The advice zone
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I have just come back from work after a day of being
bullied. I cannot carry on like this any longer, and I feel I need help.
Could you suggest anything?
I am sorry to hear you are having such a very
distressing time at work; there is no doubt that bullying can undermine
your confidence and self respect. It sounds as if this situation has been
going on for some time and something today has triggered you to seek help.
Well done—you have taken the first step in changing this untenable
situation.
Firstly you need to get advice from the BMA. If you are
a member, say that you need advice on whether the actions that are
affecting you constitute bullying in employment terms. To get an outside
view is helpful when the situation is severe. Do you have friends,
colleagues, or family who can give you wise advice?
You do not mention who is bullying you; your line
manager needs to be informed, and may be more helpful than you expect, and
you may find that others are experiencing the bullying too. It may be just
one person who is bullying you or it may be institutional, and have become
a pattern whereby you are the scapegoat. The former is obviously easier to
sort out.
You need to reflect on your own behaviour. Are you
feeling low and vulnerable due to lack of confidence, illness, depression,
or some loss or stress in your personal life? Are you sleeping well? As
doctors we are notoriously bad at spotting when we are depressed and not
acting on it. As you probably know, depression is very common and it can be
helped. Counselling, cognitive behaviour therapy in particular, can change
negative thought patterns and increase your confidence greatly. It may be
that you are a kind empathic doctor who is more passive than assertive,
your learnt response to aggressive behaviour needs tweaking, and there are
excellent courses on assertiveness that really can help.
Finally, I would advocate finding some self help
books. It is well recognised that bullying is rife in medicine and there
are books explaining the issues and solutions around bullying, depression,
and assertiveness.
Rebecca Viney, general practitioner and associate dean London Deanery
You have taken an important first step in recognising
that this problem is happening; the next question really is what you want
to do about this or indeed whether you wish to do anything at all. If you
do not wish to talk to somebody locally then your employer or deanery is
likely to have a confidential telephone advisory service or you could
contact BMA Counselling on 08459 2001 6924. The important thing is probably
not to act in anger or in haste but to seek help and advice for yourself in
the first instance.
Another important step is to write down what happened,
who was involved, the circumstances in which it happened, and how it made
you feel. If anybody witnessed these events it may help to obtain their
perspective on the situation and what they thought about what happened to
you.
There is some good, structured advice available from
the GLADD (Gay and Lesbian Association of Doctors and Dentists) website
about dealing with bullying (www.gladd.dircon.co.uk/PDFs/iwl_guid.pdf) l Although it deals with
homophobia it is fairly generic advice which can be easily adapted to other
situations. Good luck with whatever you eventually decide to do.
Dan Saunders, honorary treasurer, Gay and Lesbian
Association of Doctors
I am a psychology student applying for a graduate
course in medicine this September. What type of work experience would be
appropriate before I start a medical course?
First of all, congratulations on your decision and the
background training in psychology will be a valuable asset in your future
medical career. Auxiliary nursing would be far better experience than
phlebotomy, though rather hard work. Perhaps the best kind of experience
would be if you had any medical contacts who could help you by arranging
for you to shadow a junior doctor or sit in on a few clinics. Sitting in on
a general practitioner's surgery would also be very instructive if it
could be arranged.
If you have a good relationship with your own general
practitioner they are usually quite responsive to such requests. For short
term visits like this to the hospital or GP environment it is not usually
necessary to be a registered medical student, and informal attachments can
normally be arranged as long as they are just short term without your hosts
having to undertake a lot of paperwork. In terms of paid employment in the
NHS setting, auxiliary nursing is perhaps a good idea because it will give
you an insight into the perspective of patients and nurses, which is
clearly different from the medical role and important for you to
understand. Certainly the initiative you show in securing any relevant
experience as outlined would be regarded favourably at interview for a
medical student place, since you will be able to show that you have some
idea about what you are letting yourself in for. Hope this helps.
Howard Clark, specialist registrar in paediatrics, John Radcliffe Hospital, Oxford
I have a chronic back problem that causes me pain when
I work long hours, especially if the work entails a lot of walking along
corridors or up and down stairs. Could you please advise me on a suitable
medical career. (I am a preregistration house officer.)
Most clinical jobs will include walking between wards,
theatres, departments, and facilities, and we know that hospitals are
enormous and that many patients are outliers on distant wards. Hospital
jobs which are more "fixed" in space include laboratory and
outpatient specialties such as histopathology, dermatology, chemical
pathology, neurology, "office urology," and psychiatry.
Strenuous disciplines such as surgery, obstetrics, and accident and
emergency may be less suitable. General practice can be arranged to have
surgery work only and no visits.
One problem is that the training for all specialties
entails vast amounts of activity and is probably more ground covering than
for the senior doctors. I have a step counter and my daily step count, even
as a relatively torpid histopathologist, is in the range 2000-5000 steps. A
step counter would enable you to determine your tolerance of walking around
hospitals.
Another approach would be to see if you are truly stuck
with the limitations of your back problem, which may have some scope for
improvement. Seek a consultation with a really good back specialist,
including the wider world of practitioners, such as osteopaths. An
occupational health assessment may also help in determining your long term
prospects and capabilities.
It is important to concentrate on what you can do
rather than what you cannot do. Most medical work involves the hands, the
brain, and looking, speaking, and listening. Many doctors are wheelchair
users, and greater mobility should allow a successful career. You will have
your own ideas on what you like. In the end, your working preference will
be more important than the limitations of mobility. I expect many readers
will have further ideas on this topic. Best of luck.
Carl Gray, consultant histopathologist and executive medical director, Harrogate Health Care
studentBMJ 2005;13:265-308 July ISSN 0966-6494
