KERRY O'BRIEN, PRESENTER: Welcome to Four Corners.

And tonight we go inside Australia's hospitals to reveal an entrenched culture of bullying that's endangering young doctors and patients as well.

VYOM SHARMA, DR., GENERAL PRACTITIONER: In one moment, I could just see how this all happens. Someone bullied him; he bullies someone else. Now it's my turn.

CAROLINE TAN, DR., NEUROSURGEON: It's disgusting, what he did. He made me feel cheap and degraded on a pretext of wanting to help me.

GRAEME CAMPBELL, MR., VICE-PRESIDENT, ROYAL AUSTRALASIAN COLLEGE OF SURGEONS: The bottom line: bulling, humiliation: it impairs performance. If the doctor's performance is impaired then that's not going to result in good patient safety.

KERRY O'BRIEN: Every day around the country, Australians put their lives in the hands of doctors and surgeons in our hospitals. We like to think compassion is at the core of their dedication. We would certainly like to think their mind is on the job.

But a Four Corners investigation has laid bare a toxic culture of belittling, bullying and bastardisation, which is poisoning the lives of young trainee doctors in some of our major teaching hospitals.

One study suggests suicidal tendencies are widespread.

We first glimpsed this culture a few months ago when the case emerged of a female surgeon whose complaint of sexual harassment virtually ended her career in the public hospital system.

It was not an isolated case but, rather, an example of an endemic and widespread problem which the peak bodies in medicine are struggling to deal with.

The reporter is Quentin McDermott.

QUENTIN MCDERMOTT, REPORTER: In the rarefied world of Melbourne neurosurgery, one name is guaranteed to evoke a strong reaction: Dr Caroline Tan.

Early on in her career, Dr Tan broke an unwritten rule for surgeons who work in public hospitals.

CAROLINE TAN: Don't rock the boat. Don't complain. You know, never complain.

QUENTIN MCDERMOTT: After Dr Tan accused a senior surgeon of sexually harassing her, her career in public hospitals was derailed.

CAROLINE TAN: I find that doors are closed to me that would otherwise be open to other people, so I've suffered enormous detriment.

QUENTIN MCDERMOTT: Two months ago, Dr Tan's case provoked a public outcry when a fellow surgeon made a chance remark at a book launch.

GABRIELLE MCMULLIN, DR., VASCULAR SURGEON: I perhaps unwittingly made the remark that Caroline- if Caroline had, instead of, ah, refusing sexual advances that night, had given the surgeon a blow job, she would've been in a much better position.

I was emphasising the point that, um, it is very dangerous to, um, either refuse a sexual advance when it happens or complain about it.

QUENTIN MCDERMOTT: In a speciality like neurosurgery, graduating doesn't happen overnight. It can take 15 years to become a fellow of the Royal Australasian College of Surgeons.

And the stakes are high: bad marks from a surgeon supervising a trainee can ruin their hopes and ambitions.

GABRIELLE MCMULLIN: It's one of the failings of the training scheme that all of the trainees are at such mercy of their supervisor.

QUENTIN MCDERMOTT: Most supervisors in surgery are male - and some don't believe women have a place in the profession.

CAROLINE TAN: I remember a few weeks after I started working in Adelaide, being in theatre with one of the neurosurgeons. And he said to me, very bluntly: "Caroline, you've got to have rocks in your head if you want to be a neurosurgeon. You should be at home, bringing up a family."

Um, and I meekly responded, "Well, your wife's an ophthalmologist." And he said, "Well, that's different. She doesn't work after hours."

GABRIELLE MCMULLIN: I think every woman in surgery would tell you that they have had similar remarks made to them.

And in fact, in the last few days I was told of a young woman in surgical training who has informed, um, her supervisor that she's pregnant and she has received an email from him, saying that she'll need to give up surgery and become a GP.

QUENTIN MCDERMOTT: The incident that almost ended Dr Tan's career occurred when she moved to Monash Medical Centre in Melbourne. There, one of her key supervisors was neurosurgeon Chris Xenos.

CAROLINE TAN: To start off with it was very harmonious. He seemed to be supportive of me. It was... just incredible, having somebody take me under their wing. And, and I remember telling all my friends, um, how lucky I was that I'd found somebody who seemed to have a genuine interest in, in actually nurturing my development as a, you know, young neurosurgeon.

QUENTIN MCDERMOTT: But one night her luck ran out.

On that evening, Dr Tan met Mr Xenos in his rooms and her account of what happened next would become the focus of a long and bitterly contested legal battle.

