In fact, the coaches and referees are much like the “police” on the field. The coaches can influence how the game is played, and the referees can enforce rules to prevent certain kinds of violence.
The Doctor and Unasked Questions
It was a routine physical for the fifth-grade boy. The doctor was one the boy had known, and trusted, for several years. Toward the end of the examination, the doctor casually asked the boy his favourite subject. The answer: science. His patient had even won a prize at a science fair and was to go on and compete in a multischool fair.
But the boy was unhappy. He was being teased, jostled, and even occasionally beaten up by other students because of his success at the science fair. This was not a one-time event, but an ongoing pattern that could only be called bullying. The boy’s mother wondered whether life wouldn’t be easier if her son “just let the science thing drop.”
The doctor had a sense of personal outrage. After all, he was a person of science, and he had worked hard to practice as a medical doctor.
Prescription
The doctor encouraged the boy’s mother to call her son’s teacher and complain. And, he encouraged the boy to continue his love of science.
On reflection, the doctor noted what he did not say to his patient or to the boy’s mother:
And here are three things I now know I should have done: I didn’t tell the mother that bullying can be prevented and that it’s up to the school. I didn’t call the principal or suggest that the mother do so. And, I didn’t give even a moment’s thought to the bullies, and what their lifetime prognosis might be.… Research has described long-term risks — not just to victims, who are more likely than their peers to experience depression and suicidal thoughts, but to the bullies themselves, who are less likely to finish school or hold down a job.
So what should I ask at a checkup? How’s school, who are your friends, what do you usually do at recess? (Klass 2009)
What the doctor suggested, as a part of routine examination, was greater medical involvement — of talking not only with his young patient’s parents, but also with their teachers and principal. In effect, the doctor becomes part of a program to change the culture of a school. The doctor attempts to put in motion the kind of ongoing inquiry to get the facts of bullying and then to address those facts not simply in terms of the victim, but also, and perhaps more importantly, activating the bystanders who in the past simply watched the harassment and walked on [emphasis added].
CHALLENGE QUESTION
A Doctor’s Time
Q: In the average appointment time of fifteen minutes, how can a doctor examine a patient, ask the questions relevant to bullying, and follow up if a problem is spotted?
Pediatricians and family doctors — indeed most physicians — have busy practices. Most physicians make a living as a result of the number of patients they see. Their time is limited. As a practical matter, it is difficult for a doctor to give any one patient more than a fixed amount of time.
Many medical schools specifically train doctors to be attuned to their patient’s health through observation — questions as well as tests. Indeed, one hurdle the medical student must jump in Toronto (as in other medical centres) is to diagnose a test patient within fifteen minutes. Many medical students fail the test. Others identify accurately the problem within five minutes.
Five minutes would hardly suffice if the doctors were in practice. There would be tasks of prescribing, perhaps seeking specialist help, and asking the patient to return to see how the treatment is progressing. Identifying a bullying problem is not the same as developing a specific response and then following up to see that the problem has been resolved.
In June 2009, the American Academy of Pediatrics updated and expanded its policy on bullying. It suggested doctor involvement with, among others, parents and schools. It also developed readable brochures addressing specific aspects of bullying that doctors could place in their waiting rooms.
The following, taken from an introductory brochure, is a warning and a challenge, especially to parents who come with their children for a pediatrician check-up:
While bullying has received increased media attention, there are still many misperceptions of this problem and its solutions.
Bullying is different than fighting or teasing. It is repetitive, negative actions by one person or persons against chosen victims.
There are three groups of children involved: bullies, victims, and bystanders.
Bullying prevention is a highly researched and well-proven area of violence prevention. The social dynamics of bullying are similar in most settings — bullies begin the school year by picking on a large number of children. Those children whose emotional responses gratify the bullies become the chosen victims for the year. Victims are smaller and weaker (boys) or more socially isolated (girls) than the bullies. Since harassment rarely occurs overtly in the classroom, teachers may be slow to recognize the dynamics of bullying or to prevent it. Thus, parents should be counseled to discuss bullying prevention with school guidance counselors or administrators. While victims may be more likely to seek medical attention, long-term studies demonstrate that the poorest outcomes are among bullies themselves. Children labeled by their peers as aggressors or bullies at age 8 are more likely to end up incarcerated and are less likely to be steadily employed and in stable long-term romantic relationships by the time they reach age 30. Consequently, bullying prevention programs have a long-term benefit for both bullies and victims.
How to Use This Tool
Since parents and children are concerned about bullying, leave this brochure in the waiting room.
Ask the parents: ‘Is your child picked on in school?’ When you discover a child is being picked on, discuss the specific strategies with parents. Parents should be advised to discuss bullying with the school guidance counselor and/or principal.
This brochure is particularly useful as a handout for school and community groups.
When faced with a child who has an unusual new onset of school phobia or attention problems, gently probe about being picked on or teased before, during, or after school. This child may have difficulty focusing on class work, be reluctant to attend school, or have a variety of psychosomatic conditions.
Victims often internalize the criticism of bullies and feel that they deserve the teasing and may be ashamed.
When the school has alerted parents that their child is aggressive or a bully, insist that the child receive counseling and that the parents take the issue seriously.
When giving this brochure to their parents, note that bullies, especially male bullies, are at a high risk for poor long-term outcomes unless the bullying is stopped at a young age.
The reason why certain students become victims is not always as clear as the Academy might suggest. Sometimes it is simply a matter of happenstance. Sometimes they are chosen simply because they are, for example, new to the school. But this much is certain: they are unable to defend themselves from the taunts of others.
A central questions remains: How can schools establish an anti-bullying environment? A roving school police officer, like a constable on patrol (cop), might lessen the urge for violent behaviour. But, as we shall see, it will do little to thwart such harassment as cyberbullying. In a major article in Pediatrics, the journal of the American Academy of Pediatrics, the authors spoke of the role of teachers as an anti-bullying force:
Teachers play a key role in preventing and intervening with bullying at school, yet they receive little if any help or training in how to effectively deal with such problems. They lack information, and they are reluctant to intervene when they witness bullying. Although teachers have the benefit of understanding the social context of bullying, they do not necessarily know how to best use this