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Being civil … and how to respond when someone isn’t

Dr Emma Vaux, consultant nephrologist and immediate past RCP vice president for education and training, explores tackling rudeness at work and how to move from bystander to upstander.

I find I am constantly surprised by the rudeness of others. There have been times when I have literally dragged a consultant away from haranguing trainees about their incompetence. There have been interactions with people where I could only think of something to say an hour, or even a day, after the event.

Of course, there are also moments when I know that what I have said, or how I have said something, has fallen short. It is often those throw-away remarks that can be so damaging, especially where there is a (perceived) imbalance of power with more junior or administrative staff.

How can we move from rudeness to civility? How can we promote an everyday culture of compassion and kindness where bullying is not an everyday encounter? How can we ensure we are not bystanders1 to poor behaviours or intimidating banter but feel able to challenge without detriment? Yes, there will always be those moments where steam needs to be let off (we are not perfect) but we need to make sure that they are quickly followed by an apology.

Tackling rudeness is important as we know that it adversely impacts on patient care. Most of us also know just how it feels to dread going to work. An unhealthy culture is one that eats us up, tears into patient safety and swallows up the money.

Thinking about this, my own experiences (described on BBC Radio 4’s Woman’s Hour in 2018), the #MeToo campaign and stories of bullying (such as those described by the Doctors’ Association UK) all led to the development of the RCP Code of Conduct – the professional standards to which we should hold ourselves and others accountable. The RCP is part of an anti-bullying alliance of medical and healthcare organisations to combat bullying in the NHS. In addition, we launched a Mental health and wellbeing resource in February 2020, which explores how we can look after ourselves, find the right support when we need it and what the RCP is doing to improve wellbeing in our work.

These important foundations may be built into our everyday experiences to start to move from bully or bystander to someone trying to make a difference. Often this can feel like an overwhelming task, but I think this is everyone’s responsibility. I am a great believer in the aggregation of marginal gains: if each of us start to do this, the culture will change from an unhealthy to a nurturing one.

We should start with ourselves. The illusion of transparency means we assume others know why we behave the way we do. Let’s hold a mirror up to ourselves – can we do better? Take a moment, a balcony view on your own actions – how does it affect someone else when you lose it? A moment of your bad temper may mean a day, or longer, of lingering distress or resentment for the recipient. If you are not feeling appreciated and valued, how do you respond to this? Are you doing the same to others; have you by default become a bully?

Role modelling behaviours is a good place to start and nudging others within our circle of influence. A thank you, little act of kindness, gesture of support, or asking ‘how are you today’? Before jumping to conclusions take time to know the background and context to an event. Everyone can have a bad day: count to ten, or if you have behaved poorly, apologise. Notice your behaviours and their impact.

Learning how to challenge poor behaviours and rudeness can help strengthen your courage to take those daunting first steps in starting to move from bystander[1] to upstander.[2] Be brave in speaking out. I have found the work of Diane Goodman very helpful in framing how I might do this and how can I respond in the moment (see her excellent summary of how to respond to microaggressions – a downloadable pdf at the bottom of this page). I have been experimenting with it and finding out what seems to make a difference. Why don’t you try it too?

  1. Bystander – makes either an active or passive choice in supporting a bully
  2. Upstander –recognises there is a choice in doing something to make things better


Responding to microaggressions 139.46 KB Uploaded: 11 November 2020