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8.5 How do I speak to a person who I feel I have witnessed behaving poorly?

Numerous surveys of doctors who have been bullied have highlighted that they wished that those who had witnessed the negative behaviour had spoken up.

A document published by the BMA in 2018 (PDF) highlights the power when bystanders are ‘active’ and report poor behaviours that they witness. It also re-iterates the importance of training in having the difficult conversations and to ensure a calm and non-confrontational approach as discussed in earlier sections of this module. The basic principles of the conversations remain the same whether it is conducted by a recipient, witness or second messenger.

It is acknowledged that not all bystanders will feel comfortable to have the difficult conversation themselves but they are encouraged not to ignore negative behaviours as these behaviours are not just unpleasant but have been shown to undermine patient safety. Bystanders can help de-escalate situations in the moment, by having a conversation after the incident or by reporting the incident to someone else who may be better equipped to ‘calling it out’. They can also provide support to the person who has been subject to the adverse behaviours and reinforce that they were not acceptable- even if unintended.


  • See Question 2 and Question 3 to explore the concept of calling it out with compassion.
  • The PACERS civility Toolkit is freely available online and although based on the American system it contains some very relevant information and tools. Specifically, the final scenario (21 to 33 minutes) of Video 3 of 3 from PACERS civility Toolkit: Incivility and bullying in Healthcare ‘practice vignettes’. It provides a framework with an example of how the difficult conversation can be conducted by the bystander who has witnessed the negative behaviour.
  • There are some useful resources available from the Association Anaesthetics at #KnockItOut: tackling workplace bullying, harassment and undermining | Association of Anaesthetists