Bullying is the act of seeking to harm, intimidate, or coerce another person or people. Bullying is largely about power and about one person or a group wanting to feel more powerful than another or others perceived as vulnerable.
Bullying may be aimed at your sexual orientation, gender expression, ethnicity, colour, religion, appearance, disability, or anything the bully feels they can exploit to feel powerful over you. However, anyone can experience bullying and it can happen anywhere, including school, at home, at work, online and in your community. Bullying can take many forms. If you are experiencing any type of bullying, it is important to remember two things: it is not your fault, and it can be stopped. There is support available for those who are being bullied.
Am I being bullied?
Bullying is when someone uses their power over you to cause harm. To understand if you are being bullied, it is helpful to know about the different types.
Direct vs indirect bullying
Direct bullying involves verbal and psychological aggression, gestures, extortion and cyberbullying. The bully is clearly identified in instances of direct bullying. However, bullying is not always obvious or visible.
Indirect bullying may include passing around nasty notes, the writing of offensive graffiti in public places in or out of school, or the damage of personal property. Cyberbullying can be considered indirect if the bully keeps their identity private.
Relational or social bullying
Relational and social bullying is another form of indirect bullying. Bullies engaging in this form of abuse threaten to cause damage to someone’s relationships. They manipulate the social connections of their victim by ignoring, excluding and isolating them, as well as influencing their friends and trying to damage their victim’s reputation. Through this behaviour, the bully aims to encourage others to reject the victim.
Verbal bullying
Verbal bullying is when a person says or writes hurtful things about you. This can be in the form of name calling, put downs, mimicking, threatening to cause harm and spreading rumours.
A person who puts you down or calls you names may say that they’re “only joking”. However, it is always up to you to decide whether the behaviour is acceptable or not.
Physical bullying
Physical bullying is another type of bullying that many people experience. It involves harmful actions against another person’s body. This can include kicking, punching, hitting, pushing and pinching. Physical bullying does not have to hurt for it to be considered bullying. It can also include damaging or hiding your belongings, your physical space like a room or locker, or harm to pets.
Gesture bullying
A person may make threatening or intimidating gestures towards you on purpose. This is known as gesture bullying.
Exclusion bullying
If someone is choosing to ignore you or exclude you from activities, it can also be described as bullying. This is known as exclusion bullying. Sometimes, a bully will encourage other people to leave you out also.
Extortion bullying
Extortion bullying is when a person threatens to harm you or your belongings if you don’t do what they say. They may force you to do things that you do not want to do or things that you feel are wrong. While extortion bullying may involve peer pressure, peer pressure doesn’t always involve bullying.
Online/cyberbullying
Bullying does not always happen in person. Bullies may also use the internet, phone calls or text messages to try to harm you. This is known as cyberbullying. It can involve hurtful texts, emails, posts, images or videos. Sometimes, a bully might harm you online by spreading rumours, or by using your login details to imitate you. Cyberbullying might make it easier for a bully to hide, but it is just as serious as any other form of bullying.
Effects of being bullied
Bullying can have a huge effect on your physical and mental health, both now and in the future. Anxiety, low self-esteem, self-harm and difficulty sleeping are just some of the many things you may experience if you are being bullied. Those who experience cyberbullying may also have higher levels of depressive symptoms than victims of in-person bullying.
If you are being bullied, you may experience:
- Emotional distress, sadness and tearfulness
- Frustration and high levels of anger
- Shame, embarrassment and self-blame
- Damage to physical and emotional well-being
- Reduced self-esteem, lack of confidence and depression
- A sense of fear
- Helplessness
- Reduced academic performance, particularly if you are not feeling safe in school or college
If you are experiencing any of these effects, you are not alone. It is very normal to have these feelings when you are being bullied. Remember, there are things you can do about bullying. By reaching out for support, you can stop the bullying and reduce these unwanted effects.
OPERATING ROOM BULLYING
You’re a freshly trained, recently hired anesthesiologist at a new medical center. In your first week on your job, an attending surgeon in the operating room bullies you, making aggressive, sarcastic, and critical comments such as, “Are you trying to kill my patient? Have you ever done this before? Why is it taking you so long to get this patient to sleep?” or “My patient just moved. Can’t you give anesthesia better than that? Maybe I’d better ask for a different anesthesiologist.”
Does this ever happen? Unfortunately it does. What do you do?
