Not So Innocent Bystanders: It's Time For All of Us To Accept Responsibility

Editorials
Not so innocent bystanders

It’s time for all of us to accept responsibility
“T
he standard you walk past is the stand- senior colleagues for advancement. 3 These articles
ard you are prepared to accept.” With go some way towards explaining why victims can-
this wake-up call in June 2013, Lieutenant not be expected to solve the problem or even to take
General David Morrison challenged all those serv- primary responsibility for identifying and naming it.
ing in the Australian Army to take responsibility
for the culture and reputation of the army and the
environment in which they work.1 He made this call What can the rest of us, the bystanders, do?
in response to an emerging scandal of sexual abuse
and harassment in the army. At the 2015 Australian How can peers and colleagues not notice inappropriate
Medical Association national conference in May, behaviour going on around us? Or do we notice but
James Lawler, President of the Australian Medical feel disinclined to become involved or reluctant to
Students’ Association, named bullying, harassment, act? And how do we respond if a student or trainee
sexual harassment and their mental health as the comes to us for help and support? Or if we are part of
biggest problems affecting medical students. 2 He a formal complaints mechanism?
explained that he could not tell his peers to take a Those who are perpetrators, whether their behav-
stand against the perpetrators because “the hierarchy iour is deliberate or unconscious, need to know that
is too high and too strong”. Quoting David Morrison, their peers do not accept and will not tolerate it. The
he called on those present to help change the culture behaviour needs to be recognised and condemned as
of medicine. and where it occurs.
The lack of confidence in complaint processes and
“The lack of confidence in complaint
fear of reprisals is a sad reflection of the hidden cur-
processes and fear of reprisals is a sad riculum in medicine, the cultural norms and expec-
reflection of the hidden curriculum in tations that run counter to the explicit curriculum of
professionalism.
medicine”
Discrimination, bullying and sexual harassment are The way forward

illegal and breach both published and implicit codes
of ethics and professional standards in medicine. 3 “Good medical practice”, the code of conduct issued
Yet they are prevalent in medicine and health care, by the Medical Board of Australia outlines the profes-
not only in Australia, but in many other countries sional values on which all doctors are expected to base
and cultures and in other professions, notably law.4 their practice.9 These values include integrity, truthful-
Both men and women perpetrate this behaviour, but ness, dependability, compassion and self-awareness.
the most common pattern is a male perpetrator and Bullying, discrimination and sexual harassment are
female victim. The behaviour affects the individuals incompatible with these qualities.
involved and the organisations they work in, reduc-
ing individual and team morale and performance Problems of discrimination, bullying and harassment
and, in health care, ultimately diminishing patient are not new, but they are increasingly at odds with
safety. 5 the standards expected in the 21st Century. Other
institutions are facing up to the darker aspects of their
Most incidents are not reported. Reasons for this history and culture, bringing them into the light of day
include lack of confidence in complaint processes, and committing to eliminating abuse and exploitation.
fear of adverse consequences, reluctance to be viewed It is time for all of us to accept responsibility for the
as a victim and cultural minimisation of the problem.6
culture and reputation of our profession and work to
Hierarchies lend themselves to misuse of power. Our create environments in which respect is the dominant
profession remains hierarchical, and the further one quality of relationships with our colleagues, trainees
Joanna M Flynn
advances up the hierarchy in many parts of the pro- and patients.
MB BS, MPH, FRACGP fession, the greater the imbalance between the sexes.
Competing interests: I am Chair of the Medical Board of Australia and a member of
This is particularly so in surgery, where only 10% of the Expert Advisory Group of the Royal Australasian College of Surgeons on bullying,
Medical Board of Australia,
Melbourne, VIC.
fellows are female, and few women hold office.7 discrimination and sexual harassment.
joanna.flynn@ In this issue of the Journal, Walton points to the pro- Provenance: Commissioned; externally peer reviewed. 
ahpra.gov.au found power imbalance that exists for junior medi- © 2015 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.
cal staff8 and Mathews draws attention to the system
doi: 10.5694/mja15.00685 of patronage where trainees depend on powerful References are available online at www.mja.com.au.
MJA 203 (4) · 17 August 2015

163
Editorials
1 Australian Army Youtube channel. Chief of Army Lieutenant experiences-of-female-lawyers-in-victoria (accessed Jun
General David Morrison message about unacceptable 2015).
behaviour. 2013; 12 Jun. https://youtu.be/QaqpoeVgr8U 5 Rosenstein AH. The quality and economic impact of disruptive
(accessed Jun 2015). behaviors on clinical outcomes and patient care. Am J Med
2 Lawler J. Australian Medical Students’ Association President Qual 2011; 26: 372-379.
James Lawler’s Speech at the Australian Medical Association 6 Hinze S. Am I being oversensitive? Women’s experiences of
National Conference. 2015; 30 May. https://www.amsa.org. sexual harassment and bullying during medical training.
au/uncategoried/20150530-amsa-president-james-lawlers- Health 2004; 8: 101-127.
speech-at-the-ama-national-conference/ (accessed Jun 7 Stone L, Douglas K, Mitchell I, Raphael B. Sexual abuse of
2015). doctors by doctors: professionalism, complexity and the
3 Mathews B. Sexual harassment in the medical profession: potential for healing. Med J Aust 2015; 203: 170-171. https://
legal and ethical responsibilities. Med J Aust 2015; 203: 189-192. www.mja.com.au/doi/10.5694/mja15.00378
https://www.mja.com.au/doi/10.5694/mja15.00336 8 Walton MM. Sexual equality, discrimination and harassment in
4 Victorian Equal Opportunity and Human Rights Commission. medicine: it’s time to act. Med J Aust 2015; 203: 167-169. https://
Changing the rules: the experiences of female lawyers www.mja.com.au/doi/10.5694/mja15.00379
in Victoria. Melbourne: VEQHRC, 2012. http://www. 9 Medical Board of Australia. Good medical practice: a code
humanrightscommission.vic.gov.au/index.php/our-resources- of conduct for doctors in Australia. http://www.amc.org.au/
and-publications/reports/item/487-changing-the-rules-the- about/good-medical-practice (accessed Jul 2015). 
163e.1 MJA 203 (4) · 17 August 2015

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Editorials

Not so innocent bystanders

Discrimination, bullying and sexual harassment are The way forward

MJA 203 (4) · 17 August 2015

163e.1 MJA 203 (4) · 17 August 2015

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