CAROLINE TAN: He spoke to me on the phone and said that he was in his rooms and invited me to come around after I finished my work on the ward for a tutorial, which I didn't think was untoward.

We then proceeded into an inner room where there was a desk and a textbook open on the desk. And the next thing I recall is that, um... he groped me and, um, and then as I tried to turn around I, I saw that he... he had his, um... He had exposed himself.

And he said, um... um... "Do you want to get down on, on this?" It's... you know, it-it, it was, it was just ghastly. Ghastly and I, I just, I just fled.

QUENTIN MCDERMOTT: Caroline Tan says she retreated in shock, overwhelmed by what had occurred.

CAROLINE TAN: I spent, ah, the night just crying inconsolably, but I turned up to work the next day, you know, and, and, ah, I, I tried to act as if nothing had happened. But it was difficult, you know, and I was prone to just breaking into tears at the slightest provocation - even no provocation.

QUENTIN MCDERMOTT: Dr Tan had to continue working alongside Mr Xenos.

CAROLINE TAN: Some time after the incident, he had a word to me in a corner and said, "You know, you've got to pull yourself together and move on." And, and I said to him, "Well, how do you expect me to after what you've done?"

You know. It's, it's disgusting, what he did. You know, he made me feel cheap and degraded on the pretext of wanting to help me. I mean, th- that to me was the ultimate betrayal of my trust.

QUENTIN MCDERMOTT: Two or three months after the alleged assault, Dr Tan approached the head of neurosurgery at Monash, Andrew Danks.

CAROLINE TAN: To my surprise Mr Danks said, "Well, I do think you dress very well but I think you dress too well," or words to that effect, which, which then made me get the dis- the impression that he was saying that I had essentially invited, you know, the harassment.

GABRIELLE MCMULLIN: It seems to be a common theme in issues of sexual harassment that women get blamed for inviting the attack or the approach. And, um, and in fact women often, ah, who, who have been assaulted often look back and try and think: why did this happen to me? And maybe it was the way I dressed.

So it's a very common perception, um, that it's all about you and what you look like.

QUENTIN MCDERMOTT (to Caroline Tan): Were you scared at that point to make a formal complaint?

CAROLINE TAN: Yes, I was. I was worried that I might be perceived as a troublemaker and, and treated appr- accordingly, you know.

QUENTIN MCDERMOTT: But after confiding in her boss, her working life became harder.

CAROLINE TAN: The relationship between myself and Mr Danks deteriorated very badly, ah, and in my final assessment he was extremely critical of me and, and essentially he said I f- um, did, had not performed satisfactorily for that last six months.

QUENTIN MCDERMOTT: Was any of that criticism of your clinical performance justified?

CAROLINE TAN: There were times that year when I really was struggling to, to keep it together and sometimes it was difficult. But no, I reject the, the, um, criticisms that I wasn't performing satisfactorily.

QUENTIN MCDERMOTT: Caroline Tan was appalled to learn that Chris Xenos - the man she accused of sexually harassing her - had played a part in her last performance assessment.

She appealed for help to the Royal Australasian College of Surgeons, the body that has the final say on who graduates.

CAROLINE TAN: I wrote to them and informed them that I felt my last performance appraisal was not fair, as somebody who had, had sexually harassed me had participated in, in that performance appraisal.

And I was advised that it was not a matter for the college to get involved in; that it was an internal hospital matter.

QUENTIN MCDERMOTT (to Graeme Campbell): It was wrong of the College to say that, wasn't it?

GRAEME CAMPBELL: Well, Quentin, I think, ah, at the time the college took the view that, ah, it was better dealt with, ah, through, through the, through her employer. I think now we'd probably take a different view. We would regard it as something that the college would want to be, be more aware of and take a more active view to make sure her, er, concerns were being addressed.

QUENTIN MCDERMOTT (to Gabrielle McMullin): What does that say about the way the Royal College has treated complaints of sexual harassment in the past?

GABRIELLE MCMULLIN: It means that, despite the fact that they say they have, um, robust processes, that they're completely disinterested and do not give any credence at all to any complaints.

Ah, i- And the proof of the pudding is that no woman at the moment is prepared to give a name to any complaint.

After the remark that I made, for which I was lambasted, um, a dozen women came forward anonymously to say that exactly the same sort of thing had happened to them. And that's why it's become such a huge issue.

GRAEME CAMPBELL: Clearly there's been a problem in open reporting of this. And if there's one message that I could get out there: the only way we're going to deal with bullying or harassment is if it's reported. So in that sense we owe Dr McMullin, ah, a sense of gratitude because it's now in the public arena.

