis throughout his surgical rotation.
However, during a procedure requiring him to apply retraction
at an odd angle for an extended period, his arm began to
tremble. He informed the resident of his condition. However,
instead of requesting relief, the resident yelled at him. A
repeat scenario occurred the next day. When Aguilera-Hellweg
reminded the resident of his condition twice, she shouted both
times, “That’s not an essential tremor.”
The harsh treatment
Aguilera- Hellweg received extended to patients. When he
broached the subject of a psychiatric referral for a clinically
depressed patient, the resident dismissed the observation and
labeled the patient a “mental retard.” After
reporting these and other incidents to administration, he was
advised not to say anything for fear he might fail the
rotation.
Unfortunately, the chief
resident from surgery rotated into his subspecialty as well.
The new intern informed Aguilera-Hellweg that the resident had
characterized him as slow and incompetent. The intern advised
him to keep his head down and not to ask questions, as the
resident would only make fun of him later behind his back. The
intern hounded him on all his duties for the first two days and
pushed Aguilera-Hellweg physically. “If I couldn’t
answer a question correctly, he would shove himself into me.
Because I had been told by the administration not to say
anything, I held back.” With the support of a few
upper-level medical residents, he found the courage to tell the
intern to stop pushing him around. When he reported the new
level of abuse to one of deans who had advised against
reporting the behavior, Aguilera-Hellweg was removed from the
service.
Despite the new assignment,
he was treated as an outcast. He was so traumatized by his
surgical rotation his confidence plummeted. In a letter he
eventually sent to two administrators, Aguilera-Hellweg
described the learning atmosphere: “Daily there is
an air of intimidation, ridicule, and spite.” In closing,
he added, “I hope that drafting this letter will somehow
begin to heal me and serve to address these individuals, for no
other student or patient should suffer their brutality and
unprincipled behavior.” In the end, however,
Aguilera-Hellweg says his letter didn’t change anything.
The resident matriculated. And his best friend in medical
school, who had born witness to his plight, ultimately shunned
Aguilera-Hellweg prior to rotating into surgery with the same
abusive resident, hoping to gain favor in anticipation of a
future surgical residency application.
Bullying behavior may be
more prevalent in acute-care settings and life-or-death
situations—a work culture commonly portrayed by
prime-time television programs, such as “ER” and
“Grey’s Anatomy.” However, even a
gentler-paced field such as psychiatry can suffer the wrath of
the bully.
When Paul Rodenhauser, MD,
now an emeritus professor of psychiatry at Tulane School of
Medicine in New Orleans, accepted his first academic position
as the director of residency education at another institution,
he soon began to wonder why the chairman and the vice-chairman
had hired him. The chairman visited his office regularly to ask
one question: “What have you done now?” He
routinely accused Rodenhauser of upsetting the vice-chair.
“No matter what I did,”says Rodenhauser,
“I’d upset him. Of course, I never quite knew what
I had done.” Over time, he observed an unusual dynamic
between the two administrators that appeared to need a third
person to serve as the “bad one,” a role
unwittingly filled by Rodenhauser. “They were pleasant
socially, but in the office, they were incredibly
oppressive.”
Over several years, the
chair continued to criticize Rodenhauser’s work. One day,
the chair admitted being jealous of him, but the admission
didn’t stop the behavior. Fortunately, Rodenhauser had
supportive peers and positive feedback from his work, including
teaching awards, and there was a growing unpopularity of the
two department leaders that helped balance the skewed reality
of the encounters with his supervisors.
Five years after
Rodenhauser was hired, he was named department chair while the
chairman retired but remained on the faculty as an emeritus
professor. With the dramatic power shift and the positioning of
Rodenhauser as the vice chair’s new supervisor, the
former chair and the vice chair quieted down considerably.
Throughout the long career
in academic medicine, Rodenhauser has experienced and observed
other incidents of bullying in medicine. While he served as an
assistant dean for academic and counseling services, numerous
medical students sought his guidance in dealing with abusive
individuals. One year, reports of bullying were so prevalent
that students met as a group with Rodenhauser. The process of
sharing and discussing their experiences seemed to offer some
therapeutic benefits.
Legal considerations
Despite the cruelty of workplace bullies,
there are no laws in the United States barring such behavior.
Eleven states have introduced anti-bullying legislation since
2003; however, not one law has resulted. Anti-bullying laws do
exist in some countries in Europe and in Canada. Quebec law
states that “Every employee has a right to a work
environment free from psychological harassment.” And
“Employers must take reasonable action to prevent
psychological harassment and, whenever they become aware of
such behavior, to put a stop to it.”
