How the Medical Culture Contributes to Coworker-Perpetrated Harassment and Abuse of Family Physicians

Abstract

PURPOSE Harassment and abuse in the workplace of family physicians has been associated with higher levels of stress, increased consumption of alcohol, and higher risk for developing mental health problems. Few studies have examined issues contributing to abusive encounters in the workplace of family physicians. METHODSFor the overall study we used a mixed methods design, which included a cross-sectional survey of a randomly selected sample of active family physicians from the database of the College of Family Physicians of Canada and telephone interviews with those who reported experiencing work related harassment and abuse in the last year. The data presented here arise from the qualitative interviews of the study, which were analyzed thematically. RESULTSThe interview arm of the study included 23 female and 14 male participants. The major themes that emerged from the study were (1) modeling of abusive behaviors, (2) status hierarchy among various medical disciplines, (3) shortage of physicians, and (4) lack of transparent policies and follow-up procedures after abusive encounters. The results are discussed using the broken window theory.CONCLUSION Many family physicians experience harassing and abusive encounters during their training or in the workplace. The current medical culture appears to contribute to harassment and abuse in the workplace of family physicians in Canada. We described the components that intentionally or unintentionally facilitate abusive behavior in the medical culture. Ann Fam Med 2012;10:111-117. doi:10.1370/afm.1341. INTRODUCTIONH ealth care workers are at greater risk of workplace abuse than most other workers, with the exception of law enforcement officers and taxi drivers.1 Among health care professionals, nurses and family physicians are at greatest risk for being abused. [2][3][4][5][6] Research conducted in Canada, Japan, Australia, New Zealand, and the United States has found that in their work, physicians experience many forms of harassment and abuse, 1 including verbal abuse, intimidation, sexual harassment, stalking, and assault from both patients and colleagues.7-10 An Australian study reported that 64% of general practitioners reported abuse in the previous year, with low-level mistreatment, such as verbal abuse, being the most common. More than 10% reported experiences of sexual harassment and physical abuse. 7 Similar trends have been found in such other countries as New Zealand and Canada. 8,11 Research conducted in Canada, carried out by our research team, reported that 98% of family physicians reported having experienced at least 1 minor abusive event (eg, humiliation), 75% reported having experienced a major event (eg, sexual harassment), and 39% had experienced a severe event (eg, assault) during their career as a physician.9 Twenty-nine percent of the polled physicians reported having been abused in the previous month by either a patient or family member of a patient. A small group reported having been abused by colleagues (9%) and coworkers (6%) in the prev...

Pilot study on the prevalence of abuse and mistreatment during clinical internship: a cross-sectional study among first year residents in Oman

“…24 25 There is also an indication that medical trainees who were most distressed at the beginning of their training were likely to report continuing stress and distress in the subsequent course of their lives. 26 According to Miedema et al, 27 there are inherent mechanisms that perpetuate abusive behaviour in the medical culture, including working in what is perceived as a stressful environment. This allusion to a view that 'abuse begets abuse' 28 might imply the presence of a cycle of bullying within the medical profession.…”

Workplace violence is not part of a doctor’s job

“…It may also result in absences, physical problems, quitting or refusing to work in highrisk areas, and compromised patient care. 5 In the Canadian survey, three-quarters of those who had an abusive encounter in the previous month did not seek help, and 64% did not report the incident. 2 More than half were not aware of any policies to protect them.…”

“…Canadian physicians working in hospital and psychiatric emergency departments, and after-hours clinics have an increased chance of an abusive encounter, as do clinicians making house calls and those who treat large numbers of patients with mental illness and addiction problems. 5 A survey of about 700 family physicians in the United Kingdom reported that female and male doctors are at equal risk. 6 However, it is not known if the same holds true in Canada.…”

In This Issue: Assessing and Acting on Complexity

“…An in-depth study of family physicians in Canada uncovers elements of the workplace culture that appear to contribute to work related harassment and abuse. 11 The authors identify the training period as a critical time to interrupt cultural cycles that perpetuate harassment and abuse.…”