(Footage of Dr Tan in consultation with a patient)

CAROLINE TAN: And no more pain down your arm, have you?

QUENTIN MCDERMOTT: After receiving Dr Tan's complaint, the College of Surgeons recommended she should see a psychiatrist.

CAROLINE TAN (consultation): It's been on the low side since the surgery.

(Footage ends)

CAROLINE TAN: Clearly the inference was that I was mad. Well, I completely reject that, you know. It's... They like nothing better than to put down whoever's criticising them.

GABRIELLE MCMULLIN: I think it's completely ludicrous. Um, that someone feels that they have been sexually assaulted is obviously not a psychiatric problem.

QUENTIN MCDERMOTT: Dr Tan felt she had no option but to make a formal complaint to Monash, alleging that Mr Xenos had sexually harassed her.

(to Gabrielle McMullin) When she made her formal complaint, was she brave or foolhardy?

GABRIELLE MCMULLIN: Mm... I, I think she was backed into a corner. Um, I mean she... The reason she didn't complain initially was that she was aware of how dangerous it was to complain. She knew that she was, um, beholden to this man; that, that he had her career in his hands, um, and she didn't want to go down that path.

She only, ah, took action when she was threatened with failure. And this was having spent 15 years, um, working... oh, you know, endlessly, um, to suddenly be faced with losing it all.

QUENTIN MCDERMOTT: The hospital's review concluded that Dr Tan's complaint against Mr Xenos of "sexually molesting" her in his private consulting suite was "not established."

(to Caroline Tan) Was that investigation satisfactory?

CAROLINE TAN: It was a whitewash. It was a whitewash and then they, they came to a conclusion they wanted to come to.

QUENTIN MCDERMOTT: Dr Tan took her case to the Victorian Civil and Administrative Tribunal. During the lengthy hearing, she was put under intensive cross-examination about her performance as a trainee.

STEPHEN CURTAIN, LAWYER, AITKEN PARTNERS: This was a sustained attack on Dr Tan and her character. And Mr Xenos brought into account her competency as a factor bearing upon that issue.

And so Dr Tan had to withstand that sustained attack on her character throughout the course of the three weeks.

QUENTIN MCDERMOTT: Giving evidence under oath, Chris Xenos denied he'd sexually harassed Dr Tan and said she'd invented the assault because she was in danger of failing her neurosurgical training.

But the Tribunal's judge found Dr Tan's complaint was "proven" and awarded her $100,000 in damages. She said Dr Tan had been a credible witness and it was "more probable than not" that the incident occurred as Dr Tan had described it.

(to Stephen Curtain) The Judge made some very trenchant comments, didn't she, on Mr Xenos?

STEPHEN CURTAIN: She did. She said, "I have found that he deliberately and falsely denied the harassment. In conducting this case, he has attempted to completely smear her character. He has explored every possible aspect of her professional competence and has produced very little of relevance to this trial."

QUENTIN MCDERMOTT: The judge was scathing in her condemnation of how Mr Danks, the Head of Neurosurgery at Monash, had taken sides in the case.

STEPHEN CURTAIN: Her Honour found Dr Danks to be a partial witness. She was concerned about the relationship that he had with Mr Xenos and the fact that he'd called Mr Xenos before the hearing and wished him well.

Judge Harbison said, "He appeared not to understand his responsibility to deal with a claim such as this with an impartial and fair manner."

QUENTIN MCDERMOTT: Following the case, Chris Xenos was given a first and final warning by the hospital. He remains a neurosurgeon at Monash, where his employers say his behaviour has been "exemplary."

GABRIELLE MCMULLIN: There there's a phenomenon known as the "good guy" phenomenon, um, in which men recognise that another man is a good guy and if he's a good guy then he couldn't possibly have done something wrong. And I think that that plays a strong part in this.

QUENTIN MCDERMOTT: So they've decided Chris Xenos is a good guy?

GABRIELLE MCMULLIN: Yes and that he couldn't possibly have, um, assaulted her that night.

QUENTIN MCDERMOTT: Mr Xenos is still respected by many in the profession.

IMOGEN IBBETT, DR., NEUROSURGERY REGISTRAR: I found him to be probably one of the most professional people I've ever worked with. Um, he's an excellent surgeon and he's an absolutely excellent teacher.

