NPR report: Future doctors depict mentors as monsters

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Earlier this month, health journalist Julie Rovner reported for NPR on a class of medical students who were invited to draw comics depicting their training, workplaces, and relationships with mentors/supervisors. It’s not a pretty picture:

How stressful is medical training? So bad that in a class that encouraged medical students to express their feelings by drawing comics, nearly half of them depicted their supervisors as monsters, researchers say.

Students imagined the workplace as dank dungeons, represented supervising physicians as fiendish, foul-mouthed monsters, and themselves as sleep-deprived zombies walking through barren post-apocalyptic landscapes, the study authors, Daniel R. George and Dr. Michael Green, wrote Tuesday in JAMA, the journal of the American Medical Association.

In one particularly harrowing image, a student “depicted his supervising physician screaming at the medical team, causing one intern to urinate herself moments before having her head bitten off for possessing too little information about a patient,” the authors wrote.

Click to the full piece if you’d like to see some of the artwork.

This is yet more evidence that the health care workplace is a troubled one. In fact, last week I shared the story of a nurse who attempted suicide after enduring a prolonged course of bullying and harassment.

Because psychological abuse at work tends to roll downhill, it’s also likely that some of these doctors-in-training will take cues from what they’ve experienced and treat their colleagues and co-workers in a similar manner. In an August 2012 piece, I suggested that professional schools can be incubators for workplace bullying:

It has long been my belief that the seeds of workplace bullying are planted in professional schools that prepare people to enter occupations such as law and medicine.

You start with ambitious young people who (1) are used to being heralded as academic stars; (2) do not have a lot of life experience; and (3) tend to be driven, Type A achievers. You then put them in high-pressured educational environments that emphasize technical knowledge and skills and a lot of “left-brain” logical thinking. These degree programs don’t place a lot of emphasis on interpersonal skills and the development of emotional intelligence.

You then unleash them unto the world of work. Uh oh.

That post includes a summary of a New York Times piece about a resident doctor who terrified the medical students with his explosive behavior.

WBI: A bullied nurse shares her story after surviving a suicide attempt

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We use the term “suicidal ideation” to describe frequent thoughts about suicide, especially for those at risk. But tossing in a clinical word like “ideation” has a way of sanitizing the term and drawing attention away from its core essence: Circumstances in someone’s life can be so challenging, difficult, or dire that they are thinking about suicide.

We know that workplace bullying can be associated with suicidal thoughts. Not every instance, thank goodness, but in some instances, yes. In fact, earlier this week, Dr. Gary Namie of the Workplace Bullying Institute shared this comment, publicly posted to the WBI site, from a nurse who attempted suicide after experiencing a prolonged course of workplace mistreatment.

I’m an RN, I resigned unwillingly Sept.18 from the Veterans Affair. Its difficult for me to determine if I was experiencing bullying, harassment and or discrimination but the end result an attempt to end my life July, 30th, 2015, spending 12 days in the hospital.

I was diagnosed with PTSD and medicated for nightmares while hospitalized. I’m or I was a well functioning Bipolar II. I endured (from a newly arrived nurse manager, moreover the was not my manager) bullying/harassment for 14 months,mid Jan 2014-Mar 2015 and on March 26th 2015 – June 17th she and another official came at me with a vengeance. On June 16th 2015, around 4:30 pm after entering human resources and reading false accusations, a co-worker’s description of me and a sticky on top of the charges “AL, can we ask for fitness of duty, reprimand or suspension” (I had no write-ups prior to these false charges) I started crying, I was devastated, shocked.

. . . I can’t believe or comprehend these unfathomable events, I’m lost. How can this all be happening. I suffered/suffer fear, anxiety, terror, pain, uselessness, worthlessness, impending doom, shame and guilt!!!!!!. My livelihood was taken from me.

There are at least two important points worth drawing from this personal account. First, while suicidal thoughts usually cannot be traced to a single factor, severe bullying and mistreatment at work can be among the causes. Second, we must continue to pay close attention to worklife matters in healthcare workplaces, too many of which are stressful, dysfunctional places to earn a living.

Over the years I’ve written a lot about the healthcare workplace and about suicide. Here are some pieces if you would like to learn more:

World Suicide Prevention Day, 2014: Ties to work, bullying, and the economy (2014)

Suicide and the Great Recession: Will we heed the tragic warnings? (2013)

University of Cincinnati conference examines workplace violence, bullying, and incivility in healthcare (2012)

Cheryl Dellasega’s “When Nurses Hurt Nurses” (2012)

Nursing as a Calling: Aspirations and Realities (2010)

First in a four-part series on workplace bullying in healthcare (2009)

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Suicide prevention resource in the U.S.