Bullying in the medical profession is common, particularly during training years. A 1990 study (Silver HK, Medical student abuse. Incidence, severity, and significance, JAMA 1990 Jan 26;263(4):527-32) found that 46.4 percent of students at one major medical school had been abused at some point. By the time they were seniors, that number rose to 80.6 percent. In an Irish study, 30% of junior hospital physician responders to a questionnaire claimed to have been subjected to one or more bullying behaviors. (Cheema S, Bullying of junior doctors prevails in Irish health system: a bitter reality, Ir Med J. 2005 Oct;98(9):274-5).
The traditional medical education hierarchy of attendings > fellows > residents > interns > medical students sets up a pecking order where senior physicians pick on junior colleagues. One might paraphrase the phenomenon as “Sh__ runs downhill.” Younger colleagues are expected to do more “scut,” that is more paper work, computer work, contacting of consultants, chasing down lab and scan results, early rounds and late rounds on patients, as well as to sleep overnight in hospitals.
As physicians become more senior and exit training programs, their lifestyle improves and junior doctors, physician assistants, nurse practitioners, or registered nurses do more of their work. The tradition of condescending behavior toward those less trained may continue. When condescension crosses the line into disruptive or inappropriate behavior, it becomes a problem. Abused physicians, nurses, or techs can become angry or depressed, lose self esteem, and their physical and emotional health may suffer. Disrespect and bullying compromise patient safety because they inhibit the collegiality and cooperation essential to teamwork, cut off communication, and destroy team morale.
Joint Commission studies have shown that communication failure between health care workers is the number one cause for medication errors, delays in treatment, and surgeries at the wrong site. A 2004 study of workplace intimidation by the Institute for Safe Medication Practices (ISMP) (www.ismp.org/pressroom/pr20040331.pdf) found that nearly 40 percent of clinicians have kept quiet or ignored concerns about improper medication rather than talk to an intimidating colleague.Rather than bring their questions about medication orders to a difficult doctor, these health care personnel said they would preferred to keep silent. Seven percent of the respondents said that in the past year they’d been involved in a medication error in which intimidation was at least partly responsible.
In 2009 the Joint Commission began requiring hospitals to have a “code of conduct that defines acceptable, disruptive, and inappropriate staff behaviors” and for its “leaders [to] create and implement a process for managing disruptive and inappropriate staff behaviors.” The rationale for the standard states: “Leaders must address disruptive behavior of individuals working at all levels of the [organization], including management, clinical and administrative staff, licensed independent practitioners, and governing body members.”
Stanford University Hospital where I work has adopted such a Medical Staff Code of Professional Behavior (found online at medicalstaff.stanfordhospital.org/bylaws/documents/Code_of_Behavior).
Excerpts from this document include:
“Inappropriate behavior” means conduct that is unwarranted and is reasonably interpreted to be demeaning or offensive. Persistent, repeated inappropriate behavior can become a form of harassment and thereby become disruptive, and subject to treatment as “disruptive behavior.” Inappropriate behavior include, but are not limited to, the following: Belittling or berating statements; Name calling; Use of profanity or disrespectful language; Inappropriate comments written in the medical record; Blatant failure to respond to patient care needs or staff requests; Personal sarcasm or cynicism; Lack of cooperation without good cause; Refusal to return phone calls, pages, or other messages concerning patient care; Condescending language; and degrading or demeaning comments regarding patients and their families, nurses, physicians, hospital personnel and/or the hospital.
“Disruptive behavior” means any abusive conduct including sexual or other forms of harassment, or other forms of verbal or non-verbal conduct that harms or intimidates others to the extent that quality of care or patient safety could be compromised.
Disruptive behavior by Medical Staff members is prohibited. Examples of disruptive behavior include, but are not limited to, the following: Physically threatening language directed at anyone in the hospital including physicians, nurses, other Medical Staff members, or any hospital employee, administrator or member of the Board of Directors; Physical contact with another individual that is threatening or intimidating; Throwing instruments, charts or other things.
This is how the Stanford policy deals with inappropriate or disruptive behavior:
If this is the first incident of inappropriate behavior, the Chief of Staff (COS)or designee shall discuss the matter with the offending Medical Staff member, emphasizing that the behavior is inappropriate and must cease. The offending Medical Staff member may be asked to apologize to the complainant. The approach during this initial intervention should be collegial and helpful.