Um, he really cares about the trainees. He's very dedicated to, ah, to teaching us, um, and he's extremely supportive. Um, and I think you would struggle to find a trainee who didn't, um, really like and respect Mr Xenos.

(Footage of Dr Tan in consultation with a patient)

CAROLINE TAN: So you're sleeping OK?

QUENTIN MCDERMOTT: Dr Caroline Tan won her case, but lost the war. After graduating as a Fellow of the Royal Australasian College of Surgeons, she is now restricted to working almost solely in the private sector.

(Footage ends)

CAROLINE TAN: Now, looking back, it seems like a bit of a pyrrhic victory because I seem to have suffered a lot for having had the temerity to, to take Chris Xenos to court.

I believe very strongly that, that I've been victimised, because I see other people getting ho- public hospital positions, sometimes without even going through an application process.

GABRIELLE MCMULLIN: She has no presence in the public sector and I think it's sad that she never will have. Um, this is a woman who has dedicated her life to the study of neurosurgery.

This is what her life work was going to be and it has been cut short because of the actions of this man and the actions of the college.

QUENTIN MCDERMOTT: Will the College apologise to Dr Tan?

GRAEME CAMPBELL: Um, I think we're certainly sorry for events that happened. Um, ah, at this stage I don't think there's, we can't re-litigate them, but at this stage I think we need to learn some lessons and move forward. I think that would be the most useful thing we can do.

(Footage of Vyom Sharma onstage with Katy, an audience member)

VYOM SHARMA: It's going to go up. You're going to (makes 'pop' noise with his mouth) and catch. Then, to rapturous applause, you will remove the egg.

It's Sunday night at the Melbourne Comedy Festival and Dr Vyom Sharma is getting away from the pressures of his daytime job as a GP.

VYOM SHARMA: Now, now, now, now, don't freak out, Katy, because we are going to clean both before and afterwards, so it's all good. OK? So step one: straighten the index finger. Step two: stick it in my mouth.

(Katy puts her finger in Vyom's mouth to make 'pop' noise without success. Audience laughs)

VYOM SHARMA: I-I didn't actually think you were going to do that. (laughter)

(Footage ends)

(Footage of Dr Sharma in consultation room)

VYOM SHARMA: All right. Come in, Laura. Have a seat at the end of the bed.

LAURA, PATIENT: Thank you.

QUENTIN MCDERMOTT: Underneath his confident exterior, Dr Sharma bears the scars of the experience he had in medical training.

VYOM SHARMA: Open your mouth, stick your tongue out and say "ah".

LAURA: Aaah...

VYOM SHARMA: That's pretty good. Excellent.

(Footage ends)

QUENTIN MCDERMOTT: He gave up his ambition to be a surgeon after witnessing bullying and being bullied himself as a young doctor.

VYOM SHARMA: It was a very powerless situation to be in. And it really made me reconsider, you know, what exactly I was doing, ah, in medicine and, and where I was heading and, and what I wanted to be like.

QUENTIN MCDERMOTT: Vyom Sharma's early illusions about surgery were shattered when, as a 22-year-old, he started training at one of Melbourne's most prestigious teaching hospitals.

(Footage of Dr Sharma in consultation room)

VYOM SHARMA: Great. Just take a deep breath in and hold it.

QUENTIN MCDERMOTT: There he received a stark warning from the intern who preceded him.

VYOM SHARMA: Great.

(Footage ends)

VYOM SHARMA: He said, "The next 10 weeks are going to be a very difficult period, ah, of your life." And I asked, "Why is that? Is it because it's a lot of work? Is it a lot of responsibility? Because I'm, I'm prepared for these things." And he said, "No. Ah, you will get bullied." I was just absolutely horrified.

And so, of course, it began and, ah, and it was absolutely true.

QUENTIN MCDERMOTT: The bully was a senior registrar.

VYOM SHARMA: Outwardly this, this bully, the registrar, was, is known to be incredibly charismatic, very lovely, ah, to-to speak to, but quite literally, ah, behind closed doors at 7 pm, 8 pm - whatever it was - would begin this half an hour, hour-long tirade of just, of swearing, of abuse. And then, of course, threats. Threats that... you know, "If you don't pick up your game I'm going to, this is going to be reflected in your evaluation."

QUENTIN MCDERMOTT: How did it all affect you?

VYOM SHARMA (sighs): I'd wake up in the morning, just dreading going to work. Um... Yeah, and I'd wake up and I'd just literally count the days until it'd be over.

QUENTIN MCDERMOTT: Vyom Sharma soon learned that this type of bullying is hard-wired into the culture and hierarchy of medicine.

