Bullying Prevention Procedures Missing from Pain Management Practices

Although previous presenters along the Medical/Legal session track of PAINWeek 2013 emphasized the importance of documentation for protection against prescription drug diversion and drug testing report audits, Lisa M. McElhaney, vice president of the National Association of Drug Diversion Investigators, said documentation is just as important for protection against bullying in the healthcare field.

“The best way to combat bullying in the workplace — like if you’re getting an order from a supervisor or administrator to sign prescription blanks or lose your job — is to document it with the date, time, and an email to the person that says something like, ‘I just want to clarify your last directive. This is illegal, so I’m sure you didn’t mean this,’ ” McElhaney advised during her “Bullying in Medicine: Are You the Victim or the Perpetrator?” session. “If the hair stands up on the back of your neck, write it down. If it isn’t written down, then it did not happen.”

To prove that healthcare providers have limited knowledge about these types of procedures, McElhaney asked her listeners at the start of her presentation to raise their hands if they had ever been bullied in their workplaces. Nearly everyone in the audience raised a hand, but when McElhaney asked how many had received training on workplace bullying or established a bullying prevention plan for their medical practice, only six hands out of more than 100 remained in the air.

Part of the reason why there’s limited education, awareness, and prevention of bullying within medical practices is because 42 states have introduced bills through 2013 that address anti-bullying in schools, but only 14 of those bills reference the workplace — which McElhaney said reflects that the workplace has been left out of the definition of bullying. Another reason is that a 2007 survey of 1,069 people — 98 percent of whom said they were targets of workplace bullying — found that while bullying is four times more prevalent than illegal harassment, more than 60 percent of employers ignore the problem, and as McElhaney said, “If it happens once and it isn’t challenged, it soon becomes the norm and we become desensitized towards the bullying behavior.”

Aside from direct physical, verbal, and cyber abuse, McElhaney said the methods of bullying among physicians and other medical staff can include the aforementioned overt example of being told to sign blank prescriptions at the risk of losing a job, as well as covert examples of signing medical forms that are later twisted into something criminal. But McElhaney pointed out that “fear does not always provide a defense, especially in continuing criminal activity.”

“When I take statements, people might say to me, ‘If I don’t do this and I lose my job, who’s going to take care of these patients?’ And my response is, ‘Who’s going to take care of them when you’re in prison?’ ” McElhaney said. “There are no excuses when you’re bullied into an illegal activity by someone above you in the hierarchy, because you’re still committing a crime and you’re going to jail.”

However, McElhaney said that doesn’t mean a physician will go to prison if they get duped by a patient into prescribing controlled substances and then the patient forges new prescriptions.

“Pain doctors come to me shaking in their boots, convinced that I’m going to throw them in jail,” McElhaney said. “As long as you provided legitimate medical care in good faith to the patient and then found out you were duped and immediately reported and documented that, you have not committed a crime.”