Role of the Physician- Bystander vs. Upstander
“As I have been looking around lately at what has been happening in the world (local, national, world), the question that keeps coming back to me is how much of bystander vs. upstander can I be and should I be as a citizen and as a physician? From Executive orders bringing ICE agents into health centers to the Senate Bill 1 eliminating DEI departments, trainings and scholarships at Ohio Colleges and Universities, there is a lot for us to to react and respond to.“
Below are links to a perspective from NEJM and information on Senate Bill 1. There is also a sheet that describes bystander vs. upstander and an APP “5 Calls”, which helps you place calls to your elected officials.
For this Reflection, please review the materials linked below and respond to the prompt in the discussion board. Please also post at least one response to one of your peers’ posts.
Is there a role for us to be upstanders at the community level?
What might that look like for you?
Is there a specific population or issue that you are passionate about / concerns you?
Is there a role for us to be upstanders at the community level?
I strongly believe there we should be upstanders as physicians. As the APA article states, it’s very easy to fall victim to the “Bystander Effect” and allow inaction to become the default response. However, I do believe that as physicians, we have social capital within our communities and should to be working to advocate for the safety and well-being of our or patients and colleagues. If it impacts the quality of care we deliver to patients and the quality of medical training future physicians receive, then it should matter enough for us to feel prompted to act in some way. We many not all be “passionate” about advocacy as we discussed in previous modules. Still, we should be seeking to be educated on the current issues and the different ways in which can support impacted communities (if we are not directly affected).
What might that look like for you?
Working daily to deliver equitable care to all patients I encounter, provide them with the resources to achieve their health goals, and stand up for them and colleagues during instances of harassment, discrimination, or mistreatment. As a Black woman in medicine, I aim to work even harder to mentor those pursuing careers in medicine who are underrepresented, with the knowledge that the playing field will never truly be equal.
Is there a specific population or issue that you are passionate about / concerns you?
I fear for the future of medicine with the anti-DEI legislation, for sure. During my time at UCCOM, I am grateful for all the ways I have been able to serve, lead, and influence positive change both in and outside of the clinical space as someone from a diverse background. From admissions committee meetings to panels at local high schools to national conferences, the importance of prioritizing diversity, equity, and inclusion has been abundantly clear. Much of my research, advocacy, and even teaching experience (I.e. racism in medicine lecture for M1s) has been in the DEI space, which causes concern regarding the future of this work and how its potential absence would impact future trainees and the patients the serve.
Ebun, great post! I agree with your point on physicians having social capital within their communities. I think this is definitely something physicians should use to make positive changes within our system. You make a great point about the negative impacts anti DEI legislation will have on medicine. Treating diverse patient populations requires diversity amongst the providers. It sounds like you’ve done amazing work in the DEI space, can’t wait to see the positive impacts you will have on medicine throughout your career!
The Ohio Senate Bill 1 (S.B. 1) – The Advance Ohio Higher Education Act effectively bans diversity, equity, and inclusion (DEI) initiatives across state institutions. This includes prohibiting equity-focused scholarships and restricting funding for research that considers diversity within populations. The bill mandates institutional neutrality on controversial topics and aims to eliminate perceived ideological bias in academia. This ruling seems to be a reaction to concerns over the perceived rise of progressive values in higher education. However, it has already led to a significant rollback in representation and equity efforts within Ohio institutions. At the national level, similar executive orders from the current administration have further contributed to the decline of DEI initiatives.
As physicians, it’s crucial that we recognize the real-world implications of these policies on the communities we serve. DEI programs were established to confront a history of systemic racism in the United States. This history continues to reveal itself through persistent socioeconomic inequities in minority and marginalized populations and deep-rooted health disparities. In “Answering the Call — Sustaining Equity Efforts in the Face of Regression,” Wang et. al posed the question, “What does it mean for medicine to be complicit in systems that uphold inequity?” As hospitals and research institutions comply with DEI bans, research and community health efforts focusing on decreasing health disparities are halted, and the patients they serve suffer. As stated by Wang et. Al, when there is political regression, marginalized communities suffer from regressive policies in medicine, which widens disparities and destroys the trust that has been slowly built between these communities and healthcare systems.
