WA doctors have recently raised concerns about bad behaviour in medicine – particularly bullying and misconduct in academia.
By Cathy O’Leary
Everyone has heard stories about bullying in medicine – from junior doctors being belittled by senior consultants to professors insisting on being lead author on research they had no hand in.
Last month, the results from the 2024 Medical Training Survey commissioned by Ahpra also found that more than 1000 doctors in training – or one in 20 – reported experiencing or witnessing sexual harassment.
One third of trainees said they had experienced or witnessed bullying, discrimination, harassment, sexual harassment or racism, spiking to 54% of Aboriginal and Torres Strait Islander trainees and 44% of interns.
While sometimes the source of bullying or harassment is external to the medical profession, other times the perpetrators are from within.
A paper in The Lancet Regional Health Western Pacific last year reported that the annual rate of bullying, discrimination and harassment experienced by Australian junior doctors within healthcare teams had remained fixed at 21-22% for 2019-2023, which more than doubles the average across all industries.
The paper blamed fragmented regulation, weak correction processes, conflicts of interest and a fear of retribution, and called for a new framework for Australian specialty colleges and healthcare leaders.
While there have been moves to stamp out bad practices, two recent publications authored by WA doctors suggest problems are still rife in medical academia.
Several doctors, including a paediatric anaesthetist and WA finalist in the recent Australian of the Year awards, have called out what they say is the darker side of academia and editorial misconduct.
One third of trainees said they had experienced or witnessed bullying, discrimination, harassment, sexual harassment or racism, spiking to 54% of Aboriginal and Torres Strait Islander trainees and 44% of interns.
Speaking up
Writing in the British Journal of Anaesthesia, Professor Britta Regli-von Ungern-Sternberg and three colleagues cited their own experience in a bid to raise awareness and encourage others to speak up.
The researchers wrote that they had been invited to contribute a review article to a special issue of another journal with two guest editors, one from the same institution as the journal’s editor-in-chief.
After submitting their manuscript, they received an unexpected request by the senior guest editor of the special issue to add an additional author from their institution as first author. The additional author was unknown to them and had not contributed in any way to the manuscript.
Many attempts over six months to clarify the request with both special issue guest editors, the administrative editor and the proposed additional author remained unanswered.
The researchers’ working ethos was that a person qualified as an author if they had contributed and fulfilled the standard authorship criteria based on the International Committee of Medical Journal Editors.
But an extensive online search of the proposed additional author revealed neither a significant academic presence nor any apparent connection to the manuscript subject. While the senior guest editor of the special issue had a wider reputation, this was not the case for the other guest editor or the proposed additional author.
“More troubling, however, were the responses from colleagues we consulted about this request by the senior guest editor to add an additional author to our manuscript,” Prof Regli-von Ungern-Sternberg and her colleagues wrote in the BJA.
“While many shared their own somewhat concerning experience with the senior guest editor, none was willing to share anything in writing. The majority of colleagues, mostly senior and male academics, suggested caving in and not speaking up.”
Fear of reprisal
Comments included: ‘Be careful, don’t ruin your career;’ ‘As a female, don’t speak up against the boys’ club, it will end badly for you’; ‘You might never get invited again to meetings on the continent of this person’; ‘You may find it difficult to get international funding; they can block you’; ‘Just withdraw the manuscript but don’t give any reason’; ‘Just accept it; while it is wrong, in the long run, it will help you move forward because this person is very influential.’
When challenged, the journal’s editor-in-chief confirmed that authorship should reflect a substantial contribution to the manuscript.
“However, to our surprise, the editor-in-chief suggested during both phone and extensive face-to-face conversations with two of the senior authors that the suggested additional authorship might merely be an ‘error’, despite no communication received from the senior guest editor on this matter when the authors sought clarification with the editor-in-chief,” the researchers wrote.
“We had a discussion with the editor-in-chief about withdrawing our article unless the senior guest editor stood down…however, the editor-in chief cautioned us about potential legal repercussions, particularly for the senior guest editor but also for the editor-in-chief himself and the journal, if the senior guest editor was removed.
