Abstract
T
It is very concerning that there were no black respondents to the survey. Black and other URMM faculty have reported bullying and other mistreatment, which is well documented in the published literature. 3,5,6 Even without black respondents, and few URMM respondents, more than 28.7% reported being the victim of bullying, and 9.7% reported perpetrating it—numbers that are both extraordinarily high and inexcusable. The fact that professional women are more frequent victims of this behavior and have experienced greater negative career effects at the hands of mostly professional male perpetrators is criminal and beyond comprehension. The absence of black physicians among survey respondents and the low response rate (33.5%) suggest that this article may represent an underreporting of the bullying behavior.
Physicians who experienced bullying and actually tried to fix the situation were not able to end the bullying. Although it is possible that the limits of the survey prohibited the choosing of effective solutions, it is also likely that current solutions to ending this behavior need to be re-evaluated. It is unfortunate that the most effective solution to bullying was confronting the perpetrator, with 60.2% reporting improvement. Is it really necessary that personal energy and expertise be wasted in changing the behavior of what is essentially an abuser? Other strategies that improved the situation included complaining to supervisors (47.5%), talking to family friends and coworkers (46.6%), filing institutional complaints (45.8%), bullying back (40%), and hiring an attorney (36.4%). In every case, the effective solutions require the victim to take additional risk (and/or expense) by confronting, reporting, and sharing the experience. It should not be the victim's responsibility to fix what is an institutional problem. As physicians and scientists, it might be time to take another lesson from the business world.
In his book, The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn't, Robert Sutton, PhD, makes the case for the elimination of bullying in the workplace. 7 He defines “assholes” as people who make others feel “oppressed, humiliated, de-energized, or belittled,” or as people who “aim venom at people who are less powerful.” This definition is congruent with the definition provided by the authors of this study who define a bully as someone who engages in “derogating, intimidating and offensive, noteworthy and upsetting” behaviors. Sutton suggests that these behaviors be rooted out from the organization by eliminating the perpetrators.
This is a radically different approach to the tactics suggested in the article. Because of difficulties in retention in academic medicine, it seems ludicrous to fire people who display bullying behavior. However, Sutton makes it clear that firing bullies gives the unmistakable message that certain behaviors will not be tolerated. There are further benefits from firing bullies: 1. Increased employee loyalty. 2. Increased employee productivity. 3. Decreased bullying, as bullies tend to “breed like rabbits.” 4. Reduced absenteeism. 5. Increased motivation. 6. Increased psychological safety. 7. Increased honest discussions. 8. Increased ability to attract the best and brightest.
Sutton further details how to implement this rule, along with the correct way to gain the benefits already listed. Granted, these are business solutions, but is there a reason why we would not want the mentioned virtues in academic family medicine?
In short, the article is clear: Bullying exists, and our existing solutions do not make any difference for the majority of people surveyed. Perhaps we should look for ways to adopt the “no asshole rule” in academic medicine, protect the victims of this unconscionable behavior, and create better role models for our patients, our students, and our colleagues.