“A lot of people just wish I would shut up, but I won’t” – how a surgeon has made it his mission to stand up to bullies and discrimination.

Orthopaedic surgeon and campaigner Simon Fleming, tells Adele Waters why driving a positive workplace culture is so important.

“You've ruined your career.” “You'll never work in this town again”. 

These are just some of the verbal attacks that Simon Fleming faced from senior doctors, ironically, after he published the findings of a survey on the extent of bullying among orthopaedic trainees seven years ago.

The results, which revealed that junior doctors were being routinely undermined at work, prompted Fleming, then president of the British Orthopaedic Trainees Association, to set up the #HammeritOut initiative

Supported by several organisations, including the Academy of Medical Royal Colleges and the Royal College of Surgeons, it was the first anti-bullying campaign in UK medicine.  

“It was such an eye opener for me because the campaign was met simultaneously with applause and open arms publicly but privately, with threats and resistance,” remembers Fleming.

But if such attacks were intended to silence Fleming, they had the opposite effect – he has been challenging toxic cultures in the NHS ever since.

“I have built a reputation for standing up to scary people and scary things, of not being afraid to say the uncomfortable, difficult things. I’m not doing it to get likes on social media or for personal plaudits, it’s because I want to solve real problems.”

Today he has established himself as an acceptable face of culture change and is regularly asked to speak at conferences on the subject.  

“It’s probably because I've weathered everything that's been thrown at me, whether it's been vexatious GMC threats, death threats, you name it. I've shrugged them off and dealt with them.”

Having recently qualified as an orthopaedic surgeon, Fleming is currently completing a surgical Fellowship at the Royal North Shore Hospital, in Sydney Australia. He would like to work in the UK but is exploring options for him and his family to move to Australia or Canada.

Although he no longer has an official representative role, he continues to engage in advocacy work, describing himself as a ‘change maker’ because, he says, “nobody will publish a positive description of a shit stirrer”.

“My father was a Holocaust survivor and extremely traumatised by that experience,” he confides. “He talked about how he perceived the role of being a bystander, believing it is the job of those with power and privilege to protect those without.”

At school, Fleming found himself bullied relentlessly for “being Jewish, for being overweight, for preferring books over sport, for being too smart or not smart enough or for not being ‘one of the lads’.” He found a brief respite at medical school (St Bartholomew’s and The Royal London) but was disappointed to find regular exposure to bullying behaviour while working life as a junior doctor in the NHS. 

This ranged from innocuous comments along the lines of ‘you should know your place’ to blatant discrimination.  “I once heard a consultant say in an open forum that there are two kinds of female surgeons, the kind that shouldn't be surgeons and the kind that shouldn't be females,” he says.  

“As house officers, we were continuously made to feel small and like a burden. As a trainee surgeon, I became used to being down to, infantilised and undermined. It was part of the culture.”

A move into medical education showed him that it was possible to be treated as an adult and with his views respected. He went on to complete a PhD in medical education – a subject that he is as equally passionate about as surgery. 

After subsequently securing a place on an orthopaedic training programme, Fleming decided he wanted to do something to challenge toxic cultures. “I thought I can't sit on my hands anymore. There's so much that I've seen, witnessed and experienced that is good about surgery. But there is so much that is absolutely shocking. I witnessed bullying and I'd been bullied. I’d witnessed sexual harassment,  homophobic abuse, racism, discrimination – the whole spectrum of toxic culture behaviours”

Activism has paid off, he says. “I've seen the changes that have been made.  I've met those from underrepresented and diverse groups who have said to me, ‘you've made me think I can be a surgeon’.”

He concedes the work to reform the culture within healthcare – both in the UK and internationally – requires constant work as new challenges present themselves but he remains optimistic for the long term. “I’ve learned that it is possible to change culture with a limited budget plus a whole lot of grit, determination and passion.”

He is also determined to continue to be an agent of change. “A lot of people just wish I would shut up - but I won’t. If I am making a bully or predator's day or month worse, or making healthcare safer, fairer, more inclusive, I am doing it right,” he says. “I refuse to be cowed or silenced.”