“There were even several appeals to our kindness, and requests for us to consider the wellbeing and the potential repercussions (legally and career-wise) for the editor-in-chief’s well-respected colleague.”
The researchers withdrew their manuscript and later learnt that other authors had raised ethical concerns and withdrawn too. The editor-in-chief then confirmed that the senior guest editor would be removed from the special issue.
“Based on our experience, we see several learning points for authors, editors, editorial boards, and journals,” the researchers wrote.
“The editor-in-chief stated that anyone can make an error. However, we do not believe the initial suggestion to add an additional author to a manuscript on which they had no input can be classified as a ‘simple error’. On the contrary, this argument can be seen as an attempt to pressure us into pretending the attempted authorship abuse had never occurred and to protect their colleagues despite the lapse in ethical integrity.
“The reaction of our academic peers is concerning, demonstrating, on one hand, an acceptance of ‘normal misconduct’ and, on another, a dominant, overpowering theme of helplessness and fear that little or nothing can be done when power is abused.
“We felt an overwhelming sense of being trapped in a corrupt system that empowers these back-room associations.”
The researchers called for mandatory training on ethics, author and editorial conduct, as well as on whistle-blower safety, for all editorial roles and administrative staff.
Bullying is common
Dr Tom Brett, a Mosman Park GP and director of the General Practice and Primary Health Care Research Unit at the University of Notre Dame’s School of Medicine in Fremantle, also recently penned a paper on the issue, published in the MJA’s Insight magazine, detailing concerns about researchers with a history of bullying and harassment.
He argued it was time to enforce policies that protected against bad behaviour and weeded out the outliers, and said institutions needed to abide by their own policies when supporting victims of bullying and abusive behaviour in medical academia.
He said the bullying experienced by medical students as part of their clinical clerkships was well-documented.
“What appears clear from the emerging literature is that bullying is very common, with up to 40% of French and American medical students reporting their experiences with bullying. In New Zealand, the evidence is even greater, with 54% reporting exposure to bullying in the clinical setting and, disturbingly, 74% reporting they had witnessed another medical student being bullied,” Dr Brett wrote.
“Is there a failure of the institution (medical school, university, research institute) to recognise psychopathic tendencies and bad behaviour in some of their staff members or do some covertly tolerate it?
“How many research leaders, medical and non-medical deans have had blatant examples of bullying and staff abuse reported to them and yet they have done nothing about it or, worse still, allowed the processes of the institution to cover it up?”
Dr Brett said bad behaviours were not just in research settings but also in hospitals and medical communities.
The increasing recognition of bullying and abusive behaviours in academic settings meant that most universities and research institutes had developed their own policies and protocols to deal with such issues, but they did not always follow them.
HR no help
The role of human resources in the management of reported episodes of workplace bullying was also critical.
“Some of the literature, including victim reports on academic bullying, is keen to advise potential accusers that it would be wrong to assume that human resources will be on your side, or will have no conflict of interest in how they investigate a complaint of abuse,” he said.
“One anonymous blogger stated that HR doesn’t exist to protect you, it exists to protect the employer from you.
“What if the research institute leader or dean are themselves latent victims of a bullying subculture and they lack the moral and ethical fortitude to speak up and tell the truth?
“For many, it is all about a power struggle that results in talented young researchers being driven away, those in leadership positions getting ridiculed and blackmailed into doing nothing while the toxic environment engendered by the bullies holds sway – for now.”
Sometimes the bully was tolerated or just moved to another location where the behaviour was likely to re-emerge.
Dr Brett said a recent position statement from the National Health and Medical Research Council was a good starting point in support of research institutions being willing to acknowledge that a problem existed and to support efforts to provide a workplace free of bullying and harassment.
“All research institutions should ensure their grant applications are free of researchers/investigators with a history of bullying and harassment,” he said.
“The defunding of such grants could be a powerful weapon to ensure that the NHMRC policy is strictly adhered to and not covered up.”