Rethinking Leadership in Medicine
Thinking about switching out of your career in medicine, but too afraid to do so? Adam Harrison writes how his experiences of bullying and toxic work environments in the medical field moved him from being a General Practitioner to a life, leadership and executive coach, which he notes as one of the best decisions he has made. Finding leadership positions to help doctors and patients can be just as rewarding as having your own practice.
I graduated from St Mary’s Hospital Medical School, London, in 2000. Twenty years later I became a certified life, leadership and executive coach. Why did I do this and why am I sharing this with you? I guess I wrote this piece in the hope that it may serve my fellow physicians in some way.
Perhaps you too have “suffered the slings and arrows” of working in toxic environments and are having thoughts of modifying your medical career or even quitting medicine completely. Well, I’m here to tell you that despite us being programmed by the system to remain physicians, there is no shame in having such thoughts, and in actual fact, acting on them might be the best thing you ever do for your personal well being.
My ‘origin story’
Like the Marvel heroes, we all have a ‘backstory,’ or ‘origin story,’ to use comic book parlance, and mine goes some way toward explaining why I transitioned out of clinical medicine just under two years ago.
I was born into a modest family; my parents were both working class people with a strong work ethic, not educated beyond high school level, but well-endowed with common sense. My maternal grandfather was a bright fellow, so between the various genetic inputs, I was blessed with an above average brain.
I passed my ’11 Plus’ exam (a British selective school entrance exam) and duly attended my local all-boys ‘grammar school’ (public schools where all the boys had to pass the 11 Plus to be able to attend) from the ages of 11-18.
For the most part I enjoyed school, but I did experience some of the bullying typical of same-sex schools in the UK, at different stages of my secondary school (high-school) career. In addition to this, my step-father was strict to the point of being intimidating at times, so I also experienced what might be considered bullying at home on occasions.
Medical school was generally really enjoyable; the only negative experiences of note were the infrequent dressings-down by old-school consultants (attendings) who believed in teaching by ritual humiliation, their theory being (if indeed there was one!), that if us students were embarrassed in front of our peers, we may not make the same mistake twice.
The working years
As you would expect, the first few years in hospital were pretty brutal. Obviously the hours were extremely long and the work was, on the whole, pretty thankless, but the worst part was how I was treated by various surgical consultants.
You see, I had originally pursued a career in surgery, but unfortunately, a succession of jobs in cardiothoracics, orthopaedics, general / breast surgery and paediatric surgery, each with at least one apparently malignant narcissistic boss, put me off. It made me think that a career as a General Practitioner (Family Physician) might be more enjoyable as I’d have more clinical autonomy; at least that’s what I thought… my experiences as a GP Trainee and then a newly-qualified GP did not support that notion! As it happened, not all GPs were the friendly, helpful, ‘touchy-feely’ types I’d been led to believe; some were downright cut-throat small business owners who, it seemed to me at least, reserved their well-honed kind and caring communication skills for their patients, not utilising them in their interactions with colleagues!
My experience of workplace bullying
I think I had my first taste of this particular flavour of colleague maltreatment when I was a house officer (intern), but I was too distracted by the death of my grandmother to pay it much heed at the time. During my junior surgical training program though, I experienced the hot-headed conduct of my consultants on a regular basis. From shouting at me on a ward round in front of 10-12 colleagues and several patients, to producing a dossier of anything I did which they felt was a minor transgression (and then summoning me to bawl me out about it), to being excluded from the OR due to not being on the official training program, to being cursed at over the phone, to being told I was irrelevant because I was only in the department for six months, I experienced most forms of unpleasant treatment at the hands of my bosses. But I was resilient; my early years had made me that way, so I could take it. I didn’t fold, I didn’t break down. I returned to work the next day as if nothing had happened. I didn’t forget, but I have learned to forgive.
The legal and leadership years
After a fairly unhappy time working in general practice, I left clinical medicine to work for a medical indemnity (defence) organisation, companies which insure UK doctors against medical negligence claims and assist them in responding to patient complaints and action taken against them by the regulators.
I had a primarily medico legal advisory role, but I found this quite frustrating as I became very interested in the legal side of my cases - we had to hand them over to the lawyers when they became particularly meaty, so off I went to law school.
Three years later I qualified as a barrister (a type of lawyer in the UK who mainly advocates for clients in court) but for family reasons I never practised. Instead, I used my law qualification to do advisory work for medical organisations and this led to me being appointed to medical leadership roles.
It was while I was an assistant medical director that I had a series of leadership coaching sessions and fell in love with the idea of being able to have a more positive impact on the world as a coach than I would if I just practised clinical medicine. This heralded my latest (and possibly final!) career move, into the world of coaching.
A happy ending
It didn’t really occur to me that there was a bright side to the conduct I was on the receiving end of all those years ago until quite recently. I was a tutor for some indigenous medical students in Australia last year and one of them came to me for some advice soon after starting her first ever clinical placement. She described being publicly shamed by her consultant in front of the entire medical team she was on after presenting her first ever patient as a student. Her sad story brought the feelings I had experienced as a victim of bullying flooding back and it was then that I decided I could no longer stand by and watch this happen.
I was training to be a coach at that time and, when I completed my training, I started to look into toxic leadership coaching and now I am committed to doing what I can to help doctors who are suffering the effects of working in a toxic environment (or who are being bullied), develop the skills to successfully deal with their situation, so they can be happier and more successful at work.
My experiences of working within poorly-led, often toxic environments, have also fuelled my desire to work with the medical leaders and healthcare executives themselves to enable them to promote positive cultures within both their immediate teams and wider organisations.
I would like to end this article by reassuring my physician colleagues that:
(a) There is nothing wrong (and possibly quite a lot right) with contemplating a career change, despite what the establishment has drilled into us through our undergrad and postgrad training; and,
(b) There is no shame in being bullied, you are not to blame and you are not alone. You can also learn how not to take it personally, how not to let it affect your confidence and how to become more assertive so you can take the conversation to the perpetrator and call it out.
These and other techniques to successfully overcome the sequelae of bullying, will appear in a future article for ‘Physician Outlook’ magazine.
If you would like to learn more about my work or reach out to me for my support, please contact me at:
Clubhouse: @dradamharrison and ‘High-Performing Physician’ (Co-founder)
YouTube: Dr Adam, Physician-Coach