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

Baukje Miedema, PhD; Leslie MacIntyre, MSC; Sue Tatemichi, MD; Anita Lambert-Lanning, MLS; Francine Lemire, MD; Donna Manca, MD; Vivian Ramsden, PhD

Disclosures

Ann Fam Med. 2012;10(2):111-117. 

In This Article

Abstract and Introduction

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.
Methods For 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.
Results The 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.

Introduction

Health 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.[2–6] 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 previous month.

Some physicians may be more at risk for abuse than others. For instance, physicians working in emergency departments, psychiatric emergency departments, and after-hours clinics, as well as those on house calls, have an increased likelihood of experiencing abusive encounters.[7,12–15] Emergency departments appear to be especially problematic. An American study reported that 1 in 3 emergency department physicians was physically assaulted during the previous year.[13] Additionally, psychiatrists and physicians whose practices include large numbers of patients with mental illness and addiction problems are at higher risk of encountering abuse.[7,15–17]

Abuse in the workplace has been associated with experiencing higher levels of stress, increased consumption of alcohol, and an increased risk for developing mental health difficulties, including depression, anxiety, and suicidal ideation, as well as absence from work, physical problems, employment termination, and compromised patient care.[18–25] Abusive encounters in the workplace may lead to post-traumatic stress disorder, attrition of workers, and physician refusal to work in such high-risk areas as emergency departments and after-hours clinics.[5,8,12,21]

Hershcovis and Barling argue that negative outcomes regarding workplace abuse will be strongest when the "perpetrator is a supervisor [or] coworker," and the "weakest effects" are when the perpetrator is an outsider (patient or their family members).[26,27] Several studies have indicated that verbal abuse perpetrated by colleagues and coworkers is generational.[28–41] Surgical residents reported that belittlement, intimidation, and harassment were perceived to be motivational tools for the profession.[28] Some supervisors described feeling justified in perpetuating belittlement of residents because they themselves had been treated in a similar fashion during their training. Thus it appears that abusive interactions may be embedded in the broader medical culture.[42–45] The objective of our overall research was to document the prevalence, the monthly incidence rates, and the impact of abuse in the workplace of family physicians in Canada. This article is based on the qualitative data focusing on the experiences of the family physicians who were harassed or abused by coworkers.

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