Abuse of power in the health sector

Dr Derrick Aarons

Sunday, September 01, 2019

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ABUSE of power and privilege is pervasive in virtually all societies.

Whether it be verbal, physical or sexual, the power differential existing between those in positions of influence and those who are in vulnerable positions lends itself to a corruption of authority that manifests as one of the moral ills abhorrent to all principled individuals.

The Jamaica Observer newspaper dated August 12, 2019 carried the headline “Doctors cry sexual harassment” with the subtitle “Juniors accuse senior physicians of repeated assault”. In another Observer article entitled “More reasons to debate sexual harassment bill” on August 15, readers were told that the types of conduct that constitute sexual harassment could be employment-related, could occur within institutions, and could also arise in landlord and tenant relationships.

Invariably, all such abuses are done by individuals with power over others in vulnerable situations.

Silence due

Health professionals who are harassed by abusive superiors reportedly remain silent out of fear for their future careers.

Not surprisingly therefore, in an Observer article on August 27 entitled “UHWI urges staff to report sexual harassment”, great concern was expressed by UHWI's director of training and manpower development, who reportedly issued a memorandum to staff on the matter.

Further, in the Observer dated August 28, Health and Wellness Minister Dr Christopher Tufton reportedly gave September 30, 2019, as the deadline for a review of the protocols existing for reporting cases of sexual harassment within the health sector. It would involve a greater sensitisation of the process, which include confidentiality and the potential for victimisation.

Common elsewhere, too

Simultaneous with the article on August 12 about the sexual harassment of junior doctors in Jamaica, on August 13 there was a publication in the Journal of the American Medical Association (JAMA) entitled “Residency Bullying: Trainer on Trainee Harrassment Common”. That article reported that bullies sometimes wear white coats, and may be in charge of educating the next generation of doctors.

The publication informed that research of a national cohort of internal medicine residents (junior doctors) in the USA revealed that 14 per cent reported they had been subjected to repeated harassment by someone in authority at some point during their residency training. Most of the reported harassment was verbal, but physical, sexual, and other forms of bullying were common.

Further, of those who experienced the bullying, most kept the problem to themselves.

The lead researcher from the Johns Hopkins University School of Medicine informed that the phenomenon of workplace bullying had emerged as a pressing issue in health care and in health care training programmes in recent years, and was totally unacceptable.

The article stressed that there should be no place for harassment in medicine or medical education, and that such individuals should not be teaching or interacting with the next generation of doctors.

Harassment by superiors

Previous research studies that looked at the prevalence of harassment among medical trainees produced a range from 10 per cent to 48 per cent. The current research was designed to clarify the actual prevalence of residents in training programmes who felt they had been harassed by superiors during their training.

For the research, bullying was defined as repeated harassment by an individual in a position of power. Residents were asked if they had ever been bullied during their residency training. Those who perceived being bullied were asked to characterise the type of harassment (verbal, physical, sexual, or other), and to identify the personal consequences of bullying from a list of eight possibilities. They were also asked whether they had sought help.

Of the 21,212 residents included in the research, 13.6 per cent reported they had been harassed during their training. Of these, 80 per cent reported experiencing verbal harassment, 5.3 per cent reported physical harassment, and 3.6 per cent reported sexual harassment.

The most commonly reported consequences of being harassed were burnout (57 per cent), poorer professional performance (39 per cent), and depression (27 per cent).

Other consequences

Other consequences included weight change (15 per cent), alcohol use (6 per cent), and illicit drug use (1 per cent). In addition, two per cent of the harassed population reported that the experience led to them leaving the residency programme to work elsewhere.

The researchers also discovered that most of the victims did not tell anyone about their experiences with harassment. Further, only 31 per cent said they had sought help to deal with the harassment.

The researchers also examined the relationship between reported bullying and resident and residency programme characteristics, and found significant associations between harassment and speaking a native language that was not English, being an international medical graduate, higher post-graduate year level, and international residency training.


The publication advised that the first step in stopping harassment was to increase awareness that it is a significant problem in medical education.

Leaders in education and the directors of training programmes should be fully cognizant of the problem in order to begin working to further understand and eradicate harassment from medical education and health care delivery services.

Further, the article recommended that addressing harassment requires going to the source. The solution certainly does not involve building resiliency among residents in training.

The researchers stated that resilience does not come into play in the matter of harassment, as the problem sits squarely and entirely with the bullies.

Dr Derrick Aarons MD, PhD, is a consultant bioethicist and family physician; a specialist in ethical issues in health care, research, and the life sciences; the health registrar and head of the health secretariat for the Turks and Caicos Islands, and a member of UNESCO's International Bioethics Committee.

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