VYOM SHARMA: My first day as an intern I was told by my surgical registrar, um, "Look, I know what they've told you in medical school: that we all work as a team and we all work together and take decisions. But you follow my orders and I follow my boss's orders, and that's that."

It doesn't really sound like a medical environment, but it is. It sounds exactly like the Army.

HELEN SCHULTZ, DR, PSYCHIATRIST: I think any profession where there is a hierarchy: there's going to be perhaps some form of bullying.

Wherever there's power and a disparity of power, ah, some people will use for good and be great leaders and, and really influence people and embrace new people coming along with new ideas.

And other people will be completely abusive of their power. And that certainly happens in medicine.

QUENTIN MCDERMOTT: Helen Schultz works as a mentor of doctors in training.

HELEN SCHULTZ: It's important for people to understand that we still work largely within an apprenticeship model, so the people that are, are often our bullies are our direct supervisors. They're the ones that sign off on us on every rotation. They're the ones that provide references. They're the ones that we're frightened of; that we really, really want to impress. And they're also the ones that are capable of bullying.

QUENTIN MCDERMOTT: Dr Sharma was present when the registrar who had bullied him got his own comeuppance from a senior consultant during an operation.

VYOM SHARMA: I could tell he was nervous and he just - he made a mistake. He made a mistake. And the way this consultant surgeon ripped this registrar apart in front of me, a medical student, another resident, anaesthetists, anaesthetics nurse; i- it wa- was humiliating for him. And it was humiliating for me to watch.

QUENTIN MCDERMOTT: Dr Sharma decided then that he didn't want to be a part of this cycle of abuse.

VYOM SHARMA: In one moment I could just see how this all happens. Someone bullied him; he bullies someone else. Now it's my turn.

And we just need to stop. That's it.

QUENTIN MCDERMOTT: It's a view which is now being acknowledged at the highest levels of the profession.

(to Graeme Campbell) Is there a cycle of bullying, where young registrars learn how to behave from their senior colleagues?

GRAEME CAMPBELL: Um, actually, that's one of the things I fear might be correct. Um, and w-we often learn from role modelling, from, from our seniors.

So if we're taught in an intimidatory way or, um, behaviour that's intimidatory or, ah, not respectful, ah, is role-modelled: ah, young, younger, younger doctors can adopt those, adopt that.

And that's a cycle we need to break, 'cause that's not where we want to be.

AVRIL HENRY, LEADERSHIP CONSULTANT: People look to their most recent role model. And if your most recent role model bullied people and got away with it, it takes a really strong person with high self-awareness and emotional intelligence to look at that person and go, "I'm not going to behave that way. I am going to be different."

And so, if you don't have the capacity to do that and you don't have the emotional intelligence and self-awareness to recognise it, then you are more likely to perpetrate the behaviour, because that's who you learnt from. And I think that's why the cycle continues.

(Footage of David Morrison launching Avril Henry's book, 'Leadership Revelation III: How We Achieve the Gender Tipping Point')

DAVID MORRISON, LIEUTENANT GENERAL (RET.), FMR CHIEF OF ARMY: The "ah-ha" moment for me as your chief of Army...

QUENTIN MCDERMOTT: In recent years, Avril Henry has enjoyed a unique working partnership with Lieutenant-General David Morrison, as the then chief of Army tackled the scourge of sexism and sexual harassment within the military.

DAVID MORRISON: And I have now - and I admit this cheerfully and in public - read more feminist literature than most men my age in three lifetimes.

(Audience laughs)

DAVID MORRISON: Avril, could I invite you to address us? Congratulations.

QUENTIN MCDERMOTT: He wrote the foreword to her latest book about leadership, women and discrimination.

AVRIL HENRY: I'm actually proud not only to call you my friend, David, but a feminist: a guy who gets women. A male champion of change. A sponsor of women and a chief of Army...

QUENTIN MCDERMOTT: Avril Henry sees parallels between the Army and the medical profession and believes that bullying and sexual harassment are more widespread in medicine than many will admit.

...that inequality anywhere is a threat to equality everywhere.

(Audience applauds. Footage ends)

AVRIL HENRY: Nine times out of 10 - in fact probably 9.9 times out of ten - it is perpetrated by a more senior person towards a more junior person, because firstly: they are in a position of power and secondly: most people who are on a career path will be loath to make a complaint because they will see it as career limiting.

Georgie Harman is CEO of beyondblue. Two years ago it carried out a survey of 14,000 doctors and medical students. What the survey uncovered was alarming.

