How to deal with physician bullying in your practice
Bullying is not uncommon in ophthalmology and can have a detrimental effect on staff.
“Courage is fire, and bullying is smoke.”
– Benjamin Disraeli
“The bully knows he is despised, for he despises himself.”
– Marcus Boswell
“Those tutored beyond their level of intelligence stroll into positions of authority. When work demands surpass their abilities, these oafs begin to browbeat and bully subordinates in an effort to camouflage their own deficiencies.”
– Jerome Castlema
The most fortunate of us with any leanings toward becoming a bully are punched in the snoot by the time we reach the sixth grade and reform our ways. Unfortunately, some nascent bullies are able to avoid a good thrashing. Of these, I am afraid a few too many become ophthalmologists.
Why do these otherwise talented and admirable people become the worst kind of coward? And what can the rest of us do to deal with them? All too many who work in ophthalmology wrestle with these questions in the workplace.
Hopefully some self-recognition and self-reform will be sparked by what follows.
Why do people bully?
According to the British anti-bullying website www.bullyonline.org, “The purpose of bullying is to hide inadequacy … anyone who chooses to bully is admitting their inadequacy, and the extent to which a person bullies is a measure of their inadequacy.”
Bullies, it goes on to say, project their inadequacy onto others:
- to avoid facing up to their inadequacy and doing something about it,
- to avoid accepting responsibility for their behavior and the effect it has on others,
- to reduce their fear of being seen for what they are, namely weak, inadequate and often incompetent individuals, and
- to divert attention away from their inadequacy.
In ophthalmology, we see bullying behavior at some of the highest levels of the profession — in managing partners, department chairs and highly vetted subspecialists.
The early roots of bullying are easy to understand intuitively as a lay person: abusive family backgrounds, low self-esteem and a history of having been bullied oneself. Seen through this lens, the typical bully perhaps deserves as much sympathy, even pity, as loathing.
How ophthalmologists bully
In 34 years on the road, I have seen it all:
- The surgeon who throws instruments, projecting his own incompetence on innocent scrub techs.
- The ophthalmologist who upends a staffer’s stool in the OR, sending him to the hospital.
- The eye doctor who sneers at his patients for asking a perfectly reasonable question about their care.
- The practice owner who screams at her administrator about adverse business performance, which is in reality driven by the doctor, not the manager.
- Progressively florid swearing as a substitute for calm, clear communication.
- Giving the “silent treatment” and similar power trips.
- Nitpicking about one technician’s alleged failings while letting the same performance gaps slide for the rest of the crew.
The cost of bullying
Physicians are smart and self-interested. Those who are bullies commonly justify their behavior because, “My staff won’t perform unless I chew on them.” Many of the surgeon bullies I have counseled through the years believe they owe it to their patients to be harsh with staff in order to impose higher standards on patient care. “After all,” they say, “that’s how I was trained in medical school.”
They could not be further from reality in holding this sentiment.
Bullying subordinates actually reduces their performance and tapers a worker’s willingness to grow and widen his skill set. Bullying reduces morale and increases staff turnover, and it creates practice organizations from which the most confident and accomplishing staff flee, leaving behind the least competent workers — those willing, like battered spouses, to stick around because they “obviously deserve to be abused.”
Three types of ophthalmologist bullies
In my experience, surgeon bullies come in three basic varieties:
- Episodic/improvable: In a moment of stress, the surgeon lashes out, uncharacteristically, at others. We are all prone to this to varying degrees, and in the mildest cases, the episodic bully rapidly pulls back from the brink, recognizes the pain and harm he has caused in others, and quickly apologizes. Ideally, this kind of bully learns from each outburst and over time improves his behavior. The seriousness of episodic bullying is, of course, in the eye of the beholder. The established surgeon who loses it once or twice a year or the stressed-out young surgeon who is still trying to get a grip is pretty easy to forgive and live with.
- Chronic/escalating: This kind of sociopathic surgeon bully gets worse over time. When each fresh staff member first starts working with him, the newness and formality of the professional relationship may keep the bully at bay. But over time, the boundaries come down and the bullying behavior escalates, until the new staffer has to wince just as much as the veterans.
- Secondhand bullying: Bullying is largely a learned behavior. Those who are part of a work group led by a bully will commonly start to become bullies themselves.
Responding to ophthalmologist bullies
Life was easy (and less litigious) in grammar school, where you could simply stand up to the schoolyard bully, bop them a good one (like your dad showed you!) and be done with it. Whether you are the peer-colleague of a bully in your practice, a manager or a line staffer, if you are the target of bullying, you have four basic recourses:
- You can ignore the perpetrator. Not reacting to a bully generally stimulates their escalating efforts to control you, but if your practice is large enough and full of alternate victims, you may find it possible to bore your bully into pestering someone else.
- You can confront the surgeon bully. This sometimes works, particularly when the bully is the “episodic/improvable” variety. At the very most, your strong confrontation may be enough of a wake-up call to cease the bully’s behavior. At the very least, the bully may leave you alone and pick on a weaker victim.
- You can report the bully to a higher authority. This is the best recourse in a larger group practice. Administrators and practice boards understand and want to avoid the high cost of workplace harassment. As the average practice size grows in America, solo and small practices linger as the last refuge of bully surgeons who can skirt institutional oversight. Indeed, if you contemplate leaving your current practice to get away from a bullying doctor, consider joining a larger practice.
- You can withdraw from the practice. This is the most practical approach and the move most immediately under your control.
What can’t you do? You cannot try to elevate the level of your performance and expect that the surgeon bully will lay off of his harassment. If anything, you will invite more attention by generating even more jealousy and feelings of inadequacy over your terrific performance.