However, even without
specific anti-bullying laws in the U.S., there is potential for
legal recourse. When you put someone in fear of imminent harm,
you could be at fault, says Bond. “Some state criminal
codes define ‘assault’ to include the act of
putting someone in imminent fear of serious bodily injury even
without an actual touching,” she says. Actual physical
contact could constitute battery.
Infliction of emotional
distress, whether negligent or intentional, and
disparagement—the ruining of someone’s
reputation—are among the more likely legal claims that
could stem from workplace bullying. In addition,
“harassment, such as bullying, can be illegal if it is
directed at someone who is protected by Title VII,” says
Bond. Discriminatory practices under Title VII of the Civil
Rights Act include harassment on the basis of race, color,
religion, sex, national origin, disability, or age.
Bullying is trouble for
hospitals and medical practices and bad for business. According
to Bond, in a 2005 case, an Indiana cardiac surgeon was ordered
by a jury to pay $325,000 to a perfusionist who sued him for
assault and reckless or intentional infliction of emotional
distress. Namie says the verdict broke ground as the first
workplace bullying case heard in the United States.
How to Stop a Bully
With institutions largely ignoring the
problem, “stopping bullying falls to the individual who
is targeted,” says Namie. While some organizational
experts encourage victims to implement traditional conflict
resolution strategies, Namie believes such approaches only make
a victim more vulnerable. “You’ll never reason with
a bully.”
Instead, he advises victims
to do the following: First, name it. Labeling bullying
behavior is the first step to restoring personal power. Next,
take time off to check physical and mental health. Obtain
counseling with a personal clinician rather than one offered
through the institution’s employee assistance program.
EAP clinicians work for the institution, creating the potential
for a breach in confidentiality, however inadvertent. Determine
if the bully violated any laws. In one-fourth of bullying
cases, discrimination plays a role. Undertake the research to
determine the institutional cost of keeping the
bully—investigate staff turnover rates and the impact on
patient care and safety. Focusing on building the business case
helps victims move beyond the emotional snare. Finally, expose
the bully by presenting the business case rather than the
emotional case to the board or someone who has no alliance with
the bully and is positioned to take action.
A physician supervising an
offender should talk to the individual about the
destructiveness of bullying behavior and the consequences on
others, Namie says. Don’t wait for the offender to make
such discoveries. Implement a contract making continued
employment continent upon refraining from the problematic
behaviors. It is important to reinforce intervention at the
individual level with an anti-bullying policy or code of
conduct at the institutional level. Bullies who aren’t
psychopathological are usually able to constrain their
behavior, however, “Most of the bullies leave,”
Namie says. “They don’t want to play by the changed
rules. They refuse to be constrained because all bullying is
about control.”
Physicians who witness
their colleagues bullying should call them on it. Ask them what
such behavior has to do with patient care. Muster the courage
to stand by victims and refuse to side with a bullying
colleague. If an offender is not apparent and an office suffers
the classic symptoms of bullying, the physician/leader should
pose the tough question: “Could it be
me?”
An ounce of prevention
While there is no foolproof approach to
avoid hiring a bully disguised as a highly qualified applicant,
specific interview strategies can help pinpoint individuals who
are more likely to turn tyrannical when entrusted with a degree
of power. In addition to thoroughly checking references of all
prospective employees, Dattner suggests undertaking consistent
behavioral interviews, asking applicants to:
“describe a time when you had a difficult time
motivating an employee” or “describe ways you adapt
your style based on the unique expectations and needs of
diverse employees.” Other useful questions might include,
“Describe a time when you lost a valued employee,”
or “How would others characterize the good aspects of
your management style and the more challenging aspects of your
management style?” Such questions will help determine
whether a person is able to articulate sensitivity and
consideration for other people. Personality testing, such as
the Hogan Personality Inventory, may also be useful.
Along with carefully
screening prospective employees, “what doctors can do in
their practices is make sure there is a disincentive,”
says Dattner. The leader can make it clear to individuals in
supervisory positions—”what the people below you
think of you is as important if not more important than what I
think of you.” Implementing 360-degree feedback, in which
an individual’s compensation is a function of how well
the person is regarded by other staff, is one such strategy. If
someone begins to abuse their position of power over others,
it’s possible to reposition that individual so that they
do not have direct or indirect power over other staff.
Glaser says the U.S. must
do something about bullying in the workplace and in the world.
“It has to be elevated to the level of global
consciousness.”
It takes only one bully to
turn an entire workplace toxic. It takes only one courageous
person to stop the cruelty. A stand against bullying is a stand
against abuse.
Susan Sarver lives in Chicago and writes
regularly for Unique Opportunities.
