The Risk May Be Inside — Kerbside Consult 22/2026

In the previous Kerbside Consult, When the Patient Becomes the Threat, I asked what happens when the danger in a hospital comes from the patient or relative.

But there is another possibility.

What if the person you fear is wearing the same white coat?

Recent allegations of sexual harassment involving senior doctors in Malaysian hospitals have again raised uncomfortable questions about workplace culture in medicine. They follow years of concern about bullying, overwork and the treatment of junior doctors.

The circumstances are different. Allegations are not findings of guilt, and previous allegations of workplace bullying have sometimes not been substantiated.

But they raise a larger question.

How does medicine handle power?

When hierarchy becomes power

In September 2026, the Malaysian Medical Association called for independent investigations following sexual-harassment allegations involving senior doctors at Hospital Sultanah Aminah Johor Bahru and Likas Hospital. A separate case had also been reported at the National Heart Institute.

Those allegations remain allegations. Those accused are entitled to due process.

MMA nevertheless raised an important structural issue. It proposed that serious complaints involving senior officers should be reportable outside the immediate chain of command, with independent members on investigation panels, clear timelines and protection against retaliation.

Why does the chain of command matter?

Because medicine is hierarchical.

It has to be.

A house officer and a consultant are not clinically interchangeable. Experience matters. Someone must supervise, correct mistakes and ultimately take responsibility for the patient.

But hierarchy also creates power.

Depending on their role, senior doctors may contribute to assessments, training opportunities, work allocation, recommendations and professional progression. Raising a complaint about someone involved in those decisions can therefore feel very different from complaining about a colleague who has no such role.

This does not mean seniority causes misconduct. It means that when misconduct occurs or is alleged, the difference in power matters.

A consultant must be able to tell a trainee that an important diagnosis has been missed. A surgeon must be able to stop an unsafe procedure. A head of department must be able to identify poor performance. Firm, proportionate clinical supervision — including correction and, where necessary, formal performance management — is not in itself bullying.

None of that requires humiliation, intimidation, sexualised behaviour or threats to someone's career.

Medicine needs hierarchy. It does not need fear.

Kerbside Consult infographic showing a clinical hierarchy from consultant to specialist or medical officer to house officer, alongside the Malaysian Medical Association September 2026 proposal for protected reporting outside the immediate chain of command, independent investigation, clear timelines and protection against retaliation, and fair process for both sides. — **Hierarchy without fear: a proposed safer model, not a depiction of the current MOH process.** Clinical seniority is necessary for safe patient care; complaint handling should recognise the power imbalance it can create. The protected-reporting route shown here is based on the Malaysian Medical Association’s September 2026 proposals for serious complaints involving senior officers: reporting outside the immediate chain of command, independent panel members, clear timelines, protection against retaliation and due process for both sides.

This is not merely anecdotal

Malaysian research suggests that workplace bullying among junior doctors deserves serious attention.

A 2021 multicentre study involving 1,074 house officers in 12 government hospitals in central Malaysia reported a six-month workplace-bullying prevalence of 13%. Medical officers were the most commonly reported perpetrators of negative workplace actions, although consultants, nurses and support staff, and other house officers were also identified.

A 2026 multicentre study across 13 Malaysian public hospitals reported workplace bullying among 23.4% of participating house officers. The researchers described heavy workloads and rigid hierarchies and found that a stronger psychosocial safety climate was associated with less bullying.

The two percentages should not be interpreted as showing that bullying has risen from 13% to 23.4%. These were different cross-sectional studies, not repeated national surveillance.

But together they establish something important:

Workplace bullying among Malaysian junior doctors is measurable, not merely anecdotal.

The concern is not new. In 2018, Malaysian medical discussion was already examining the relationship between hierarchical healthcare culture, leadership and workplace bullying. That year, junior-doctor representatives also adopted the Penang Declaration against bullying and harassment.

The organisational response also developed. A 2023 Medical Journal of Malaysia commentary records that Malaysia’s Junior Doctors Network was formed in 2016, describes the 2018 Penang Declaration as its first milestone, and documents MMA’s formal establishment of MMA-JDN in 2022. Its conference memorandum argued that the vulnerability of junior doctors should not be exploited and that senior doctors have a duty to support the next generation.

Reporting, independence and due process

In 2022, following the death of a 25-year-old house officer attached to Penang Hospital and public allegations about bullying, the Ministry of Health established the Healthcare Work Culture Improvement Task Force — HWCITF.

It produced 10 principal recommendations for improving healthcare work culture. Importantly, it did not establish that bullying had caused the doctor's death.

In 2024, following renewed concerns about workplace culture, MMA called for greater transparency over implementation of those recommendations.

The death of pathology specialist Dr Tay Tien Yaa at Lahad Datu Hospital that year again generated allegations of workplace bullying from her family. But the subsequent independent task force reported in January 2025 that it had found no evidence of bullying, oppression or mistreatment.

When another young house officer died at Hospital Sultan Ismail Petra in Kuala Krai in March 2026 and questions about bullying arose, Health Minister Dr Dzulkefly Ahmad similarly cautioned against premature conclusions.

A death followed by an allegation is not proof that bullying caused the death.

But uncertainty about individual cases does not erase a workplace problem demonstrated independently in Malaysian research.