If you or someone you care about is having suicidal thoughts, the National Suicide Prevention Lifeline can be reached around the clock at 1-800-273-TALK (8255). In addition, you can go to a hospital emergency room and ask for help.

Professional coaching

Targets of workplace bullying may consider confidential coaching by telephone offered by the Workplace Bullying Institute through Jessi Eden Brown, a licensed counselor and WBI’s professional coach. For more information, including availability and rates, go here. You may find helpful this article about her work in Counseling Today.

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Cultivating heart quality in professional practices

Carolyn Thomas, a heart attack survivor and women’s health advocate, writes about the importance of kindness in health care practice in her popular Heart Sisters blog, starting with a story about her visit to the emergency room and subsequent placement in the cardiac care unit:

What I do vividly remember, however, is a small but profound act of kindness later that day when I was brought to my bed in the CCU (the cardiac intensive care unit). The nurse who came to greet me as my gurney was pushed off the elevator placed one gentle hand on my shoulder (and more importantly kept it right there as she walked alongside down the long corridor). As we moved, she bent lower over my head to speak slowly and softly into one ear, introducing herself and assuring me that I was “in the right place” – and that her whole team would do their best to take very good care of me while I was with them.

She goes on to reference, among other things, studies showing that medical students’ levels of empathy begin to decline during the course of their training:

Much of this interaction, however, depends largely on health care professionals’ ability to empathize – to imagine what it’s like to walk in the hospital booties of their patients.

So it’s shocking for many people to learn that, even among naturally kind and empathetic medical students, studies suggest that empathy for others begins to wane by the third year of med school as students progress. This is particularly true, apparently, for future doctors entering technology-oriented specialties – like cardiology.

Thomas’s article raises important questions about the training and education of those entering the helping and human service professions, especially fields such as health care, law, and social services.

For example, a healthy dose of training in client counseling should be an important part of a law school program, including the cultivation of greater sensitivity to a client’s emotional state during often stressful legal proceedings. Therapeutic jurisprudence, the school of legal thought that examines the therapeutic and anti-therapeutic properties of the law, legal practice, and legal education, takes these matters seriously.

To illustrate, in a 2010 law review article, “Employment Law as if People Mattered: Bringing Therapeutic Jurisprudence into the Workplace,” I devote a lot of attention to client counseling in the context of employment disputes, including the recognition that clients may be experiencing considerable anxiety and stress in view of the stakes involved.

These considerations should be examined against the broader canvass of emotional and social intelligence. As I wrote four years ago in a post on leadership:

For those who have the personal qualities to be effective leaders but lack the background and experience, leadership and management training programs emphasizing the so-called “soft skills” would help sensitize them to the human aspects of their jobs.

In fact, it’s arguable that basic management training should be part of all professional degree programs, such as medicine, education, law, and business. This initial exposure can be augmented by continuing education offerings for those elevated to leadership positions.

Maybe this seems like a lot in order to get back to the point of Carolyn Thomas’s blog post: How a nurse’s simple words of comfort and reassurance helped her to deal with a life-threatening health crisis. Nevertheless, in professions that, by their nature, must place great emphasis on analysis and problem solving, the human element needs reinforcing as well.

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Hat tip to Peggy Berry for the Thomas article.

U.K. report: Health care whistleblowers experience retaliatory bullying

In a recent article for The Guardian newspaper, Denis Campbell and Matthew Weaver highlight an independent investigative report finding that British National Health Service workers “who blow the whistle on substandard and dangerous practices are being ignored, bullied or even intimidated in a ‘climate of fear.'”

The investigation, led by Sir Robert Francis QC at the request of the Health Secretary, “reveal[s] how staff who have sounded the alarm about dangerous practices have found themselves shunned, suspended and sacked by hospital bosses instead of having their concerns taken seriously.”

Campbell and Weaver quoted Francis in a BBC interview, acknowledging the severe human costs of this retaliation:

“I’ve spoken to people who have not only lost their jobs, their livelihood, they’ve not been able to find other jobs to do. And I’m afraid in some cases have felt suicidal and become ill as a result.”

Recommendations

According to the official report website (which provides links to the executive summary and full report), Francis “sets out 20 Principles and Actions which aim to create the right conditions for NHS staff to speak up, share what works right across the NHS and get all organisations up to the standard of the best and provide redress when things go wrong in future.”

These include fostering a healthier organizational culture, better handling of individual complaints, and stronger legal protections.

Lessons reinforced

This report reinforces at least five lessons about whistleblowing, workplace bullying, and workplace retaliation:

First, even in a nation with more extensive worker protections, including some that address workplace bullying, bullying and intimidation are significant problems. The U.K. generally has been ahead of the U.S. in recognizing workplace bullying through its legal and labor dispute resolution systems, but the problems continue to exist.

