Editor's note: This popular story from the Daily Briefing's archives was republished on Oct. 30, 2019.

Bullying and its "pernicious, even tragic, repercussions" are well known among school-age children, but it's also "far more common than we acknowledge" in the medical field, leading to problems such as burnout and depression, Mikkael Sekeres, director of the Cleveland Clinic's leukemia program, writes for the New York Times.

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A common problem

Bullying typically involves "an imbalance of power between the perpetrator and the victim," Sekeres writes, with the victim unable to defend him- or herself. In the medical field, that power dynamic can happen "between a fellow or staff physician and a resident or medical student."

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Sekeres recalls his own personal experience being bullied as a medical student: "Toward the end of my surgery rotation, I scrubbed in on a patient undergoing coronary artery bypass surgery. ... The cardiac surgeon had spent the majority of the case berating me for my inadequacies, from how I held a retractor to the way I was standing or had tied my surgical cap. Eventually, he called me over to his side of the operating table." According to Sekeres, the surgeon instructed Sekeres to hold the patient's heart in his hands. Once he "gingerly" eased his hands underneath, the surgeon shouted, "'What the hell are you doing? You almost tore it out of this man's chest when I just fixed the damn thing! Get out of here!'" And Sekeres fled.

Sekeres writes he and his peers had few options to defend themselves against their bullies: "We feared any grade less than high honors, which could compromise the type or quality of residency we might obtain, and would be determined largely by the fellow." Another factor in bullying, Sekeres writes, is that it's intended "to cause harm or distress." In his case, Sekeres writes, "Our fellow seemed to delight in our fear."

According to Sekeres, his experience is not unique. He cites a study published in BMJ Open that found more than half of 635 doctors working in NICUs in Greece said that they had witnessed or had been a victim of bullying in the workplace. Ilias Chatziioannidis, the lead author on the study, said the bullying behaviors typically fell into three categories:

• Personal bullying, such as insulting or offensive remarks about one's appearance;
• Personal intimidation, such as threats of violence; and
• Workplace bullying, such as being pressured not to take sick leave.

The rate of bullying may be even higher in the United States, Sekeres writes. He cites a study of American medical students that found 42% of more than 1,300 medical students said they had experienced harassment, and 84% said they had experienced belittlement during their time in medical school. "Most commonly, the bullying behavior came from the residents and professors supervising them," Sekeres writes.

The consequences of bullying

The harmful consequences of bullying are well known, and in health care they may include anxiety, burnout, depression, and even potentially drug misuse, Sekeres writes.

Sekeres points to a recent essay published in the New England Journal of Medicine in which Michael Weinstein, a trauma surgeon at Sidney Kimmel Medical College at Thomas Jefferson University, describes how he spiraled into depression after "silently enduring feelings of inadequacy for years while working in a culture that wouldn't allow him to share those feelings."

"It is a cruel irony that doctors and nurses are drawn to medicine to care for others, yet the majority have been bullied by their colleagues and superiors," Sekeres writes. "We should all be able to turn to one another for support, to be able to admit that we are hurting, and to ask for a system that allows for missing work in the event of illness, without suffering castigation for being weak. It's in our patients' best interests, and in ours" (Sekeres, New York Times, 6/14).

5 myths physicians believe about patient experience

Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.

Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief."

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