MOH already has MyHelp, a formal reporting mechanism for workplace bullying involving ministry personnel. Sexual harassment is excluded from MyHelp and handled through a separate public-service framework.

But the public-facing portal is slow and not particularly easy to navigate. That is an observation about its usability, not a formal evaluation. Even so, a reporting mechanism must not only exist; it must also be accessible and straightforward to use.

So mechanisms exist.

The harder question is whether someone lower in the hierarchy believes it is safe to use them.

If the person being reported can influence your assessment, posting, training or professional future, is the existence of a reporting portal enough?

This is why reporting outside the immediate chain of command matters.

Can a complaint really feel independent if the complainant must return to the same department and professional hierarchy the following morning?

But independence must work both ways.

Protecting complainants must not mean treating accusation as conviction. Someone accused of bullying or sexual harassment deserves an impartial investigation and a fair opportunity to respond.

A credible system must be strong enough to protect a junior doctor making a genuine complaint and fair enough to clear a senior doctor when an allegation is not substantiated.

What did everybody else in the room do?

There is another group we seldom discuss.

The witnesses.

If a house officer is repeatedly humiliated during ward rounds, others usually hear it. If inappropriate comments become routine, others may notice. If someone who complains suddenly becomes isolated, colleagues may see that too.

In a 1998 Cybermed editorial about a very different issue — doctors' participation in the Malaysian Medical Association and healthcare policy — Dr David KL Quek argued that doctors could not simply complain privately and leave others to act. They had to participate in shaping their profession.

He was not writing about bullying or harassment.

But the principle travels well.

Responsibility for workplace culture cannot rest solely upon the person being bullied or harassed.

That does not mean blaming someone who is frightened to report. Fear of professional consequences may be entirely understandable.

It means colleagues who witness unacceptable behaviour should also know how — and feel safe enough — to respond.

A culture changes not only when victims can speak, but when witnesses no longer assume that silence is the safest response.

Perhaps we are starting too late

There is an intriguing thread running through the old Cybermed archive.

In January 1999, David Quek questioned whether attempts to improve the “caring attitude” of practising healthcare professionals through courses and workshops came too late:

“Would these correct behavioural emphases not have been more beneficial during medical school curricular teaching?”

In July 2000, writing about empathy and communication, he argued that such qualities should be inculcated throughout medical training.

He was discussing the doctor-patient relationship, not bullying or sexual harassment.

But more than a quarter-century later, perhaps the question can be widened.

If we teach future doctors how to care for patients, should we also teach them how to exercise power over one another?

Malaysian medical schools already teach ethics and professionalism. The question is whether future doctors are adequately prepared for the exercise of professional power — supervision, boundaries, bullying, sexual harassment, bystander behaviour and retaliation — and whether what is taught formally survives what students subsequently observe on the wards.

Students watch their teachers.

House officers discover what seniority permits.

Medical officers learn which behaviours are challenged and which are quietly tolerated.

Some eventually become specialists, consultants and heads of department.

This is the hidden curriculum.

The formal curriculum tells students what medicine says it values.

The hidden curriculum shows them what medicine actually tolerates.

A student may hear a lecture about professionalism and then watch a junior doctor being humiliated during a ward round.

Which lesson will be remembered?

Professionalism training therefore has to involve more than abstract ethics. Doctors need to recognise the difference between legitimate supervision and humiliation; between professional relationships and inappropriate personal behaviour; and between remaining a bystander and knowing when and how to intervene.

And training cannot be confined to students and house officers.

Consultants and clinical teachers must be part of it too.

Otherwise the lecture hall teaches one curriculum while the ward teaches another.

Today's frightened house officer can become tomorrow's intimidating consultant. “I went through it too” can become justification for repeating behaviour that should instead have ended with the previous generation.

Medical culture is not inherited genetically. It is taught. Sometimes by what we teach — and sometimes by what we tolerate.

Beyond the delayed wisdom of hindsight

In another Cybermed editorial in October 2000, David Quek was discussing very different ethical challenges when he asked whether medicine had mechanisms to anticipate them — or whether problems would emerge piecemeal, leaving only the “delayed wisdom of hindsight.”

The context was different.

The question travels well.

Malaysia now has research, reporting mechanisms, declarations, task forces and recommendations.

Perhaps the next step is not another slogan or another committee.

It is to determine whether the mechanisms already created actually work when power is unequal.

Prevention should begin in medical school and continue through housemanship, postgraduate training and consultant practice.

When prevention fails, reporting must be safe.

When an allegation is made, investigation must be independent enough to protect the complainant and fair enough to protect the accused.

And when misconduct is established, seniority or clinical usefulness should never become immunity.

Authority is not immunity.

A good hierarchy uses the knowledge of the senior person while protecting the dignity of the junior one.

Hospitals spend enormous effort making patients safe from infection, medication errors, falls and wrong-site surgery.

In the previous Kerbside Consult, we asked what happens when the patient becomes the threat.

Perhaps medicine must also be willing to ask the more uncomfortable question:

How safe is the person standing beside the patient?

Sources & further reading

Malaysian evidence

Ministry of Health Malaysia

Malaysian Medical Association and current reporting

Cybermed Archive — Vads Corner

Published 22/2026 · 18 September 2026 · No corrections to date · Corrections policy