by Dr Shivali Fulchand
Last week, in the first issue of ‘The Doctor’, a magazine for doctors started by the BMA, Keith Cooper discussed bullying among NHS doctors. The article highlighted that doctors at all levels of training, even at consultant level, can face harassment and bullying. This has long been accepted culture within hospitals, not just in the UK, but across the world. TV shows such as Scrubs or House often feature the grumpy consultant or senior doctor who passes snide remarks at their junior colleagues. Although this can be entertaining when watching a fictitious, scripted show, it can be immensely damaging in the real-life situation.
In 2017, NHS staff took a total of 17 million days of leave due to illness and this is 46% higher than the average for any other working sector. Mental health issues are a significant cause of these absences. Working in the healthcare sector can be particularly challenging; hospitals are open 24 hours a day and there are huge physical, emotional and social pressures. There has also been a large increase in workload on the front line and in the care of the elderly.
This highlights several important issues that do not have one easy solution. For new doctors entering the healthcare service, this can also be a huge shock as medical students are somewhat spared from hospital politics. Starting as an FY1 is already a very daunting experience: new location, new people, new hospital, and a new loaded responsibility for protecting lives. However, what I was least prepared for was understanding how to handle people. The majority of medical students have simulated sessions with actors to take focused histories and be empathetic during consultations, however I haven’t met any doctor who had a simulation of ‘how to deal with a challenging colleague’. You don’t learn this until you reach day 1 as an FY1.
The difficulty is, even if you do recognise the behaviour targeted towards you is inappropriate, is it worth speaking out? Keeping your head down and carrying on is the easy solution because nobody wants to risk getting bad feedback on their TAB round – a feedback questionnaire completed by colleagues – which can determine if you ‘pass the year’.
Leadership training includes development of a wide range of skills from better understanding of your own character, to stress management and resilience, as well the theoretical underpinnings of successful organisations. We expect our Chief Executives to be adept at this because they are responsible for a large group of people. However, leadership is required both on a macro- and micro-level.
Leadership means to encourage people, to foster an environment that enables people to grow and become the best they can be, and to facilitate healthy relationships between our colleagues.
When we read the qualities of ‘leadership’, it is really what we would like to receive and give to everyone. As such, leadership becomes synonymous with personal development and team-building.
As Foundation Year Two doctors, we have this privileged opportunity to undertake more advanced leadership training in the form of a post-graduate certificate, which will be starting on Tuesday, as well as conducting our own individual projects focused on an aspect of healthcare leadership. Although I feel fortunate to be receiving this opportunity at this early stage of my career, my hope and ambition for the future is that leadership training becomes a vital part of healthcare education. Reflecting on the suffering of patients at Stafford Hospital, Cooper’s article in The Doctor argued “Bad behaviour begets bad care”. Therefore, through healthy team environments and positive leadership, we can ultimately improve patient care.