Second, this is one more example of the heavy prices that some whistleblowers pay for raising concerns about improper, illegal, and/or unethical behavior. Workplace bullying is a common form of retaliation for whistleblowing.

Third, Francis’s observations about the effects of severe, bullying-type behaviors on individuals validates what we’ve known for years about the human costs of sustained, targeted work abuse. This includes the possibility of suicidal ideation.

Fourth, this underscores ongoing concerns about bullying behaviors in the health care sector, something we know a lot about here in the United States. Health care workers too often toil in stressed out, hostile, and bullying work environments.

Finally, the report’s recommendations remind us that reform and problem solving must be a multifaceted endeavor. This includes broader questions of organizational culture, specific measures and best practices, and effective legal protections.

Blessed are the caregivers

Several months ago, after settling into my seat for a plane flight, I looked up the aisle and noticed a physically slight older woman lugging along a large man, and he was basically leaning on her back as they moved forward. She led him to their seats and attended to his seatbelt. Later, when he had to use the restroom, she helped him to get up, and once again he leaned on her back as they made their way to the front of the plane.

The man appeared to be severely developmentally disabled, and she was his caregiver, probably his mom. In her eyes I saw what I can only describe as a tired yet peaceful sense of devotion and acceptance.

It so happened that I was traveling that day to visit a dear friend who is caring for her father who has Alzheimer’s. Because of her selflessness, this good man is living comfortably at home, enjoying his favorite meals, watching football games, and having someone tuck him into bed every night with a hug.

Every day and night, millions of people around the world are rendering emotionally and physically demanding labor without pay, serving as caregivers to loved ones with illnesses or disabilities. It is hard work that tugs at the heartstrings. Oftentimes it is a manifestation of pure love and commitment.

34 million

According to a fact sheet prepared by the Centers for Disease Control and Prevention, some 34 million people are serving as unpaid caregivers in the U.S. alone. Here are a few key facts and figures:

  • “An estimated 21% of households in the United States are impacted by caregiving responsibilities (NAC, 2004).”
  • “Unpaid caregivers provide an estimated 90% of the long-term care (IOM, 2008).”
  • “Caregivers report having difficulty finding time for one’s self (35%), managing emotional and physical stress (29%), and balancing work and family responsibilities (29%) (NAC, 2004).”
  • “About 73% of surveyed caregivers said praying helps them cope with caregiving stress, 61% said that they talk with or seek advice from friends or relatives, and 44% read about caregiving in books or other materials (NAC, 2004).”

Furthermore, caregiving is a very gendered role, with women bearing the heaviest proportion of these responsibilities. Often they are doing so while sacrificing opportunities to pursue careers and engage in income-producing work.

A preview of the future

As I read about the challenges we face with an aging population, among the emerging points of clarity is that our ability to keep people alive has far outstripped our current resources and systems to provide affordable, dignified long-term care to those who need it, especially without exhausting their caregivers.

This reality dovetails with projections of sharply increasing numbers of people needing such help, especially those suffering from Alzheimer’s and other disabling conditions.

We must reorient our priorities if we are to avoid the specter of an aging population withering away in terrible living conditions and lacking dignified care, with burned out caregivers trying to fill the many voids. This will include controlling the costs of respite and long-term care, while at the same time offering living wages to health care attendants and providing financial support for those who take on unpaid caregiving responsibilities.

In an era of limited financial resources for the vast majority of the population, this will not be easy. It will require, among other things, that we rethink what is important in our lives and for our society.

Unsung heroes

Anyway, the main purpose of this piece is not to engage in a public policy discussion, as necessary as it happens to be. Rather, it is to recognize that caregivers are among the unsung heroes of our everyday lives. They are doing work of a higher order, and they deserve our praise, thanks, and support.

Recycling: Five years of December

Each month I’m reaching into the archives to highlight a piece from that month of each past year. Especially for those of you who missed them the first time around, I hope they provide interesting and useful reading. For each piece I’m including a short excerpt; you may click on the title for the full article.

December 2013: UMass-Amherst launches campus-wide workplace anti-bullying initiative — Yesterday the University of Massachusetts Amherst, the flagship entity of a major public university system, publicly launched a workplace anti-bullying initiative with a campus symposium that attracted over 500 UMass employees. This remarkable turnout, which included staff, faculty, and administrators, was over triple the number of RSVPs for the event. . . . I had the privilege of presenting the keynote address, and one of the lasting memories I’ll have is that of standing at the podium and seeing the large auditorium fill with people, with some having to stand even after dozens of extra chairs were brought in to accommodate the overflow.

