24 April 2019

In his latest blog, Dr Chris Tiplady explores the subject of bullying and the many different ways of responding to and resolving aggressive or intimidating behaviour.

I have been bullied before – have we all at some point?

Maybe it happened to you as a child or more recently, but the bullying that affects us as adults is different to that which happens in the playground. It is not always easy to detect – there may just be a niggling uncertainty at the back of your mind that something isn’t quite right, rather than noisy shows of aggression and intimidation.

I'm lucky enough not to have experienced a great deal first hand, but I've witnessed it countless times. I particularly remember the questioning conversation I had with two medical students about an experience in an out-patient clinic they were meant to attend. In an effort to introduce themselves to the consultant whose appointments they were supposed to be observing, they gently knocked on the door of the consulting room, and after a brief exchange, were told in no uncertain terms told to go back out and wait until called. They eventually went back in and were told to sit in the corner and stay quiet: they were not to speak unless spoken to. They had an hour of angry questioning in front of and in between patients which left them feeling shaken and confused.   

I also remember the doctor who felt they would never be able to go into their chosen specialty as they had disagreed with a consultant, who’d proceeded to shout at them across a ward of patients. A terrible thought – that one incidence could be enough to make some rethink their career.

Not only do these attacks hurt those who they’re directed at: research has shown that witnessing bullying and harassment has a significant impact on the health and well-being of bystanders. Bystanders, of course, includes patients.

It is really hard for me to share stories like this, since every single one is upsetting. But I don’t want to shirk from sharing examples – I just hope one day I stop hearing about them altogether.

Of course, the only way that will ever happen is if we can all recognise bullying, know what to do when it happens and have someone willing to sort it out. In this blog, I'll explore how to recognise bullying and what can you do when you find yourself in situations like these.

In the moment

Keep calm

No matter if someone’s behaviour is outright aggressive or subtly undermining, try to stay as calm as you can when it’s happening. It’s deeply unpleasant to feel attacked, but don’t escalate things into a fight. Also, try not to make apologies for yourself – feeling like you have to apologise is one of those alarm bells that you are being bullied and helps to validate the other person’s nasty behaviour.

Reflect and clarify

Reflection is a useful tactic to unearth what’s really going on with someone: acknowledge what is happening and being said, and repeat phrases back for confirmation. If you feel safe to, you can ask them to explain why they are saying or doing things. I think of this as my “customer services mode”. 

After the incident

Take some time to process what happened

Step back. Recognise your feelings in the heat of the moment. Sometimes after a bit of time reflecting, you may realise that what upset you was a bit of hard truth: a lot of people have mistaken well-meaning, direct feedback for harsh criticism.

Similarly, you might realise that this person really overstepped the mark, making you feel belittled or humiliated. Some warning signs include:

  • disbelief and shock at someone's behaviour, that stays with you even after you have got home and calmed down
  • dread and worry about meeting this person again
  • an unexplainable feeling of shame, even though you have done nothing wrong
  • a feeling like you were powerless to say or do anything to resolve the conflict
  • a feeling like you are being made to apologise
  • the urge to go and tell someone what just happened.

If that’s the case…

Talk to someone

It doesn’t matter who – it just has to be someone you trust. They may be your supervisor, your line manager, a colleague, a friend or one of the more official roles that many places have – like a Freedom to Speak up Guardian, the Director of Medical Education or a College Representative.

This person needs to have the skills to listen and help you define what’s happened. The right person may also be aware of other concerns about the individual.

Write it all down

Where were you, what day, what time, what else was happening, who was around, who saw or heard things? You forget this kind of detail very rapidly and it can all be very useful in the future. Keep emails or any correspondence you get from the person causing you upset.

Remember that emails are an easy way of escalating conflicts as well – they are the road rage of communications. Avoid replying if you’re feeling angry. I used to have an inbox folder labelled “emails that made me angry”. Just putting them there was helpful.

Taking it further

So – you’ve sought support and processed your experience and things are not resolved. At this point, you have a few options.

Speak to the person in question

Maybe on reflection you’ve realised that what happened was unintentional – despite its impact – and the person just doesn’t realise how it made you feel. This is a situation where talking to the person directly can help.

You need to prepare that chat and plan it through so you know exactly what you want to get across. Be objective: say in a factual way what happened and why it was unacceptable. You may want to do this with a friend and practice what you want to say. You may even want that friend to come with you when you talk.

Use a mediator

Resolution of the situation could also be achieved by a manager, a good friend or a skilled mediator. Many organisations now have access to mediation as it is a very effective alternative to the more formal processes.

Mediation is useful when a relationship at work has deteriorated to the point that angry words are being exchanged and behaviours simply fan the flames of conflict. Mediators are non-judgmental and will, through a series of conversations, listen to both sides of the story attempting to understand what has led to the current situation. They will help people understand their feelings and actions and most importantly explore what will resolve a dispute. Many people who have been through conflict just want it to stop and to return to a nice (or even just civil) working relationship. If this is what you are after then mediation is ideal.

Make a formal complaint

If informal routes of resolution don’t result in the outcome you want, you can make a formal complaint. Every organisation will have a policy for doing this, but it needs careful consideration: once formal policies are triggered, things can become very unpleasant for everyone, with statements, investigations and lots of emotions flying around.

Importantly, that doesn’t mean it isn’t sometimes exactly the right thing to do. Those who bully and harass shouldn’t be able to do so with impunity. Formal processes are there to empower those who are victimised – as well as making sure genuinely unpleasant and disruptive people aren’t allowed to continue hurting others.

Final thoughts

When it comes to dealing with bullying and harassment, many people are unsure what to do or how far to take things. I always ask people what they want to achieve. If you simply want the person to apologise, that’s a very different route to if want them formally punished.

Personally, I am lucky not to encounter this too often, partly as I make sure I am very clear that any behaviour that makes people feel uncomfortable is completely unacceptable. We can all afford to cultivate more awareness of the impact that our behaviours and words have on those around us and must all play a part in calling out any behaviour that could be perceived as bullying or undermining. A safe and nastiness-free working environment is our collective responsibility and it will always make care better for our patients.

We’re all responsible for ending bullying

The examples provided by Chris here hit home for me - I experienced and witnessed bullying far too many times during my undergraduate and postgraduate study. Humiliation and belittling behaviour were cited as the most frequent forms of bullying and harassment in both the 2017 and 2018 GMC Trainee surveys and have become ingrained in the culture of training.

The responsibility for tackling bullying shouldn’t just fall on those victimised – we all need to take a stand. ‘Bystanders’ often have the power to diffuse an unpleasant situation that they are witnessing or support the person going through it. As Chris has said, we can and do lose great doctors and scientists to these often preventable incidents: I’d encourage anyone working in pathology to keep their eyes and ears open and to always speak up when witnessing someone being treated with unkindness or disrespect.

Dr Matthew Clarke Chair of Trainee Advisory Committee (TAC)