Over the past two years, I have powerfully experienced how unnecessarily destructive it is for doctors to operate in a rigid professional hierarchy – and discovered how far the institutions that regulate the medical practice will go to defend this system.
In June 2015, I completed a feedback form in my internship logbook after a two-month rotation at Durban’s Addington Hospital. I mentioned that on-duty senior doctors were not available after midnight to support junior doctors. I also criticised the department’s tolerance of sexual harassment and racism after I had complained but was advised that nothing was likely to change.
The comments were intended to be constructive, but the response was disproportionately defensive. I was instructed to destroy the logbook and when I didn’t I was labelled a grossly incompetent doctor who was creating a smokescreen to hide my deficiencies. I was ordered to repeat my training and prevented from taking up a new job as a medical officer.
During my two years as an intern, my record had been spotless, so I appealed the decision through the Health Professions Council of South Africa (HPCSA). Eventually, the decision was overturned and I was allowed to register as a medical officer. The HPCSA also found that the doctors involved in my case should be investigated by its ombudsman for professional misconduct.
Last year, I decided to make a YouTube video about what had happened to show that threats to junior doctors are real but can be overcome. I had felt isolated for many months and wanted to encourage others who might be in the same position.
I wanted something good to come out of what had happened to me to justify the trauma.
The video met with a strong, positive response and I was contacted by hundreds of people who had faced similar situations. Where such threats were ongoing, I provided support, including to some at Addington Hospital who continue to deal with extreme bullying.
There was reason for hope.
In January, I appeared before an HPCSA preliminary inquiry committee as investigations continued into the conduct of the doctors who had supervised me at Addington. I played aloud one of the recordings I had submitted in my original appeal – the one in which my supervisor threatens me with arrest if I don’t throw away my logbook. He instructs me to lie about what happened and says he will blackmail me with that lie if I try to retract it.
The audio file was part of a small mountain of evidence I submitted to the HPCSA. It seemed to me that clear cases of professional misconduct could be made against at least two of the Addington doctors involved.
But the HPCSA has informed me that I was mistaken.
The committee did not dispute the facts I presented but, rather than focus its attention on the threats and career sabotage by senior staff, it asked what I had done to provoke the attack.
The chairperson suggested that it was I who should be apologising to my seniors for what happened. The HPCSA has now closed the inquiry, stating that my supervisors “remain ethical, clinical [sic] and professional”.
Meanwhile, the bullying at Addington is worse. Since I left in 2015, at least two more interns have had their careers severely disrupted after complaining. Pushing back seems to have made the management more aggressive, organised and brazen. For me, this – that other junior doctors at this hospital have continued to suffer extreme levels of victimisation – has been one of the most horrifying parts of my ordeal.
In my 2016 viral video, I called on other young doctors to stand up to bullies in the medical hierarchy. But after everything I have experienced in the past two years, I feel I must retract what I said and apologise for speaking recklessly.
Junior doctors, the institutions that govern our profession are not prepared to support you. They demonstrate little commitment to the modern, humane standards of conduct that our generation was promised.
Be warned, if you stand up you will be on your own – your only option will be to fight in court, and your career will suffer.
I was in a privileged position. I had a family that could support me and other career options, but others I’ve been in contact with are not nearly so lucky. And I don’t know anyone who’s met with success.
Almost a year ago, I called for young doctors to take a stand but today I am calling for updated professional guidelines that explicitly discourage the coercion and intimidation of junior doctors.
The many doctors who reached out to me after my video and spoke of similar abuse need to be assured their situations are not hopeless. Without this kind of regulation, the bullying will continue – but so too will the abuse of state funds.
South Africa allows senior public- sector doctors to practise privately and draw two salaries as long as they work a certain number of hours at state facilities, often supervising junior doctors.
We know that some doctors abuse this, failing to show up at public clinics or hospitals.
Junior doctors are often the only ones who can report this kind of abuse. If they are silenced and this abuse of resources continues unchecked, young doctors may find themselves carrying out procedures that they may not be properly trained for and it is patients who will suffer the ultimate cost.
Our silence is essential for senior doctors’ schemes to continue. When feedback is shut down, problems do not get dealt with.
Particularly in the public sector, medicine is not a caring profession. We are treated callously by our employer, and too often we treat other staff members and patients in the same way.
But people work and heal better when they are part of institutions that value them and respect their human dignity.
This year, I have worked in a small rural hospital where budget shortfalls have cut the number of doctors in half. The threat of the complete collapse of services has only sharpened the need to treat staff well, and I am managed by people who care deeply about sustaining an institution that provides holistic care for workers and patients.
We cannot afford to lose more doctors. The lesson is very clear: high workloads and resource constraints are not an excuse for treating staff poorly; they are another good reason to treat people well.
In South Africa in 2017, we can no longer be a profession in which our society’s worst forms of repression are given free rein.
Yumna Moosa is a community service medical officer. Read more at yumnasapology.co.za