December 2012: American elders: Human dignity and an aging population — At some point soon, America is going to have to come to grips with the massive psychological and economic implications of its aging population. It won’t be easy. . . . These challenges will have significant implications for the world of work. They will impact the demographics of the workplace and employee benefit programs. They also will create an expanding sector of the labor market devoted to elder care and health care. If we’re capable of philosophically redefining a crisis as an opportunity, then perhaps this is the best we can hope for. I believe these coming decades will be a test not only of our policy and economic ingenuity, but also of our hearts.

December 2011: Workplace bullying and families of targets — Workplace bullying often creates victims in addition to the target of the abuse. In particular, close family members often pay a price as well, as personal relationships are severely tested and sometimes fractured. Many bullying targets, and those who have interviewed, counseled, and coached them, have known this for a long time. Now, emerging research is helping to build the evidence-based case. Here are two helpful pieces . . . .

December 2010: “Ruthlessness, callousness and arrogance don’t belong here” — Do you like the quote that headlines this blog post? Isn’t it an important statement for a workplace with a heart? Uh oh. Too bad it came from Enron’s code of ethics. Alas, great policies do not always translate into great leadership.

December 2009: Workplace bullying in health care IV: Nurses bullied and responding — “After you read this post, go to Google and type in these two words as a search request: nurses bullying. If you had a dollar for every hit, you could retire right now and live very, very comfortably. When it comes to workplace bullying in the healthcare workplace, nurses get the worst of it. They are bullied by doctors. They are bullied by fellow nurses. And when patients act out, they’re more likely to take it out on a nurse than someone else, at times using physical violence.”

Working Notes: Interview with workplace anti-bullying activist, Kaplan survey on bullying & nurses, freelancers & nasty clients

Good morning, dear readers! Here are three items that may be of interest to you:

1. Tufts professor profiles Massachusetts anti-bullying activist and labor leader Greg Sorozan

Tufts University professor Lisa Gualtieri did an excellent in-depth interview Greg Sorozan, coordinator of the Massachusetts Healthy Workplace Advocates and union president. Greg has been a pioneering voice in the labor movement on workplace bullying and is an initial Fellow of the U.S. Academy of Workplace Bullying, Mobbing, and Abuse. I encourage you to read Dr. Gualtieri’s full profile of Greg; here’s the intro:

“Bullying is part of the spectrum of abusive behaviors that exist in this world. I know about child abuse, child neglect, sexual abuse, domestic violence, substance abuse, and now adult abuse at work. They all work together to create many, if not most, of the health and mental health problems we have,” said Greg Sorozan. Greg is President of SEIU/NAGE Local 282 and Massachusetts State Coordinator of The Healthy Workplace Bill, working to prevent bullying in the workplace. I read about his work in a Boston Globe article and his MA legislative activity and asked to interview him about his work as a patient activist.

2. Kaplan survey: Nursing school graduates concerned about workplace bullying

A survey by the Kaplan testing preparation company shows that nearly half of surveyed 2014 nursing school graduates are concerned about experiencing bullying and related behaviors. Here’s the lede from the Kaplan news release:

For those entering the workforce, typical top-of-mind issues include opportunities for growth, benefits, and job security — but nearly half of those entering the nursing profession voice another concern: being bullied by colleagues. According to a just-released Kaplan survey of over 2,000 nursing school graduates from the class of 2014, 48% say they are concerned about being the victims of workplace bullying or working in a hostile working environment. The survey also found that 39% personally knew nurses who were victims of workplace bullying or a hostile working environment.

 3. Freelancers Union piece on working with jerks

A sense of independence is one of the great appeals of going the freelance route, and that may include being able to work with agreeable clients instead of difficult ones. But it’s not always that easy; bullying-type behaviors rear their ugly heads in the indie sector as well. Kate Hamill, writing for the Freelancers Union blog, shares a bad client situation from her early freelancing days and lessons learned from it. Here’s a snippet:

Early on in my freelance career, I worked with a company that has since gone under – quite deservedly. Looking back, there were a lot of red flags: a haphazard hiring process, an unclear reporting structure (to this day, I can’t tell you exactly who my boss was), relatively low pay, and unreasonable demand. Most tellingly, they employed an army of freelance writers, with a high turnover rate.

…It didn’t take long for the client to become unpleasant. It started out with small things; deadlines that seemed unreasonable, unsubtle demands to work overtime, a tendency to ignore boundaries. I would send emails that got no response, only to get chewed out days later for not following policy. When I forwarded emails that exonerated me… no reply. They kept giving me more and more work, including assignments I was painfully unqualified for. Then I found out how much money they were charging THEIR clients for my services, while claiming I possessed certain certifications… that I didn’t.  I was making about 10% of what they were charging. Their language got increasingly harsh – with me, with everybody.

 

 

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