GEORGIE HARMAN, CEO, BEYONDBLUE: The bullying figures were, were really quite astounding. One in 20, ah, Australian doctors were left feeling stressed because of bullying in the workplace. That's a significant number and, again, one that, ah, I think was a, quite a revelation to everybody.

QUENTIN MCDERMOTT: According to your report 24.8 percent of doctors had had thoughts of suicide. Did, did that figure surprise you?

GEORGIE HARMAN: Look, that was probably the most shocking. So, um, one in five medical students had had thoughts of suicide in the previous 12 months; one in 10 doctors, compared to one in 45 in the general population. I mean, so those are absolutely astonishing figures.

QUENTIN MCDERMOTT: When this young man was bullied as a medical student, it nearly drove him to take his own life.

MEDICAL STUDENT: There was a culture or an acceptance that teaching by belittling was OK and was acceptable - and not just acceptable but was the way to do things.

QUENTIN MCDERMOTT: Teaching by humiliation?

MEDICAL STUDENT: Yes.

QUENTIN MCDERMOTT: The student, who asked us to conceal his identity, found the teaching he received from one consultant especially confronting.

(to medical student) How did you feel whenever you went out on a ward round?

MEDICAL STUDENT: Terrified, absolutely terrified. He would ask us questions that were impossibly difficult and if we knew the answer, he would ask us another and another. And the worst part was he would do it in front of the patient and the patient's look of terror, when we didn't know the answer, was probably the worst thing about it.

They looked at us like: how is this person going to be a doctor? You know, they are going to kill someone. And all they see is inadequacy.

QUENTIN MCDERMOTT: What did that do for your sense of self-confidence?

MEDICAL STUDENT: It shattered it: just shattered it. It, it made me feel worthless. It made me feel like I knew nothing, which wasn't true. Ah, it made me feel like I was dangerous, ah, and that I was going to kill someone.

QUENTIN MCDERMOTT: The fear and dread he felt would nearly lead him to kill himself.

MEDICAL STUDENT: I just started going very, very downhill and I, I ended up in a very dark place. I was severely depressed. I, I'd stopped enjoying anything. I didn't want to go to university. I didn't want to go to the hospital. I didn't want to see friends. I wasn't eating much. Um, and... I just, I didn't see a way out. I ended up, about two months after the rotation, attempting suicide and I nearly succeeded. And afterwards, when I hadn't, I wished that I had.

QUENTIN MCDERMOTT: The medical student's life was turned around when he received psychiatric treatment, but his mental state is still vulnerable.

(to medical student) How are you feeling now?

MEDICAL STUDENT: Angry. List- listening to myself tell that story again, I just get angry. I, I- It shouldn't have happened. Um, I shouldn't have been made to feel like that. But at the time I didn't think that. I thought: I deserve this. I didn't know enough. I should've known more, you know, um...

QUENTIN MCDERMOTT: So you blamed yourself?

MEDICAL STUDENT: Of course, absolutely blamed myself. Because that was what I was being told: was that I was inadequate. I wasn't safe. I didn't know enough. But the problem was: you could never know enough.

GEORGIE HARMAN: What we do know is that a toxic work culture can significantly contribute to psychological distress. It can... Ah, anything that makes you feel bad about yourself, that makes you l-ah, lose confidence in yourself, that makes you feel worthless, ah, can be a major contributor to suicidal ideation.

AVRIL HENRY: The thing about bullying is: it whittles away at your self-esteem and self-belief. And then you start to think that you've done something wrong or there must be something wrong with you. And it's just like a spiral that people get into.

And once people get into that spiral, they feel like there's nothing they can do right. They feel like they've got nowhere to go. And that's what causes the depression and, ultimately, that's what can lead to people committing suicide.

In this young man's case, like so many others, the bully escaped unscathed. Even now the student fears retribution if his identity is revealed.

MEDICAL STUDENT: I didn't report it to the hospital.

QUENTIN MCDERMOTT: Why not?

MEDICAL STUDENT: I was terrified. I-I... I knew nothing would happen. He's the head of a unit. And that comes with a lot of power and a lot of protection. There's a very close-knit community in medicine, where the senior staff close ranks and they deny there's a problem. And the problem, if it does exist, is with the person reporting, not with the person who's perpetrating it.

(Footage of Dr Tan in consultation with a patient)

CAROLINE TAN: Can you just show me if I...

(Dr Tan removes neck brace from patient)

CAROLINE TAN: Just turn your head as far as you can that way. And the other way.

