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More Hypocrisy Than Hippocrates

25/09/2015 5:30 AM AEST | Updated 15/07/2016 12:51 PM AEST
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Doctor using medical equipment during procedure

Most medical graduations now include some kind of 'oath ceremony' -- a commitment to an updated version of the Hippocratic Oath, the original code of conduct for physicians.

Given recent revelations concerning widespread bullying and sexual harassment by Australian surgeons, it seems there's more hypocrisy than Hippocrates in our operating rooms.

An independent report presented to the Royal Australasian College of Surgeons states that almost 40 percent of surgical fellows experience workplace bullying. Further, almost 20 percent face discrimination and harassment, and 7 percent suffer sexual harassment.

This would be staggering in any industry. However, it is especially troubling to see it taking place in a so-called "helping profession". We afford those within the medical profession an unusually high level of trust because of their role. We have to -- they see us at our most vulnerable.

This trust is founded in the "social contract" the public has with the medical profession, which is based on an assumption that the highest behavioural and ethical standards will be upheld. That's why we provide doctors with the power to act on our behalf -- we trust them to act in our best interests.

We would be probably happy to hear our doctor had wielded power to get us into a much needed experimental trial, or an urgent theatre booking. However, were our doctor abusive to colleagues, we would have less reason to trust him or her. The behaviour undermines our beliefs about what the medical profession should look like, and how professionals should conduct themselves.

A culture of bullying and harassment is worrying because it can ruin the lives of individual surgeons, doctors, and nurses. Moreover, it is worrying because it can eradicate the community trust and goodwill on which the medical profession relies. Poor workplace relationships can also come back to harm patients by undermining communication and teamwork.

There is something deeply hypocritical about some surgeons -- devoted to helping others and improving people's quality of life -- being involved in bullying. It displays a lack of sensitivity or regard for other people that contradicts their professional purpose. Only by understanding hypocrisy and how it arises can we start to address the "toxic culture" among surgeons.

When we look at the way the medical profession is structured, we can start to see structural supports for surgery's toxic culture. It begins, like all doctors, with the process of admission into the profession.

Most universities, if they offer undergraduate medicine at all, demand a TER of 99+ for entry.

This is just the first hurdle. From there, most medical admission programs use a combination of intelligence and academic testing to determine successful candidates. This means we can know how clever an admitted student is.

What we are less certain of is how new candidates can address the non-academic aspects of medicine. Very few application processes examine a candidate's social and interpersonal skills, despite them being crucial for the delivery of service as a "helping professional".

A good doctor is defined by more than intellectual qualities (although these are extremely important). Display of empathy, listening, respect and care operate alongside intelligence to operate in the best interests of the vulnerable party in the relationship -- the patient. This is what is meant by "bedside manner".

Students selected solely on the basis of their cerebral capacity generate medical professionals who are empathetic more by chance than design. This is no guarantee of ethical conduct -- cognitive and emotional abilities operate hand-in-hand to guide our moral decisions and govern our relationships with others. A deficiency in either area will increase the likelihood of ethical failures.

Emerging research reveals that those who bully when in senior roles displayed similar characteristics throughout medical school. Power doesn't corrupt. It merely provides a level of authority by which an individual with limited ethical or relational capacities can operate with relative impunity.

That such behaviour isn't explicitly addressed or dealt with during a candidate's training demonstrates the shortcomings in current medical training approaches.

Furthermore, we shouldn't romanticise the moral character of helping professionals. As human beings, occasionally they will be racist, misogynist or abusive. These behaviours, though intolerable, occur across all walks of life. We shouldn't be surprised to see them appear in medical practice.

What is surprising is the lack of formal intervention within training programs. Doctors and surgeons -- like all of us -- need help developing interpersonal skills. They also require guidance in order to align their values, beliefs and behaviours to those of the profession.

Studies into ethical hypocrisy show exposing bad behaviour is insufficient to make lasting changes to an ethical culture. Our experiences working with organisational culture have revealed similar truths -- changing a person's behaviour demands more than telling them they're a hypocrite.

What works is a multi-faceted approach, addressing individual values, attitudes, behaviour and systemic issues.

Ethical culture is best upheld when professions co-ordinate their activities to reflect an explicit set of core values. This requires incorporating ethical training into training curricula in a robust way. Ethics is about more than compliance -- training needs to address topics like personal and professional maturity, relational ethics and interpersonal skill building. This must be supplemented by professional development in matters of ethical literacy.

Ultimately, this aims to develop ethical literacy. This, in turn, generates professionals who reflect the core values of the profession. In the case of medicine, this means valuing compassion, empathy, and care for others alongside technical skill and scientific knowledge.

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Elisabeth Shaw is a clinical and counselling psychologist and Senior Consultant at The Ethics Centre, an independent not-for-profit organisation that provides an open forum for the promotion and exploration of ethical questions.

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