The CDC defines health equity as “the state in which everyone has a fair and just opportunity to attain their highest level of health.” The dismantling of DEI efforts threatens that goal, especially for marginalized populations who remain disproportionately affected. Physicians must be up standers against regressive policies that affect the care they deliver patients. I am especially concerned about how a decline in health equity research funding will delay efforts to include minority populations in more clinical studies and increase efficacy of research in these populations. As I advance in my career in women’s health, I remain committed to advocacy—both at the individual level, by supporting and empowering my patients, and at the community level, through involvement in initiatives like my service advocacy project, which focused on providing access to health education and preventive cancer care for women from low SES backgrounds.
Yes. Addressing discrimination, health disparities, and systemic biases requires active intervention. Being an upstander means advocating for equity in healthcare, education, or public spaces.
For me, this means ensuring equitable access to eye care for underserved and Spanish-speaking patients. Language barriers and systemic inequities lead to preventable blindness, and I’ve seen firsthand how patient trust improves when we communicate effectively in a culturally and linguistically competent manner.
I’m passionate about reducing disparities in ophthalmology and medical education. This includes: advocating for medical interpreters and culturally competent care, supporting community eye clinics and mentorship programs, and challenging policies that limit DEI efforts in medicine (However, I am not aware of how to do this effectively at this point in my career. I would be interested to hear others thoughts).
Alec, fighting for equitable care is so needed and exciting that Bearcat Eye has been able to do just that. As for challenging policies that limit DEI, it is tough with so much happening around us, but I think trying to keep apprised of the issue is the first battle – a lot of information to sort through. As a student, supporting each other, and adding your voice to any concerns or praise as leadership navigates these difficult asks.
Hi Alec! I agree we should stand up against discrimination, and we have a unique roll in this space as (future) physicians! You make some excellent points.
Is there a role for us to be upstanders at the community level?
Admittedly, I had never heard the term “upstanders” before this discussion post- however after reading the passage about what it means to be a bystander vs an upstander, I would say that there is absolutely a role or place for “us” (i.e.- medical professionals) to be upstanders at the community level. The degree of which this is a responsibility we carry vs an opportunity for us to grow and become better people and physicians could be debated, however that does not change the fact that there is absolutely a place for us to use our knowledge and positions to better society.
What might that look like for you?
I think it is important for us to have both general stances as upstanders of the community (i.e.- everyone deserves basic human rights which include things such as women’s rights, the rights of POC, the LGBTQ+ community, etc.), but can also be specific to things related to our fields. I think it is important for us to have both, because the more people who stand for basic human rights the louder our voices are and the better chance we will be heard. However I also think it is important for us to use our knowledge from our specialties and our specific education to help be heard. For example, while it is important for all of us to stand up for women’s rights, those who go into OBGYN can use their education and specialization to lead the discussion and give evidence about the medicine and why it is so important.
Is there a specific population or issue that you are passionate about / concerns you?
As someone going into Med-Peds, I am passionate about the rights and representation of those with complex medical conditions and disabilities. Hence my project being with St. Joseph’s Home. One thing I am passionate about regarding the recent legislation is the importance of having special education available for those who would not benefit from being in a standard classroom, and this should be available to them. However some recent legislations and the changes in government puts this at risk, and now people might not have the access to education they deserve.
Grace, I definitely agree that we have a role as upstanders. Using our knowledge to amplify important issues is a powerful way to make a difference. I didn’t know you had a passion about the rights and representation of those with complex medical conditions and disabilities. I had no idea that recent legislation may possibly affect special education access, which is a great example of how your voice (you Grace) can amplify important issues in a powerful an meaningful way. Thank you for sharing!