QUENTIN MCDERMOTT: Ten years after reporting what happened to her, Dr Caroline Tan is still seen by some colleagues as the problem and not the victim.

CAROLINE TAN (re-attaching neck brace): You'll find that will actually improve.

PATIENT: Yeah.

QUENTIN MCDERMOTT: Her punishment for speaking out has been to have her path into public hospitals blocked at almost every turn.

(Footage ends)

CAROLINE TAN: My good fortune is that I've had wonderful patients and, really, my patients are everything to me. You know, I, I'm so grateful to be able to continue treating people. And, and I have to say that they keep me going. They keep me, um, fighting on for, for what little, um, toehold I can get in the medical system.

(Footage of Quentin McDermott with a group of Dr Tan's patients)

QUENTIN MCDERMOTT: What kind of message do you think that sends out...

QUENTIN MCDERMOTT: Dr Tan's patients are appalled that the only access she has to a public hospital is the use of an operating theatre for half a day a month.

SUSIE LOSA, DR TAN'S PATIENT: I just think it's laudable that here is someone who is obviously at the top of her game, she's an excellent surgeon and she actually wants to work in the public service. She doesn't want to go and make squillions in private practice. She actually just wants to help people.

SUE HARVEY, DR TAN'S PATIENT: She wants to give her skills.

SUSIE LOSA: She wants to, she wants to give her skills. And she is being prevented from doing this.

SUE HARVEY: And I think it's very, very sad. It's, it's almost criminal that she's not allowed to practice as she wants to and give her skills, offer her skills to people who really need it.

I mean, John: we both...

QUENTIN MCDERMOTT: But both the Royal College and the Australian Medical Association say they cannot help.

BRIAN OWLER, ASSOC. PROF., PRESIDENT, AUSTRALIAN MEDICAL ASSOCIATION: The AMA does not provide support in terms of finding people employment. That's not the role of the AMA.

QUENTIN MCDERMOTT (to Graeme Campbell): Are you simply washing your hands of that?

GRAEME CAMPBELL: No, I'm not washing my hands of it. I'm just saying it's not our area of responsibility. So at the end of the day, employment is a matter for an employer. Um, as far as, D, far as, ah, Dr Tan stands with the college: she completed her training, she passed her examination, she became a Fellow, she remains a Fellow of the college in good standing. Ah, and that's, that's what the college has control over.

QUENTIN MCDERMOTT: Dr Tan's case has become a catalyst for change. In recent weeks the college has set up an expert advisory group to combat bullying and harassment. One aim is to ensure that complaints of bad behaviour are properly investigated.

But now, fresh questions are being asked about Monash Medical Centre and how it's handled recent, serious allegations against another surgeon.

Dr Imogen Ibbett is an accredited surgical registrar. From 2011 to 2013, she worked at Monash Medical Centre.

IMOGEN IBBETT: Overall I had a very positive experience at Monash, um, and, ah, I found most of the surgeons there to be extremely supportive and, and, excellent surgeons as well as educators.

But certainly a predominant theme was bullying from one of the female surgeons there, um, and really just a, a sort of constant feeling of fear, um, whilst, whilst working there when, when she was around at work.

QUENTIN MCDERMOTT: Tonight she is laying her career on the line by speaking openly about the bullying she says she experienced during her time at Monash.

(to Imogen Ibbett) How did this particular surgeon treat you?

IMOGEN IBBETT: Ah, she was awful to me. Um, you know, just constantly being made to feel that I wasn't good enough, um, constantly being made to feel that I was, um, missing things, that I was lazy, um, that I was stupid. Um, and, and that was really exactly how she said it as well.

QUENTIN MCDERMOTT: Was she uniquely unpleasant to you?

IMOGEN IBBETT: No, no, absolutely not. Um, most of the, the other registrars that I worked with, um, have had similar experiences.

QUENTIN MCDERMOTT: The neurosurgeon concerned is Dr Helen Maroulis.

Imogen Ibbett says Dr Maroulis continued to denigrate her, even after she won a coveted place on the college's surgical program.

(to Imogen Ibbett) Was it constructive or was it destructive?

IMOGEN IBBETT: Oh, it was absolutely destructive. Ah, there was never really any sort of comment on how I could improve. Um, often there wasn't really any specific explanation for what she felt I'd done wrong. Um, it really just felt that it was, um... It just felt as though it was an attack on me.

