Table 5.

Summary of themes and illustrative comments

Themes (Note: Comments could reference multiple themes simultaneously.)	Illustrative comments
Minor consequence/coping: Dealt with bully personally (n=3) Coping by acquiescence, retreat, keeping head down (n=21) Little effect or no significant impact (n=49)	‘Recognise the behaviour and dismiss it and remain calm… Does not affect me and I do not try to defend against allegations made. Have had many years of practice.’
Moderate consequences: Defamation, character attacks, unfounded gossip or rumours (n=12) Not wanting to go to work (n=20) Undermining of abilities or professional standing (n=20) Feeling unappreciated and/or unacknowledged (n=20) Affected sleep (n=26) Reduced hours and level of involvement (n=28) Impeded ability to innovate or improve clinically (n=31) Anger, irritation, frustration (n=42) Loss of self-confidence and faith in abilities (n=42) Affected personal life or home dynamic (n=49) Compromised ability to work or perform to usual standards (n=51) Negative work dynamic resulted (n=52) Affected collegiality and willingness to collaborate (n=59) Anxiety, loss of trust, faith in system, feeling isolated (n=66) Disillusionment loss of enjoyment or love of job (n=76)	‘For the first time in 19 years working as a doctor, I dislike coming to work. I am anxious and sleep poorly. I am struggling in my personal relationships because I feel like I should be able to cope but don’t seem to be able to…I often feel unsafe now at work, and I worry that my experience here will have a negative impact on future positions I apply for. I am considering leaving the field of medicine because of my experience at this particular DHB.’
	‘As the person doesn’t speak, communicate or interact with [me] and hasn’t for 2.5 years. I am at a loss as to how to fulfil my role…[I’m] basically guessing what to do. Plus [I] have been undermined and humiliated and disenfranchised and the staff I give clinical guidance to know it. I have lost confidence in myself and in my professional abilities.’
	‘… Bullying wrecks a whole week. It leads to self-doubt and second guessing. It takes a long time to recover from. It is poorly recognised. It is difficult as an SMO to call out on bullying as it is a sign of weakness. Therefore, many of us put up with it especially in a system where we are overworked with unrealistic schedules and no hope of making an improvement.’
	‘You pull back and do the bare minimum to keep a service running. Bringing the behaviour to the attention of managers further up the pecking order has made no difference. Patient health is at risk.’
	‘Professionally it has affected my enjoyment of my job and I am considering moving to another DHB as I feel that I am so intimidated at times that I am unable to do my job to the best of my abilities. At times it is intolerable. The behaviour has caused me stress which has spilled over into my personal life too.’
Significant consequences: Taken leave (n=7) Burnout, mental health issues, depression (n=25) Significant stress (n=58) Contemplating leaving, early retirement, quitting medicine (n=64)	‘I fear going to work. I feel as if I am being watched the whole time. I feel as though it doesn’t matter how good my clinical work is, that my manager and [clinical director] will find a way to put a negative spin on it… I have lost confidence in myself as a doctor and a person. I feel disempowered… I am very anxious about work. This affects my sleep, which makes me worry more… I find it harder to trust people in general, and am more defensive…I am less patient with my children, as I feel so stressed. It feels like being trapped in an abusive relationship… I often dream of leaving. I often feel I have wasted my life, investing so much of myself in my work, when it is not valued by my seniors, even though patients value what I do.…I see patient care compromised, and the quality of the service being eroded. …I feel ethically compromised every day.’