Thanks, Grace and Alec. Yes, our areas of expertise give us a perspective and podium to speak more effectively. Those with disabilities are at risk from many avenues. (https://thehill.com/homenews/education/5165509-trump-anti-deia-accessibility-disabled-students-ada-idea/) and (https://www.disabilityscoop.com/2025/02/20/lawsuit-filed-by-17-states-threatens-disability-protections-advocates-say/31309/),
Thanks for sharing Grace! I agree that we should be all the standing for the same things while also capitalizing on the knowledge and expertise we have in our respective fields. And the access to special education is something that I value as well as a sibling to someone with autism, and didn’t realize it could be impacted!
Is there a role for us to be upstanders at the community level?
I do believe there is a role for physicians to be upstanders at the community level. Physicians historically have a place of status and privilege in society, which means that they have a prime opportunity for using their voices to positive change their community. That said, I don’t think it being an updstander in the community is necessarily an obligation; the job of a physician is taxing at baseline and I think it is unreasonable to expect physicians to use their limited free time to participate in activism and activities that qualify as being “upstanders”.
What might that look like for you?
I plan to continue being engaged in the community in ways that I have been for years – volunteering in community organizations, especially, but also advocating politically by making phone calls to representatives and voting. In the future, I hope to financially support these organizations as well and perhaps become more involved in community resources (like serving on the board for a local food bank). I can also see myself participating more actively in political organizations and perhaps serving on local governments in some capacity, although I anticipate this would take more time away from practicing medicine than I would like.
Is there a specific population or issue that you are passionate about / concerns you?
I am very passionate about working with low income populations. For many years, I have found ways to volunteer in food banks and community resource centers. With the current trajectory of the United States government, I see this being a population that will be increasing in size in coming years with less and less resources available to provide them.
Caroline- Thanks. “At a community level”, was to broaden this out from being an upstander for the individual. You still speak to how you are advocating for the populations you are concerned about – through advocacy phone calls, non-profit boards. You are right, there is a limited amount of time that we need to manage.
I do totally agree that making sure you have the bandwidth to be an upstander is important. It’s vital to give your best self to everything you do, very much including being a doctor as well as being an upstander. Lousy advocacy is not beneficial and may be harmful to the cause. I agree with the worry about the low income population- many recent government policies are not in their favor and I worry about their ability to receive healthcare as well as other basic necessities.
I think your point about bandwidth is a good one, and means that we must all be strategic about how we fit in our advocacy. We’ve done a lot of work with resident teams/other trainees, but I recently did a rotation where I was the only learner and it gave me a better look at attending life. From that experience, I saw several ways to make systemic change just by helping to shape the trajectory of your own practice. One doctor pushed for two BP checks on every patient, catching way more cases of HTN – which, of course, hits lower SES/Black/other marginalized communities harder. But there are a lot of ways to make wide-reaching changes without spending a ton of time, as long as you are aware, engaged, and speak up when it matters to you.
Is there a role for us to be upstanders at the community level?
As doctors, I believe we are fairly prominent figures in our communities, and people look to us for our opinions. While some of these policies may not directly impact our patients’ health, it does impact their quality of life. Therefore, we must stand up for what will be best for our patients. One very important quote I saw in the readings was, “When someone witnesses and ignores a prejudiced attack, whether through choice or ignorance of the discriminatory nature of the situation, they can appear to be condoning or reinforcing the offender’s behavior and add to the alienation of the targeted individual.” Even though silence is easier and some people have good reasons for staying silent, I believe that it’s important to say something when you can. Speaking up can have social and economic consequences, and with the pattern of violence in our country can certainly also put lives at risk. So it’s not always an easy path, but super important to push back when you can.
What might that look like for you?
I think for me this would look like some more behind the scenes work, like working with my hospital board to ensure equitable policies are in place, working with my community to inquire what support they need, etc. I will be doing what I can to make sure the places that I am a leader in are safe spaces for people. I’m not much of a public speaker so you probably won’t be seeing me on the news or on a podium.
Is there a specific population or issue that you are passionate about / concerns you?
With the recent legislation put in place, I am particularly concerned for minority and LGBTQ populations. These policies essentially allow discrimination and set back much of what so many have worked so hard for. I worry about opportunities for people in these groups, as well as violence or other injustices against them.
