You can’t sit with us! Surgeons as… Mean Girls?

By Kara Hessel

When I considered writing a blog post about bullying in surgery, I thought, “Sure I can do that.” Then, I sat down to write. Every snarky comment and eye roll that I’ve directed at a junior resident or medical student surfaced in my mind. I wondered whether I am the right person to be writing a blog post on bullying. As I reflect on my time in surgery, I have to admit that I have said and done things that could easily be interpreted as bullying.

I come from a very benign surgical residency, particularly when you compare our interactions with staff to the “good old days.” The transgressions that can be described as potential bullying are nothing compared to the stories that my staff tell about their residency experiences. But when I read a recent article in The Annals of Surgery, I realized that what I see as normal surgeon behavior is viewed by the outside world and apparently many surgeons, as bullying. I have to admit that I instinctively reject this notion. M&M is definitely more malignant in some places than others, but attending surgeons repeatedly questioning residents in M&M or in the OR does not resonate as bullying with me. Are my board examiners going to think of themselves as bullies if I become flustered and flounder during my oral exam? Are my patients’ families going to consider themselves bullies when they pepper me with questions about their family member? Is this really not just preparation for what we are to encounter as we gain more responsibility for our patient’s care?

Are these valid arguments? Or is this culture so ingrained in me after 7 years of exposure to surgeons that I do not recognize it as abnormal behavior? Is there a more effective way of teaching? I personally learn best when I am put on the spot. If I feel stupid after a presentation, I generally assume that I was underprepared and I often remember the clinical pearls that come from the exposure of my misconceptions better than any others.

However, there are many people who do not learn well in this manner. When I am honest with myself, I can recognize that I do not necessarily adjust my style of “teaching” when the learner is clearly uncomfortable and not benefiting from our interaction. I still consider this “teaching”, but there are many who would consider that “bullying”. The conclusion I reach is that I need to make it a focus to provide feedback in a manner that is not only constructive in my mind, but also constructive in my junior resident or medical student’s mind. If they are not responding to the way that I am approaching an issue, perhaps their interpretation is not to blame and my approach is. Perhaps this is something that many surgeons could admit to themselves.

The behaviors I have described above are potentially defensible. However, I have also witnessed overt bullying in the hospital from attending to attending, from attending to resident, from resident to nurse, and from nurse to resident. But most concerning to me is the bullying I have witnessed occurring among women. Are we women not at enough of a disadvantage without belittling one another? Don’t we face enough challenges from inherent bias? Do we need to propagate the image of a bunch of gossiping high school girls who isolate and humiliate other individuals? Shouldn’t the goal be to lift and support one another? Why is it that out of all the “bullying” I have witnessed, the incidents that most readily come to mind were girl on girl crime?

I think we all have to ask ourselves the question and face the hard truth. Are you guilty of being a bully? And- if the honest answer is yes, what are you going to do to change it?

Join AWS (@womensurgeons) along with the authors of Workplace Bullying Among Surgeons – The Perfect Crime Drs. Amalia Cochran (@AmaliaCochranMD) and Kevin Pei (@kipsDS2010) for a tweetchat on March 18th at 8 pm Eastern Time to discuss #Bullying in the OR, surgery and medicine. Follow #AWSchat and @womensurgeons. If you haven’t participated in a tweetchat with us before, check out this tutorial written by Dr. Heather Yeo (@heatheryeomd) to know more.

Dr. Kara Hessel is a 5th year General Surgery resident at the University of Kansas. She is a graduate of Kansas City University of Medicine. She will move with her husband and daughter to Columbus, Ohio this summer to start fellowship in Vascular surgery at The Ohio State University.

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Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.