Harassment in Medicine: A Systemic Problem Openly Spoken About by a Doctor from the National Cancer Institute
Among the numerous problems that accompany Ukrainian medicine today, the majority of society pays attention only to those that are clearly visible: lack of funding, old equipment, mass emigration of doctors, staff shortage. However, there is another layer of reality that is left in the shadows not only by external observers, but also by medical workers themselves. It is about the phenomenon of systemic pressure, psychological violence, discrimination and humiliation, i.e. harassment, which has become commonplace in many hospitals and polyclinics.
This pressure is not always loud and obvious, it hides in the form of a superior tone of the manager, tactless remarks from patients, silent ignoring of complaints, secondary victimization after a conflict. It forms an internal barrier of silence – doctors rarely dare to talk about it openly, for fear of losing their job or facing additional pressure. At the same time, the consequences are very specific: burnout, decrease in professional motivation, transition to another profession, emigration.
Today, this topic does not require backroom conversations, but public reflection. And this is exactly what Ksenia Bolgarina, a clinical oncologist at the Department of Bone Marrow Transplantation of the National Cancer Institute of the National Cancer Institute, tried to do. presented the results of a large survey of doctors and gave an analysis of the causes, forms, and consequences of unemployment in the Ukrainian health care system. In her presentation, there are not only numbers, but also an attempt to understand: why the problem has become the norm, why it remains invisible to the system, and what exactly can be done to move the situation from its place.
Ksenia Bolgarina noted that this topic is almost never discussed publicly, although she sees and hears its consequences every day. Amid talk of low wages, equipment shortages, and staffing shortages, the toxic culture in medical facilities remains a backroom topic rather than a systemic discussion.
She explains that harassment does not mean only obvious cases of sexual harassment. It is a broader and deeper phenomenon that encompasses psychological, physical or sexual pressure, as well as discrimination. All that leads to oppression, violation of boundaries, traumatization and destruction of professional dignity. Manifestations of this include aggression from patients — verbal, emotional, threats for an unpleasant diagnosis — as well as tactless comments or gestures, harassment after work, complaints to higher authorities that have no basis, but are aimed at harassment. Manipulation on the part of management, shouting communication, demonstrative ignoring or hierarchical discrimination are also not uncommon. All these, the doctor believes, are the same forms of violence that require reaction and protection, not the habit of tolerance.
To understand the scale of the problem, Bolgarina organized a large-scale anonymous survey among doctors of state and communal medical institutions. 969 respondents took part in it — the largest sample in the history of Ukrainian medical surveys on this topic. The reaction of the medical community was immediate: the questionnaire was filled out every hour during the week. This, according to the oncologist, indicates a deep request to speak about something that has been ignored for years.
According to the results of the survey, the most widespread form of violence in medicine is psychological pressure. In 35.7% of cases, the source of such pressure was patients, in 34.6% — management. Physical violence is most often recorded on the part of colleagues (10%), sexual harassment is also mostly on the part of employees (9.7%). The sample was dominated by specialists under the age of 40 — 52%, as well as women — about 73% of respondents. According to the doctor, this demonstrates the special vulnerability of young professionals, mostly women, to various forms of systemic pressure.
She emphasizes that peer review in the medical environment is not exclusively vertical, that is, not only “from top to bottom”, but also horizontal – between colleagues, in teams. More than 60% of cases of violence come from patients, almost 50% from colleagues, 43% from management. This indicates the general toxicity of the entire communication ecosystem of medicine, where aggression has become the norm. At the same time, 646 medics stated that the experienced trauma had a serious impact on their psycho-emotional state. 568 – admitted that this reduced their professional efficiency. Another 279 doctors were so tired of this pressure that they thought about changing the place of work or even the profession, 196 of them left medicine.
At the same time, Bolgarina explains, the majority do not ask for help – due to the lack of clear response mechanisms, weak legal understanding of the phenomenon itself, as well as the fear that applying will only worsen the situation. Of the 308 respondents who did turn to management, only 8% of cases received any kind of response.
This, as the oncologist notes, proves the inability of the current system to protect doctors. Formally, the legislation guarantees equality and protection, but in practice these guarantees remain declarative. Managers often fail to understand that personnel problems are not a threat to reputation, but a fundamental challenge to the effectiveness of the institution. Legal departments, she explains, are mainly focused on preserving the image of the institution or officials, and not on supporting doctors.
According to her, the toxic culture is fueled by stereotypes, paternalism, the lack of clear policies, and complete ignorance of doctors about their rights. This allows the system to function, leveling individual dignity. In her opinion, it is also indicative that the institutions are not interested in trainings or seminars on combating harassment. Because a doctor who understands his rights and limits becomes “uncomfortable”, while being controlled by fear seems more effective. But whether such a model contributes to development is an open question.
Among the possible solutions that, in her opinion, can be implemented today are the implementation of an internal response policy, the creation of independent ethics commissions and the launch of educational programs. It is worth noting that more than 83% of respondents have never received anti-harassment trainings, simply because they do not exist.
Summarizing, Bolgarina emphasizes: this is not a local problem of individual people, but a systemic defect. It destroys not only professional teams, but also undermines the prestige and capacity of the health care system itself. Doctors, who should save others, are left alone with humiliation and discrimination. In a structure where there are no protection mechanisms, the responsibility shifts to the one who is least protected — the doctor himself.
