Emily Fowler. Bystander Awareness, Don't Forget the Bubbles, 2021. Available at:
‘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.
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?
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.
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
Talk on bystander awareness given by the University of Leeds Equality and Inclusion Unit