By Dr Dominique Lee
Public trust in oncology relies on strong professional standards, transparent governance, and confidence that concerns will be investigated and acted upon. When that trust is weakened, the consequences extend to workforce stability, patient safety, and the credibility of the profession.
Early in my career, under the guise of mentorship, a senior doctor invited me to his home, drugged and sexually assaulted me. The criminal and civil processes that followed extended over several years and required sustained personal, professional,l and financial endurance. Only afterwards did I learn that concerns about his behaviour had existed before my experience, and I always knew I was not the first victim.
That experience changed how I understand risk in medicine. It rarely appears suddenly or without warning. It develops over time, through behaviour that is observed, discussed, and often rationalised, but not acted upon in a way that prevents harm.
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In medicine, seniority is often conflated with moral authority. Reputation can eclipse scrutiny. Hierarchy can shape whose voice carries weight and whose is discounted.
From the earliest days of training, students quickly learn where they stand within a hierarchy. Obedience, resilience, and conformity are rewarded. Deviation can carry consequences. By the time doctors enter specialist training, many have internalised the belief that speaking up is risky. Creating noise can be interpreted as disloyalty rather than integrity.
The explanation sits within the structure of the system itself.
Hierarchy shapes behaviour very early.y
As a trainee, I saw colleagues pushed out not for serious misconduct, but for creating noise, and the message was clear that speaking up carried consequences that could follow you for years. People are conditioned early to believe that speaking up is dangerous, so silence becomes a form of self-protection. When silence is normalised, the behaviour of a small minority is allowed to continue.
When silence is normalised, the behaviour of a small minority is allowed to continue.
In my own case, concerns about the doctor who assaulted me existed, but did not result in intervention. During sentencing, a large volume of character references was presented to the court, many from senior doctors describing him as dedicated, hardworking,g and compassionate. Reading those statements, written by people I had worked with and who had previously supported me, was one of the most difficult parts of the process. It reinforced how professional standing can shape how behaviour is interpreted and how harm is weighed.
That dynamic continues to influence how matters are evaluated and progressed within the system.
The 2025 Resident Hospital Health Check, conducted by ASMOFQ and AMA Queensland, reflects the environment that many junior doctors describe. Nearly half of respondents reported experiencing or witnessing bullying, discrimination, or sexual harassment, an increase from previous years. Among those affected, only a third reported the incident, and more than half remained concerned about negative consequences if they did. Senior medical officers and consultants were identified as perpetrators in a substantial proportion of cases.
For many junior doctors, the decision to report behaviour is not simply about what is right. It is about what it will cost. The time and effort required to reach specialist training is significant, and there is a real fear that raising concerns will affect references, progression, and future opportunities. I have seen people stay silent because the perceived risk of speaking up outweighed the risk of remaining in an unsafe environment.
In my experience, the majority of clinicians are good, kind,d and ethical. The issue is not why a small minority causes harm, but why the majority does not feel able to intervene when behaviour is observed.
Lack of visibility magnifies harm.
Concerns are often managed within internal processes that lack independence and transparency. Outcomes are not always visible, and over time, this erodes confidence in reporting pathways. When people do not believe concerns will be acted upon, they stop raising them, or they raise them in ways that do not trigger formal review.
When I reported what had happened to me, I did not understand the process ahead or how decisions would be made. I did not know what support was available or how long it would take. The uncertainty, combined with the length of the process, made an already difficult situation harder.
Processes need to be sufficiently independent to maintain confidence, and outcomes need to be visible enough to demonstrate that action has been taken. Training environments need to reinforce that raising concerns is part of professional responsibility, not a deviation from it.
Over time, my focus shifted from the personal injustice to the broader conditions that enabled it. Ethical reform requires more than cultural aspiration. It requires a structural change that makes moral action sustainable.
Where culture fails, both staff and patient safety follow
In oncology, where care is complex and multidisciplinary, this has direct implications for patient safety. Optimising team structures, clarifying roles, and supporting shared responsibility reduces individual workload and improves coordination of care.
American Society of Clinical Oncology (ASCO) research from 2025 shows burnout is associated with reduced patient safety and increased medical errors, even at moderate levels. In 2024, the ESMO Resilience Task Force, established to support the well-being of oncology professionals globally, found that it also drives workforce attrition, early retirement, and reduced hours, compounding existing shortages.
A global study of 542 oncology professionals published by the American Society of Clinical Oncology found that 56.1 per cent met criteria for burnout, while 34.1 per cent reported high levels of impostor phenomenon and 38 per cent demonstrated maladaptive perfectionism. Burnout was most prevalent among early-career clinicians, particularly those under 40, and was associated with longer working hours and reduced ability to speak openly about workplace stress. Higher levels of impostor phenomenon and perfectionistic discrepancy were independently associated with increased burnout risk, highlighting how structural pressures and internalised expectations interact to increase risk.
In hierarchical environments, junior clinicians quickly learn what is safe to raise and what is not. Those who persist can be labelled difficult, disruptive,e or not a “good cultural fit”.
Embedding psychological safety
For clinicians to be able to raise concerns without fear of reprisal, clear escalation pathways, transparent processes, and leadership behaviours are required.
If senior clinicians model openness, accountability, and respect, those behaviours propagate. If they do not, the opposite occurs.
Oncology is a specialty that depends on trust, continuity and multidisciplinary coordination.
This is particularly relevant in training environments, where norms are established early and reinforced over time.
Through HeyBoss, a leadership and wellbeing initiative developed outside traditional institutional structures, I now work with clinicians navigating challenging professional environments. The aim is not to recount trauma but to strengthen ethical agency. Doctors are trained extensively in patient care, yet rarely trained to recognise unhealthy power dynamics or navigate professional boundary violations. Preparing clinicians for the relational realities of medicine is itself an ethical responsibility.
Moving from awareness to accountability
Health systems need to shift from reactive, individual-focused interventions to proactive, system-level approaches that address the drivers of risk. This includes redesigning work, strengthening governance, and embedding psychological safety into everyday practice.
Oncology is a specialty that depends on trust, continuity,y and multidisciplinary coordination.
The systems that recognise this and act on it will be the ones best positioned to deliver safe, high-quality cancer care in the years ahead.
Dr Dominque Lee is a Radiation oncologist, director of training at Princess Alexandra Hospital and ICON in Brisbane, Australia, and a senior lecturer at the University of Queensland. She is also the Founder of HeyBoss.org, an organisation that offers a variety of physician wellbeing programs and services to support mental health, including counseling, support groups,s and educational workshops.
