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Harmony in the NICU
  1. T H H G Koh, Senior Specialist in Neonatal Paediatrics1,
  2. T S Koh2
  1. 1Kirwan Hospital/The Townsville Hospital Townsville QLD 4814 Australia; guan_koh{at}
  2. 2Koh Enterprise Pty Ltd, PO Box 10209, Gouger St, Adelaide SA 5000 Australia

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    Neonatal intensive care units (NICUs) are stressful places for both parents of babies and health professionals. Most junior doctors in NICUs are competent and find their neonatal experience enjoyable and beneficial to their career. The name neonatal intensive care unit emphasises that the focus is not only INTENSIVE, in terms of trying to cure the critically sick babies, but that our approach is one of intensive CARE: caring for the baby and the parents as much as for other members in the neonatal team. In our NICU, we are fortunate that most members from various disciplines work in harmony. One example of this is the team contribution from neonatal nurses who perform many duties normally done by doctors: taking blood, labelling and sending samples to laboratories, and chasing tests results. It is tragic and disturbing when a small proportion of doctors interpret reasonable efforts by both senior nurses and consultants to ensure optimal care of the babies in NICU as bullying. Although most of us have experienced clashes of personalities it would be unfair to single NICUs as areas where bullying is rampant. To put it in perspective, one of us—THHG Koh—has experienced bullying on three occasions in his 21 years as a doctor: once in general medicine, once in paediatrics, and once in neonatology.1 We would refute the Hobbesian view that NICUs are irretrievably dark, vengeful, and egocentric.

    At a time when vengeance and retribution saturate the electronic and print media, we read with interest the recent articles on the promotion of well being amongst doctors,2 and a Lancet editorial on bullying amongst health professionals.3 Workplace bullying is “the deliberate, repeated, hurtful mistreatment of one person (the Target) by a perpetrator (the bully) whose destructive actions are fuelled by the bully's need to control the target.”4 The incidence of bullying ranges from 5% amongst doctors and nurses in Finland5 to 80% for Australian nurses.6 These findings may be signals of widespread distress amongst doctors and nurses calling for remedial action.

    We have noted with interest that there has not been any discussion about the role of emotional intelligence (EI) in bullying.1 Bullying or disruptive behaviour amongst health professionals is the breakdown of personal and interpersonal skills, or the lack of EI. Espoused by D Goleman, and adopted by industry in recent years EI, not IQ, is emerging as the major contributor to our success in life.7 EI refers to the ability to accurately identify and understand one's own emotions and those of others. It also involves the ability to regulate one's emotions and apply effective social skills to attain personal and workplace harmony. Accordingly, those with high EI are more likely to have the ability to manage feelings such as anger, anxiety, and disruptive behaviour.

    We have suggested that emotion based medicine is as important as evidence based medicine, and should be integrated into the training and practice of health professionals.8,9 In a recent survey among the Deans of medical schools in Australia, we found that one of the six respondents (out of 10 medical schools) had any specific knowledge of EI. We advocate that the medical professions consider EI as an important adjunct in a holistic solution to workplace disharmony.