asshole avoidance

Recently a trainee doctor left me a message on the website asking for some help with dealing with a number of senior colleagues who were bullying them in the workplace. Unfortunately, he or she did not leave any contact details. But given that this is certainly not the first time I have been asked for help in this manner I thought it would be a good idea for me to share some thoughts on the subject.

I want to make this a practical post for any of your struggling with dealing with difficult behaviour in the hospital or community medicine. I’m more than happy to write an article on the causes or potential solutions to bullying and in fact, have done so in the past. But this post is for those of you already immersed in the problem with no hope of a rapid culture change program to bail you out right now.

So here are a few practical tips for things you can do or try if you are encountering a bully in medicine. You can:

  • use distance to avoid the doctor bully
  • dodge and avoid encounters with the doctor bully
  • slow down the rhythm of encounters with the doctor bully
  • become invisible to the doctor bully
  • find someone who can act as a “bully blocker” to the doctor bully
  • tag-team with partners to deal with the doctor bully
  • find or establish safety zones for recovery from the doctor bully
  • establish an early warning system to avoid doctor bullies

I do however emphasise that this is a list of tactics for dealing with the acute issue of a bully in the workplace. For long term problems, there is a need for a more systemic approach. But given that hospital cultures often take years and many trainee doctors rotate every 10 to 26 weeks or so, some practical tips are justifiable.

So let’s explore these tips one by one in more detail below.But first, let’s credit the source of inspiration which is Professor Robert Sutton who is, in my opinion, the world’s leading authority on workplace bullies or what he terms “assholes”. He has written a number of books on the topic all of which I would highly recommend. But the inspiration for this particular article comes from one of his later books. The Asshole Survival Guide.

Tip 1 Keeping Your Distance

This may seem obvious but most places where we work in Medicine afford us a fair deal of space. As Sutton points out in his book generally the closer you are to someone in the workplace the more often you communicate. Which is great if you get on with that person, but if that person is a bully then closeness is a bit of a problem. You may not be able to get the bully to move away from you but perhaps there are opportunities for you to move a bit further away to avoid being in the line of fire?

For example, can you move desks or change your presence in the ward round line? Maybe rather than accompanying them in the lift, suggest you are happy to wait for the next one or take the stairs instead. Or rather than sit opposite them in a meeting, sit on the same side of the room but a few chairs down so that its harder to make immediate eye contact?

If you are in some sort of position to get the bully themselves to move you might try to the trick that a few university professors used to move on a rather pompous colleague. They offered the colleague a new and better office away from the main campus and the colleague took the bait and was rarely seen again.

Tip 2 Dodging and Weaving

This next tip may take a bit of creativity. But if you think about it there are often all kinds of reasons not to be near a bully when you are working in a hospital or other health care environment. Perhaps a sick patient needs to be urgently reviewed. Perhaps there is a relative that needs to speak with a doctor. Perhaps you can be off collecting the XRays for the XRay meeting (OK yep I know these are mainly on the computer these days but you get where I am going with this).

Tip 3 Slowing the Rhythm

This next tip is especially effective if the doctor who is bullying you is keen on having a series of communication exchanges with you, and can work especially well if its something like email.

To perfect this you will need to adopt a “passive-aggressive” approach. What you are trying to do is break the momentum of the bully so that they don’t get rewarded by the bully exchange and eventually get bored and move on.

When a bully comes at you in full throttle it is tempting to try to respond and defend yourself. But this actually gives the bully a response and a dopamine rush which is exactly why they are engaging in the behaviour.

So rather than fight back directly. Offer to take on board the bullies comments (criticisms) and do some research or some thinking, and indicate you will get back to them. And then take your time. Chances are they won’t follow up.

If its an aggressive email. Park it and respond at another time. Chances are there are a number of issues that need responding to in the email. Just pick the lease controversial one and respond to it. Ignore the others and wait to see how the bully responds.

Tip 4 Hide In Plain Sight

We obviously do have to turn up to work, do our job and associate with those doctor bullies. But bullies often only notice you when they believe you’ve done something wrong or offensive. You might find it easier to “be there” but not being noticeable.

How does this work? Try being boring. Do consistent work but not good work (at least not good work that is noticed by the bully). Be quiet when others are talking in the presence of the bully. Let them be noticed not you. Find opportunities to be more engaged in other things, such as lingering over your breaks or taking a bit longer to perform that cannula that needs to be done. Anything that has you there but in the background.

For those of you who like wearing crazy socks to work (and I’m certainly a fan of crazy socks) perhaps this rotation is the time to get the beige ones out of the bottom of the pile instead.

Tip 5 Find a Human Shield

In Medicine, there is often several layers of hierarchy. You may for example, as a resident, find that your bully is a burnt-out senior consultant but that there are sympathetic junior consultants or specialty trainees willing to help act as a buffer or barrier for you.

Treat these people kindly (the buffers not the bullies). Not only do we obviously need more of them in Medicine. But you will also find that they can help you more if you can minimise the attention you might draw from the bully by not only doing your job well but supporting the doctor buffering you in their job.

Tip 6 Form a Team

As an alternative to finding a human shield, you may be able to collaborate with your peers to alternate your exposure to bullies and assholes in the workplace. Taking it, in turn, to be in the firing line and supporting and debriefing each other as you go.

Perhaps you can make a compact with your colleague to never leave each other alone with your bully.

Tip 7 Safe Zones

The ultimate safe zone for a trainee doctor to shield them from a senior bully colleague is the resident doctors’ lounge. A surprising amount of work can be done from most lounges these days with the aid of IT – checking results, calling for consults, and completing discharge summaries for example.

Psychologically you also know that you are safe for the time that you are in the lounge and of course you often have the support of your colleagues available.

Want a more immediate safe zone? Try the bathroom. If the bully is in full throttle and you are feeling the tears start to well up a quick dart to the bathroom could be the fix to calm your feelings and restore your resolve.

Tip 8 Early Warning Systems

Many bullies have good and not so good days. Having systems in place to prepare the team for a bully on a bad day can be helpful so that people can prepare, leave or hide, hide in plain sight or group together.


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