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Bystander Awareness

Cite this article as:
Emily Fowler. Bystander Awareness, Don't Forget the Bubbles, 2021. Available at:
https://doi.org/10.31440/DFTB.33482
Elie Wiesel on bystander awareness - "What hurts the victim the most is not the cruelty of the oppressor, but the silence of the bystander

You look too young to be a doctor,’ would be a flattering phrase now (and one I haven’t heard in a while!). But when I qualified back in 2011 I’d hear it every week.

I didn’t translate this as a compliment, but as, You look too young to be competent to look after me/this patient/my relative’. It was never a welcome comment. I had never identified it as anything more than a throwaway line until I learnt about bystander awareness and micro-aggressions.

Bystander awareness- What is it?

As a GP registrar, I recently attended a session on bystander awareness. I will admit, I’d never heard the phrase before and had no idea what to expect from the session. It’s a concept much more commonplace in schools, universities and the military, but one I now think we should be very aware of in healthcare.

During the teaching session I realised I knew exactly what bystander awareness was. Here’s my explanation:

It’s that uncomfortable feeling of being a witness to a conversation you feel is discriminatory on some level.

Sometimes we witness obvious discrimination and bullying in the workplace. This session was more focused on being aware of subtle acts of discrimination, or micro-aggressions, as I now know to call them. These may relate to age, race, sex, gender identity, sexuality, disability… the list goes on.

Ashamedly, I now have to admit that I have been a passive bystander and I have witnessed these micro-aggressions without choosing to act. The incidents I remember have nearly all been at work. Following discussion with peers at this teaching session I realise I’m not alone.

I think the example I’ve most witnessed and the one which came up repeatedly in our teaching session is this one…

Person 1: Where are you from?

Person 2: *UK place name inserted*

Person 1: No, I mean originally?

…and so on.

This could be rephrased as you don’t belong here particularly if it’s asked often and out of context. People don’t like to be asked this. It is uncomfortable and this was reflected in our session. In fact, why would people ask that question? How is it relevant to the situation in the workplace? It’s (almost always) not. This is a micro-aggression.

Other examples of these micro-aggressions mentioned by colleagues included subtle discriminatory remarks/questions about size or height, as well as sex and sexual orientation. It was hard to imagine how most of these topics would ever be part of a relevant discussion at work. Once we got started it was really quite easy to identify that these were examples of micro-aggressions.

Solutions

Micro-aggressions can lead to a toxic culture in the workplace, and these behaviours become normalised over time. They can build up and really affect an individual’s confidence and enjoyment of their job and workplace. Some colleagues expressed how challenging and upsetting they found this sort of dialogue.

Some of the skills needed to tackle these micro-aggressions are very simple, and might just slowly start to shift the boundaries of what behaviour is considered to be acceptable.

So what can we, as individuals, do about it?

Bystander awareness infographic

1. Call it out

This is the obvious one, but it’s often incredibly tricky. For example; you’re in a group on a ward round where there is a clear hierarchy, and a patient says something inappropriate to a colleague which your seniors don’t react to.

It can be really hard to be the one to say I don’t think you should say/ask that when no one else is acknowledging it. In fact, this bystander effect is well recognised by psychologists as one reason people in a group don’t act. You could just make a simple statement such as I don’t see the relevance of that’ or ‘That is not appropriate’.

2. Provide a distraction

Change the topic of conversation, interrupt the conversation, ask an unrelated question.

3. Use body language

If you don’t feel able to speak up or it doesn’t feel appropriate, then try some disapproving body language. This can be highly effective. It can be as simple as not laughing at the racist joke, if that was the expected reaction, or providing a silent stare, followed by the statement “Can you explain how that was funny?” Nothing makes people more uncomfortable than having to explain their behaviour. Other options include moving next to the person being targeted as a silent show of support or simply changing your position by sitting/standing unexpectedly.

4. Discuss after the event

If you feel unable to react at the time, all is not lost. Approach the perpetrator directly afterwards to discuss your feelings. Or try a discussion with the targeted person afterwards to confirm if they see the situation as you did and ask how you could help. A discussion with other bystanders could help to work out a group strategy for further episodes.

To Conclude

In healthcare, we can only benefit from being aware of micro-aggressions towards others. Unfortunately, most of us (with a new understanding of what a micro-aggression is) will recognise situations where we were passive bystanders and did not act.

Having better awareness of what micro-aggressions are, and how detrimental they can be to an individual will help us to make the transition from passive to active bystander with the aim, in time, to have a positive impact on our workplace environment.

Selected references on bystander awareness

Bubble Wrap Live – Top 5 papers in Pediatric Surgery: Craig McBride at DFTB19

Cite this article as:
Team DFTB. Bubble Wrap Live – Top 5 papers in Pediatric Surgery: Craig McBride at DFTB19, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.22052

In the three years since we launched the Bubble Wrap segment, we have been able to highlight a number of key articles in paediatric research.  In this talk from the popular Bubble Wrap Live! sessions, Craig McBride brought us his top five favourite articles from the land of scalpels and sutures.

 

Here are the five articles Craig chose.

Brown EA, De Young A, Kimble R, Kenardy J. Impact of parental acute psychological distress on young child pain-related behavior through differences in parenting behavior during pediatric burn wound care. Journal of clinical psychology in medical settings. 2019 Jan 4:1-4.

 
 
 
 
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This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal. DFTB20 will be held in Brisbane, Australia.

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The 9th Bubble Wrap

Cite this article as:
Grace Leo. The 9th Bubble Wrap, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.12336

With millions upon millions of journal articles being published every year it is impossible to keep up.  Every month we ask some of our friends from PERUKI (Paediatric Emergency Research in UK and Ireland) to point out something that has caught their eye.

Playground behaviour – in adults

Cite this article as:
Andrew Tagg. Playground behaviour – in adults, Don't Forget the Bubbles, 2016. Available at:
https://doi.org/10.31440/DFTB.9377

This week Lieutenant General David Morrison AO (Retd) has been invited to my healthcare to a give a talk on workplace bullying and harassment.  Earlier this week I wrote about the pervasiveness of childhood bullying and asked you all to reflect on what it might mean for us at work. In light of recent findings in Ballarat changing culture becomes even more important.