Hi Jenna, I think you make a great point about silence and how not speaking up can be confused with complacency, even if that is not your intention. Like you, I am not much of a public speaker, but I can find ways to speak up – either with my real voice or metaphorically with my actions – to stand up for people and causes I value. I think this prompt has reminded me that in this time of political turmoil, it is important to continue to speak up for what we believe in, especially when being quiet puts marginalized groups at risk.
There is absolutely a role for physicians to be upstanders in the community. I had a mentor before medical school who had joined with other community members to respond to the issue of teens causing damage and coming into contact with the justice system on Halloween night. She and her neighbors created an alternate event for teens on Halloween. While she told me about this event and how it came to be, she said “people will listen to you simply because you are a doctor. Be conscientious about how you use that.” For her, she usually went by her first name. But when advocating and organizing, she leveraged the weight of her doctor title. I think this is a useful lesson in how to protect and support members of marginalized groups.
As a lesbian, the queer community is really important to me. Especially with the very targeted attacks on trans people right now, supporting that community is going to be a part of my practice in the future. So, I think being an upstander at the community level might include creating groups or events that give queer youth a place to gather and connect, while learning about ways to support their mental and physical health. Like my mentor, I’ll be sure to let folks know that I am a physician, so I can amplify others’ voices when they might have otherwise been overlooked.
Taylor,
I think it’s powerful to hear an example of the privilege and prestige that physicians have, even on topics not directly linked to medicine. It’s easy to forget that “people will listen” just because of a few extra letters after our names. There are so many ways that we are able to advocate within the community about the issues we are passionate about, and I really appreciate your examples that extend beyond healthcare.
Taylor,
I agree with you that doctors are influential community leaders that can really protect and support people as well as influence those around them to do the same.
I also, particularly, enjoyed your discussion of what upstander behavior might look like for you in your career especially in terms of how it relates to protecting and supporting the queer community!
Is there a role for us to be upstanders at the community level?
Many times during medical training, we are told that we are leaders in the community. That in and of itself puts us, as future physicians, in a position where we have the opportunity to be upstanders. I hadn’t specifically heard the term of “upstander” before, but I appreciate the contrast of the concept of upstander relative to bystander. As highly educated professionals, we are able to appreciate the systems and social impact of policy changes and, through our medical training, have perspective and specialized knowledge to frame these. Particularly when it comes to policy on topics related to access equality, healthcare systems, and clinical research, we have the privilege and responsibility as physicians to advocate for our patients. Even if we are not specialists in every aspect of medicine, we can generally be informed and recognize when select groups of patients are being selectively impacted. I do think this creates a natural role for us to be upstanders.
What might that look like for you?
As someone interested in head neck cancers within the field of ENT, one specific topic that relates is assess to healthcare particularly in terms of cancer screenings and detection. It is well established that HPV-driven cancer is increasing, particularly in men, as the HPV vaccination has had low uptake in the US. HPV-driven cancers tend to occur in the oropharyngeal region, which means that patients may not seek care until advanced stages of disease. Advocating for better access to care for my patients and for community-based screenings, regardless of insurance status, is one way that I envision helping.
Is there a specific population or issue that you are passionate about / concerns you?
As someone who has spent a lot of time learning Spanish, traveling in Spanish-speaking countries, and volunteering in clinics for uninsured patients (a large proportion of whom are Spanish-speaking), the current policies and political environment hits hard. I believe people deserve access to healthcare and to be treated for disease, including preventative measures, regardless of immigration or insurance status. I also don’t think that people should be financially devastated by seeking healthcare. Speaking up against policy to prevent individuals from having access to care and treating all patients as equal humans is another way that I see myself being an upstander as a medical professional.
