Workplace Mistreatment in Medicine

Workplace mistreatment is a widespread issue, occurring in all subspecialties in medicine and at all levels of the medical hierarchy. Mistreatment includes discrimination, verbal or physical abuse, and sexual harassment. More subtle forms may include micro-aggressions or gaslighting arising from conscious or unconscious bias. Mistreatment toward medical professionals may lead to burnout, which is defined by the World Health Organization as emotional exhaustion and fatigue. Burnout can contribute to depression and suicidal ideation, which increases the risk for suicide completion. 28% of resident physicians experience a major depressive episode during training compared to 7-8% of similarly aged adults in the U.S. general population¹. An estimated 300 physicians die by suicide every year at nearly twice the rate of the general population¹. Not only is physician mistreatment detrimental to the physicians, but it also negatively impacts patient care. Long-term effects cause suboptimal care practices, medical and medication errors, and decreased patient satisfaction with medical care⁵. It is important to understand the causes and components leading to these statistics in order to prevent them in the future.

Among resident physicians, commonly reported examples of workplace mistreatment include gender discrimination, racial discrimination, verbal abuse and sexual harrassment.² In a 2020 meta-analysis, researchers found 64.1% of resident physicians experienced some form of intimidation, harassment, or discrimination.³ The most common forms of mistreatment were verbal, physical, and sexual abuse. The people who most frequently caused the mistreatment were relatives or friends of patients, nurses, and patients. In another study, researchers found similar results with the additional conclusion that women experienced more gender discrimination and sexual harassment. Patients and their families more often discriminated by gender while attending physicians were reported more for sexual harassment and abuse.²

Even after completion of residency training, attending physicians can experience workplace mistreatment. A 2021 cross-sectional study surveyed nearly 600 attending anesthesiologists about microaggressions. 94% of female physicians reported experiencing sexist microaggressions of hearing or seeing degrading female terms and images. 81% of minority physicians experienced racial and ethnic microaggressions. Of note, levels of burnout were higher among female and minority physicians, associating increased workplace mistreatment with increased levels of burnout.

One way to combat workplace mistreatment in medicine is to educate all levels of healthcare workers about what abuse looks like and empower them to be “upstanders” instead of passive bystanders.⁵ Strategies include educating healthcare workers on how to intervene when they observe abuse or mistreatment, either through direct or indirect intervention. Direct intervention involves acknowledging abuse or micro-aggressions and starting a conversation about it such as saying, “I heard you say this, which makes me feel…”. By addressing the behavior, the perpetrator may realize the behavior is unacceptable in the workplace and can self-reflect on the perspective that led them to behave in that manner. Indirect intervention redirects attention by shifting the conversation to other topics, which may be a valuable tool when bystanders do not feel comfortable directly addressing the perpetrator. With widespread education, time, and cultural change, hopefully, the prevalence of workplace mistreatment will decrease, leading to downstream effects of better mental health for medical professionals in the future.

References

1. American Foundation for Suicide Prevention. (n.d.). 10 Facts About Physician Suicide and Mental Health [Brochure]. New York, NY: Author.
2. Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Angelantonio ED, Sen S. (2015). Prevalence of Depression and Depressive Symptoms among Resident Physicians. JAMA, 314(22), 2373. doi:10.1001/jama.2015.15845. PMID: 26647259; PMCID: PMC4866499.
3. Bahji A, Altomare J. Prevalence of intimidation, harassment, and discrimination among resident physicians: a systematic review and meta-analysis. Can Med Educ J. 2020 Mar 16;11(1):e97-e123. doi: 10.36834/cmej.57019. PMID: 32215147; PMCID: PMC7082478.
4. Sudol NT, Guaderrama NM, Honsberger P, Weiss J, Li Q, Whitcomb EL. Prevalence and Nature of Sexist and Racial/Ethnic Microaggressions Against Surgeons and Anesthesiologists. JAMA Surg. 2021 May 1;156(5):e210265. doi: 10.1001/jamasurg.2021.0265. Epub 2021 May 12. PMID: 33760000; PMCID: PMC7992024.
5. Ehie O, Muse I, Hill L, Bastien A. Professionalism: microaggression in the healthcare setting. Curr Opin Anaesthesiol. 2021 Apr 1;34(2):131-136. doi: 10.1097/ACO.0000000000000966. PMID: 33630771; PMCID: PMC7984763.