George Miller, HLA scholar, interviews Dr Judy Evans and Miss Alice Hartley about bullying, discrimination and the #LetsRemoveIt campaign
Dr Judy Evans Photo credit: RCSEd
Dr Judy Evans- the first female Office Bearer at the Royal College of Surgeons of Edinburgh- is telling me about her Fellowship exam. “I had all sorts of things happen when I was a candidate,” she recalls. “I went in several months pregnant and I still remember the first question they asked me: “What do you think you are doing here… looking like that?”
Unlike her male peers, every question she was asked concerned the anatomy of the womb. She allowed them to upset her and she failed.
“I was so angry. That’s why I became an examiner so many years later; to make sure no other women go through that again. But thankfully the exams are now so standardized they’re almost boring for the examiners.”
But it wasn’t to be the last time Dr Evans, now an expert plastic surgeon, came face to face with discrimination.
“Many years later in 1999 while at Derriford hospital, a female trainee came to me and said she’d been racially abused by a colleague.”
The trainee, a British woman of Nigerian ancestry, was allegedly told: “You are not operating on bloody Nigerians now. These are my patients – they are normal human beings.”
“I’d been working there for 14 years with no complaints against me, but within 10 days of carrying that complaint forward I was put on gardening leave”. Dr Evans looks sombre. “It was absolutely horrendous, and it was discriminatory, and it was bullying.”
Sadly, this case isn’t unique. But times are changing. Together she is working with Alice Hartley, a senior surgical trainee, on a new Royal College campaign to stamp out bullying in surgery for good.
I ask why change has taken so long.
“I almost think there was a feeling amongst surgeons that it was always going to be a tough vocation, and you needed to be tough and resilient to work within it”, Hartley explains. “You put on a brave face and get on with it. There was a degree of arrogance that we didn’t need to do anything.”
So, I wonder, why now? “Well, this isn’t just about being nice to people, it’s not only about creating a positive environment to work in, it’s really having an impact on patient safety. And that’s why the college involved itself. We had to intervene. But we are not wanting to develop another stick to beat people with. Rather, instead of saying, ‘You’re a bully, you should be struck off by the GMC’, it’s about saying, ‘Did you know you’re a bully? It’s ok, that can change. We just need to talk about it.”
Many women, I say, are put off surgery because of the macho culture. She nods. “They think their face doesn’t fit and actually it’s not true. It’s the specialty that needs to change. When you go around departments it’s usually easy to see one or two doctors who are obviously behaving poorly. But they must be more commonplace than that for almost 40% of our Members and Fellows to experience bullying”.
I wondered if, like Evans, Hartley had experienced sexism at work first hand.
Is she hopeful that things will get better? “Overall things are improving. About 9% of surgical consultants, and 27% of trainees, are female. So more women are choosing surgery, but I do think that they are still put off more than men by the current environment.”
I ask her why so many trainees are bullied, and why so many bully in return. “You realise over time after you qualify that this behaviour has become accepted…you get a phone call from A+E and you shout down the line. You know it’s not their fault that they have a patient you need to see, but it’s become normal to act that way, and it needs to be stopped.”
Did it ever make her reconsider the job? She smiles. “When I graduated I loved surgery but I had no intention of pursuing it.” Oh? “Well, I just thought I couldn’t work with those people. But then I started as a doctor and I met some lovely surgeons who showed me you didn’t have to conform to a certain stereotype. The thing is, you don’t have to adopt that attitude. And I think if you do you make it even harder for yourself.”
The sentencing this last month of Surgeon Ian Paterson yet again brought the twin issues of bullying and complacency in surgery to the fore of the national press. Leaders in the profession, both domestic and international, were quick and unambiguous in their response. When a surgeon can go unchallenged despite concerns about their conduct, the culture must change. But there is already a zero-tolerance policy, and it is already condemned in all circumstances. So what more can be done now to ensure that those patterns of behaviour become so unaccepted that they stop entirely?
“What I didn’t realise when I started is the importance of the director for medical education at each trust. They get all the feedback from the GMC survey, and so have a very large role to play although many trainees may not be aware of it. No victim should feel isolated and left to deal with these issues alone”.
“The problem is that lot of the time in medicine you are on a placement for 4-6 months, and although it may be rubbish, you would rather keep your head down and just get through it and avoid the confrontation. So the bully never gets dealt with. Really, you have to be very brave to stand up.” She pauses. “We are going to offer more support to those who suffer from bullying, and do more to get perpetrators to reflect on their own behaviour. We are working with the GMC and the deaneries to make things more transparent. Trainees often fear reprisals if they are whistle-blowers. But this is everyone’s problem.”
Evans nods in agreement, “We have a network of regional surgical advisors, paralleled by the Royal College of Physicians. If it gets to the point where someone wants to speak out they need to be able to go to the various college websites and be able to find the right person to help them. We haven’t got there yet, but we must.”
But it won’t be easy.
“When I first started this project I went to a Royal College of Surgeons of Edinburgh Council meeting and asked everyone present, all successful surgeons at the top of their profession, if they felt they’d been bullied, or witnessed bullying, in the last year.”
They all raised their hands.
___ Judy Evans is a consultant plastic surgeon, Honorary Secretary of The Royal College of Surgeons of Edinburgh (RCSEd) and a senior College examiner. Alice Hartley is a specialty registrar in Urology, RCSEd Trainees’ Committee Co-chair and Trainee Member of Council.