I appreciate you sharing about a specific topic within ENT. Even though I am going into primary care, I like hearing how different specialties advocate for their patients and what areas that we still have gaps. There are so many issues that i want to support and advocate for patients, I often have a hard time narrowing down what I am truly passionate about. I recognize it is not possible to do everything and no one has the bandwidth for that. I guess in some ways I am still trying to find that specific topic. I have appreciated learning more about homelessness. In that sense, I think its great that you also speak spanish and care for that population. I may be a little jealous haha
I believe the nature of our profession automatically means society looks to physicians as a source of leadership, authority and prestige when it comes to medical matters and that means we are expected to be upstanders. However, this brings its own challenges as someone who is still human and prone to making mistakes. I believe our expertise in medicine and healthcare can give us perspective to advocate on a lot of different topics, but it might be harder to convince the rest of society of this. Some may feel that physicians should not involve themselves in politics for instance, or speak on matters that are not specifically tied to medicine. My biggest concern comes with the growth in medical disinformation and patient self education (or like Google MD). There was so much backlash to Dr. Fauci during his role as the chief medical advisor during COVID. How do we overcome this challenge at a systems based level when there seems to be so much distrust towards our profession.
A lot of these thoughts have informed how I see myself as a primary care physician working with marginalized populations. At least on an individual level, I believe building strong longitudinal relationships will help me create the trust necessary to overcome medical disinformation. Part of that is doing a lot of community outreach and development to support the community in the gaps that current healthcare does not address. However, it is very much a grassroots approach and would take a long time to see change. I do not have a specific population in mind but would very much love to focus on holistic or integrative practices like nutrition, lifestyle and alternative therapies to support communities who do not have access or medical knowledge of these options.
I agree, Pooja. It is so important for us as physician to disperse factual medical information to communities and to our patients especially in the current climate. I do think it can be challenging as there is a growing mistrust of physicians and research institutions. It is difficult to convince people of the scientific process and the mechanisms that are in place to prevent biases in research findings. However, I know that while you do not have a specific population in mind the longitudinal relationships that you build in your community will be incredibly beneficial.
Is there a role to be upstanders at the community level?
I absolutely believe that physicians should have a role of upstanders on the community level. Throughout the last 4 years, we have learned about SDOH in the classroom, and during our clinical years (or through various volunteer opportunities), we have seen SDOH in action. At a very rudimentary level, a physician’s function is to improve the health of their patients. Beyond diseases/illnesses there is so much that goes into a person’s health both mental and physical. With this knowledge I think physician’s should be upstanders because they can relate to their audience why certain systemic changes are good for their patients. However, beyond SDOH, I think to a certain degree physician’s are still well respected in society and may have a more influential role when it comes to advocating for systemic changes. We may not have time to be true upstanders for all issues, but if physicians pick certain issues they are passionate about, while uplifting physician’s with differing passions we could definitely cover a lot more ground collectively.
What might that look like for you/Is there a specific population or issue that you are passionate about?
Health equity is an issue that I’ve been passionate about and want to continue exploring as we move towards residency. Personally, I feel like every person should have access to healthcare regardless of circumstance. I’ve been fortunate to gain some experience in this area through the SRFC but I’d love to have my own organization one day that offers care to underserved populations. Additionally, down the line I’d like to get involved in some policy/advocacy work to help advocate for more systemic changes.
The bystander intervention tip sheet makes clear that there is a role for us as upstanders at the community level. Physicians have a responsibility to recognize and confront the discrimination that their patient’s face on an individual level. However, beyond that, as community leaders, Physicians must also model upstander behavior so as to shape social norms toward not tolerating discrimination. If discrimination is not tolerated, upstanding behaviors are then promoted for the community as a whole.
In terms of what upstanding will look like for me, I believe that it means that I must actively and even publicly face call out discrimination. Interpersonally, I must ensure that I call out discrimination even when it puts me in an uncomfortable position (so as to both call out the discrimination and promote upstander behavior to all those watching). Publicly, I must take a stance on issues of discrimination and injustice, call it out, and work to address it
Women’s rights and empowering girls and women will always be a cause that is near and dear to my heart. Seeing how we have regressed in these areas has been extremely disappointing to watch. As I move through this next chapter, I look forward to being an upstander and actively fighting back against this regression.