Further isolated incidents that do not constitute persistent, repeated inappropriate behavior will be handled by providing the offending Medical Staff member with notification of each incident, and a reminder of the expectation the individual comply with this Code of Behavior.
If the COS or designee determines the Medical Staff member has demonstrated persistent, repeated inappropriate behavior, constituting harassment (a form of disruptive behavior), or has engaged in disruptive behavior on the first offense, the case will be referred to the COS and/or the Committee on Professionalism (COP). The subject will be notified of this decision and given an opportunity to provide a written response both prior to and subsequent to meeting with the COS or COP.
If it is determined that the subject has engaged in disruptive behavior, a letter of admonition will be sent to the offending member, and, as appropriate, a rehabilitation action plan developed by the COS and/or COP, with the advice and counsel of the medical executive committee as indicated. The assistance of the Wellbeing Committee may be offered at any stage of this process.
If, in spite of this admonition and intervention, disruptive behavior recurs, the COS or designee shall meet with and advise the offending Medical Staff member such behavior must immediately cease or corrective action will be initiated. This “final warning” shall be sent to the offending Medical Staff member in writing.
If after the “final warning” the disruptive behavior recurs, corrective action (including possible suspension or termination of privileges) shall be initiated pursuant to the Medical Staff bylaws of which this Code of Behavior is a part, and the Medical Staff member shall have all of the due process rights set forth in the Medical Staff bylaws.
What do you do when inappropriate or disruptive behavior occurs in your operating room? The specialty of anesthesia provides wonderful positives such as intellectual challenge, multiple different subspecialties, hands-on procedures, and solid financial reimbursement. A disadvantage of the specialty of anesthesia is that anesthesiologists are consultants who do not have their own patients. No patient goes to the hospital or surgery center solely to have an anesthetic. Patients are there for some invasive procedure that requires an anesthetic.
Because the patient “belongs” to the surgeon, some surgeons use this fact to lord power over the anesthesiology provider, the operating room nurses, and surgical technicians, as well as over the hospital administration. A busy surgeon with a hefty workload brings a great deal of revenue to the hospital or surgery center he or she chooses to operate at. Some surgeons feel entitled to exercise condescending behavior toward nurses and anesthesiologists who they perceive to be merely part of hospital or surgery center services. Some surgeons yell, cuss, and throw things. Some engage in more subversive behaviors such as ignoring questions, acting impatient, insulting colleagues or speaking to them in condescending tones. Only a small percent of surgeons are bad actors, but a small proportion can have a big impact.
In my 25-year anesthesia career I’ve seen multiple examples of verbally and emotionally abusive surgeons. In distant years most of these surgeons met little resistance to their behavior. Staff who opposed them were moved to different operating rooms, and more enabling nurses and techs were found. The enablers were quiet, agreeable, hard working, and rarely questioned the surgeon’s authority. Anesthesiologists who resisted surgeon bullying stopped working with that surgeon, per both the surgeon and the anesthesiologist’s wishes. Alternate anesthesia providers were tried until a subgroup of passive enabler anesthetists was found.
My advice to any anesthesiologist out there is: Don’t be an enabler. You are a highly trained physician, deserving of respect. If a surgeon has an episode of acting disrespectfully to you or to any of the other operating room staff, conclude your care of that current patient without a confrontation. After the case is finished, choose a time to hold a face-to-face conversation with the surgeon. The setting could be a hallway, in the locker room, or at some other location where no patient care is being done. Tell him or her that you find their behavior toward you unacceptable, and that they need to stop it. If you get pushback, and you probably will, you have several choices: 1) have a loud verbal argument, asserting your will against theirs, 2) grin, bear it, and stop complaining about the circumstance; 3) request your scheduler to never schedule you with this surgeon again; or 4) kick it upstairs to the chief of the department and/or the chief of the surgery department.
Which option should you choose?
1) gets you a boisterous unprofessional argument with an individual who will be resistant to change. 2) results in a long-term unacceptable solution for you and your professional esteem. 3) gets you off the hook but does nothing to change the situation for others in the operating room. Only 4) will set the wheels in motion toward significant change. Stay calm and confident and refer the incident up to senior physician administrators to evoke change. If the department chairs can not impact behavioral change, take the issue higher to the Chief of Staff.