Um, and, you know, I, I, I remember days when I would just go home and, and, and just cry, just sit in a dark room and, and just cry. And, um, we're so vulnerable anyway when we're at that junior stage in our career and really all the way through our training we're very, very vulnerable.

QUENTIN MCDERMOTT: Like other trainees who have experienced bullying behaviour, Dr Ibbett's confidence was rocked by the constant attacks.

IMOGEN IBBETT: It's awful. You know, it, it's humiliating, actually. Um, you know, we are training to be specialists and we do have a level of expertise in the specialty, even though we're only trainees. So yeah, it was extremely degrading.

QUENTIN MCDERMOTT: A formal complaint against Dr Maroulis from another former registrar has gone to Monash Medical Centre.

It alleges that, on several occasions, Dr Maroulis was "verbally abusive towards the nursing staff." One theatre nurse emailed the hospital's administration, saying that: "Many of the nurses are afraid of her."

She added, "When I have to reluctantly scrub for her, I feel my performance can be compromised and I can make mistakes."

(to Imogen Ibbett) What was her behaviour in theatre like?

IMOGEN IBBETT: She'd be extremely abusive to, um, the staff. A lot of the nursing staff won't work with her. Um, a lot of them are very, very scared of her.

Um, you know, she shouts at people. She makes unreasonable demands. Um, even just little things, you know: she grabs the instruments from the nurses. She chucks instruments back on the bed instead of handing them back to the nurses. Um, and they all just generally find her very, very hard to work for.

Um, and she, if she feels she's struggling with a case, she certainly will take it out on the nurses or the registrar assisting her.

GRAEME CAMPBELL: The bottom line: bullying, humiliation: it impairs performance. It impairs the performance of the person who's bullied. It impairs performance, indeed, of the bully themself. And ultimately it's an issue about patient safety, 'cause if the doctor's performance is impaired then that's not a, that's not going to result in good patient safety.

QUENTIN MCDERMOTT: Four Corners has learned that Monash is now investigating Dr Maroulis' clinical performance, as well as the claims of bullying.

Dr Ibbett wasn't invited to participate in that inquiry.

IMOGEN IBBETT: I actually contacted the HR department myself, um, and said, "I would very much like to, um, be involved in the investigation and give evidence." I was told at that point it was an internal investigation and because I no longer worked at that hospital, um, they didn't want any input. Um, I did point out that I had made a complaint to the head of unit when I worked there, um, but they, they didn't want to speak to me.

QUENTIN MCDERMOTT: In March the hospital cleared Dr Maroulis of bullying for lack of evidence, but the complaints are now being re-examined.

Four Corners has spoken to other colleagues of Dr Maroulis who say that they too were bullied.

She remains at Monash, but is not performing operations.

(to Imogen Ibbett) Did she come and apologise to you or to any of the other registrars?

IMOGEN IBBETT: Ah, no. She's never apologised to me. Um, and as far as I know she's never apologised to any of the others.

QUENTIN MCDERMOTT: The College of Surgeons is now investigating a separate complaint about Dr Maroulis' behaviour from a consultant who believes the hospital's own inquiry was manifestly inadequate.

GRAEME CAMPBELL: We need to have a culture that's respectful. One of the things in the college's new, er, complaints process that we're putting in train at the moment: there will be a degree of independent oversight.

So one of the things that I think we'll need to oversight is to be sure that there is no retribution to someone who has complained. It's up to us to do that.

QUENTIN MCDERMOTT: The medical profession now accepts it has an entrenched problem in its culture. But does it have the will to fix it and the courage to support those who speak out?

BRIAN OWLER: As I think, ah, General Morrison has said in the past: the sort of behaviour that you accept is that that you're willing to walk past. So I think it's up to all of us as, as colleagues to actually examine not only our own behaviour, but also the behaviour of those around us and to make sure that we take the appropriate steps if we see things getting out of line.

(Footage of Dr Tan in consultation with a patient)

CAROLINE TAN: Do you have any nausea?

(Footage ends)

CAROLINE TAN: I don't regret what I did - even though, as you heard, I've suffered for it. I think that, at the end of the day, you have to be able to respect yourself. And if you give in to people who, who are predatory like that, then you've lost some self-respect. Um, and I personally couldn't live with that.

KERRY O'BRIEN: A stark case of "physician, heal thyself," writ large.

For the record, Helen Maroulis and Andrew Danks from Monash Medical Centre declined to comment for Four Corners and Chris Xenos couldn't be reached for comment.

The medical centre itself also declined to appear on the program but it's provided a statement which is on our website.

That's the program for tonight. Until next week, good night.