Gaslighting is a form of psychological manipulation that involves abusers seeking control over other individuals by making them question their own judgment and intuition. Bullying is more overt — behavior or actions that people can see from the outside. Most people can witness bullying behavior and recognize that something isn’t right. Gaslighting is more subversive, but still a type of bullying. It dismisses a person’s reality, making them feel like they’re making things up or being too sensitive. It depends on having a gaslighter, who needs to be right, and a gaslightee, who needs the gaslighter’s approval at all costs.
Bullying & Gaslighting in Medicine
Medical culture is rife with bullying and gaslighting. It’s so ubiquitous, it’s like calling water wet. In the medical hierarchy, bullying/gaslighting is used regularly as a way to maintain position in the ranks. Medical students may be afraid of residents and everyone above them. Residents may be afraid of fellows and attendings, and those people afraid of the chair, and the chair afraid of the administration. This vertical power structure limits an individual’s ability to speak out about what’s OK and what’s not OK.
It’s terribly ironic because most people go into medicine to help people, but then power erodes compassion, and all sorts of shit goes down.
Bullying behavior may involve abuse, humiliation, intimidation or insults, at the cost of great distress that may impact mental and physical health. Workplace bullying is more common in healthcare than in other industries and can prove detrimental to the delivery of quality patient care.
How Bullying Manifests in Medical Culture
There may be a denial of privileges, like the amount of time allocated to academic pursuits. Undesirable shifts or duties are sometimes given only to certain staff. Denying or delaying promotions for an extended period with insufficient explanation or justification can also qualify as bullying. Other examples include repeatedly declining to put someone’s name forward for a leadership position or preventing some from sitting on or chairing committees.
Women, people of color, trainees, residents, and younger physicians tend to be the most frequent targets for bullying. Trainees need a degree to qualify as doctors, and residents need someone at a higher level to sign off on their certificate, for example. A person in a position of power can affect whether someone gets that degree or certificate. Younger physicians who aren’t familiar with a working group’s culture may have fewer support options or allies than more seasoned colleagues. They may have no one to champion for them.
It can take the form of spreading rumors or planting seeds of doubt. Sometimes all it takes is someone commenting offhandedly to others, “ I hope this person doesn’t come in late tonight, because they were late yesterday.” Then others may say, “Oh yeah, I noticed that, too. They are often late.” Little comments like this can put that person in the crosshairs. A similar result may happen if someone tells residents they aren’t going to pass boards.
Often, bullying or gaslighting is done subconsciously as a response to feeling ‘not enough’ — not smart enough, not fast enough, not skilled enough. Ironically, shame is often what causes bullying and gaslighting, and shame is also the result of such behaviors.
How Leaders Can Prevent Bullying in the Medical Workplace
When it comes to leadership’s role in preventing and eradicating bullying in the medical workplace, first and foremost they must have the desire to do so. If a leader doesn’t see an issue with the bad behavior, nothing will change. Those in positions of power need to set the tone for professionalism, inclusion, and flattening the hierarchy. Leaders should strive to create a welcoming and less formal environment. Assuming leadership is committed to reducing and eliminating bullying, they need to be involved in the goings-on of their department. If they rely on intermediaries, they increase the likelihood of bias distorting the information they are given. It’s critical to know what’s going on with your people at the ground level in any organization. If folks don’t feel safe reporting a case of bullying or another form of harassment, they’re sacrificing their own well-being and potentially the safety of patients.
People find it difficult to talk about bullying. They can often work in bad situations for a long time, until they can’t anymore. You can sacrifice your well-being for decades, until it becomes unsustainable.
That’s what happened to me. I left a private practice radiology job 6 years ago after working in a psychologically unsafe place for 16 years. A psychologically unsafe environment is a place where no one speaks up or offers support. I realized I didn’t need to tolerate bullying — that I could go work somewhere else where I’m valued and can have relationships with colleagues based in mutual trust. I now do teleradiology and coach physicians who are being gaslighted and bullied.
Share Your Story
I am currently collecting stories of gaslighting/bullying in a medical setting (patients, trainees, nurses, physician assistants, technologists, physicians, etc.) to raise awareness and provide a safe outlet where people can share what’s happened to them (named or anonymously), and not only heal personally, but pave a new path forward professionally.
I’d love to start a #metoo movement around what’s true and what can no longer be tolerated. This story will culminate in an anthology of stories, a memoir, and an educational text.
If you’ve read this far, I bet you have a story. Your story matters and is key to changing the current system.
You are not alone.
Please email me at firstname.lastname@example.org to learn more about the story project and how you can contribute to this rapidly growing group endeavor.
*Content selected from Kelly, AM. Meltzer, CC. O’Connell, TH. Chonde, DB, Hudnall, CE. No bullying: Underreported bad behavior puts radiologists’ well-being and performance at risk. ACR Bulletin June 2023;78(6); 8-11.
Tracey O’Connell, MD
Tracey is an educator and coach, fostering positive self-worth and sustainable well-being with physicians, teens, and LGBTQ+ as a certified facilitator of expressive writing and Brené Brown’s shame resilience programs. Her change of direction came after many years of feeling “not enough” as a person, a physician, a parent, or a partner. Tracey has found that expressive writing gives us access to who we really are, helps us gain trust in ourselves, and be kinder to ourselves, culminating in a more authentic and wholehearted way of belonging to the world. She has lived in Durham/Chapel Hill, NC since 1992, beginning her medical career in radiology.
As a lifelong learner, she enjoys gardening, hiking, reading, spending time with her spouse of 30 years and their 3 adult children, and remembering what really matters by watching her dog.