A genuine problem occurs when a bullying surgeon leaves all major medical centers and starts his or her own surgery center where he or she is the Medical Director and his or her bad behavior goes unscrutinized. If you are working in such a setting, I’d advise you to find another place to give anesthetics. Without an unbiased administrator, the surgeon bullying behaviors will never go away.
You’ll be happier working in an operating room cured of disruptive behavior, and the real winners will be the patients, who will come and go through a hospital free of disruptive behavior and bullying.
Why do people bully?
There are many reasons why people bully. A person might bully because of abuse and violence in the home, a lack of love or attention, anger problems or low self-esteem. They may have been bullied themselves. While there are many reasons why someone may bully, there is no excuse for it. It is a serious issue that needs to be stopped.
What can you do if you’re being bullied?
While it might be hard to believe, bullying can always be stopped, no matter how bad it is or how long it has been going on for. There are several steps you can take if you are experiencing bullying.
Talk to someone you trust
Speak with an adult that you trust about your situation. This could be a friend, a family member or a teacher. They will be able to provide you with advice and take further action to address the bullying. If you are experiencing harassment, you are also completely within your rights to report the harassment to the Gardaí.
Report the bully
If you feel comfortable doing so, you can report the bully to the appropriate person.
If the bullying is taking place at school or involves a person or group at your school, you can report it to your teacher, principal or guidance counsellor, who should be able to provide support in line with your school’s anti-bullying policy. If you are bullied at college or by somebody at your college, you can report it to the head of school, college counsellor or welfare officer. Your college should also have a policy which explains how reports of bullying will be dealt with.
All employers are required by law to prevent bullying and harassment at work. If someone is bullying you at work, on a training course, on a work trip or at a work social event, you can report it to someone in human resources (HR).
If you are experiencing cyberbullying, you can report it to the relevant platform. Some forms of cyberbullying are illegal including inappropriate sexual suggestions and comments, racist remarks, distribution or publication of intimate images without consent, harassment and any form of persistent bullying. In cases that could be illegal, you can report the bullying to the Gardaí.
Confront the bully
If you feel safe doing so, you could speak calmly to the bully about their behaviour. Tell them that their actions are hurting you and that you would like them to stop. Asking a trusted friend to come with you for this conversation may be helpful. Speaking with the bully may not lead them to stop bullying. If this happens, do not fight back as it may make the situation worse. It can be very difficult to deal with a bully on your own, so it is important to remember you are not alone in this experience. You have other places to turn to.
If you don’t think confronting the bully will help or if you do not want to do so, that’s ok. It’s important to take care of yourself and only do what feels comfortable for you. There are many things that you can do to stop bullying that do not involve speaking with the bully directly.
Look after yourself
If you have experienced bullying, you might find that you are feeling low in yourself and forgetting about your own needs. Rather than judging these feelings, try to see them as a sign that you need extra care and support. Through self-care, you can offer this to yourself. Self-care is always important, particularly during challenging times like this. It can be as simple as reading a book, enjoying a cup of tea or making sure you get enough sleep at night.
Find support
There are several organisations that offer free and confidential support and counselling to those who are being bullied. You will find a list of these services below.
Remember that this is not your fault. What the bully is saying about you is not true, they are just trying to hurt you. You did not do anything to cause them to bully you. Listen to those who love and value you.
Finding support for bullying
Experiencing bullying can be incredibly distressing – you can reach out to the support organisations below for support:
50808
50808 is a free, 24/7 text message support service providing everything from a calming chat to immediate support for people going through a mental health or emotional crisis – big or small.
To talk to a trained volunteer now, free-text SPUNOUT to 50808 to begin.
If you are a customer of the 48 or An Post network or cannot get through using the ‘50808’ short code please text HELLO to 086 1800 280 (standard message rates may apply). Some smaller networks do not support short codes like ‘50808’.
Childline
Childline has a 24 hour freephone number for under 18’s – you can call 1800 666 666 any time, day or night.
Their text service is available from 10am to 4pm every day – you can start a conversation by texting 50101. You can also chat online at childline.ie from 10am to 4pm every day.
TeenLine
Teenline is a 24/7 national active listening service for children and young people up to the age of 18 in Ireland. You can contact them for free any time of the day or night by calling 1800 833 634.
TeenLine is free to contact and is confidential, non-directive and non-judgmental.
Samaritans
Samaritans are a 24/7 active listening service, there to listen to you no matter what’s going on. You can talk to a Samaritans volunteer for free by calling 116 123 any time of the day or night.
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