A whole new ball game?

By Homa Arshada and Deborah Eastwoodb
aConsultant Arthroplasty, Pelvic and Acetabular Surgeon, Barts Health NHS Trust 
bConsultant Paediatric Orthopaedic Surgeon in London and President of the BOA

Corresponding author e-mail: [email protected]

Published 27th April, 2023

We are well on our way with culture change, to challenge bias, bullying, harassment and misconduct: to change the playing field and the way the game is played. Nevertheless, promoting our professional standards and values is more essential than ever, while we face tremendous challenges to the delivery of healthcare, and the General Medical Council struggles with the trust and respect of the profession1.

How can we teach ourselves and others the ball skills to equip ourselves with this more open playing field and modified rules? How can we best support each other in learning and becoming better versions of ourselves? Fear and negativity rarely lead to growth.  A skill set that includes confidence, compassion and empathy helps everyone. Our profession spans generations and includes colleagues who are diverse in their lived experience of discrimination and privilege. Personality characteristics such as narcissism and Machiavellianism are found in some high achievers, but may make it difficult for the person to recognise the experiences of others as valid. Neurodiverse colleagues experience communication differently and have specific needs. It is hard to learn from each other when offence is tolerated and glossed over, when our hierarchical structures encourage a thick skin, resilience and turning the other cheek.

Catching and/or gathering a ball can act as a metaphor for receiving unsettling comments. What do I do with the ball in my possession?

I can throw it back, with a degree of force which reflects my upset feelings, keep it to show to someone later, hide it, or simply let it fall to the floor and walk away. I could also punch a hole in it and deflate it, or react with violence and get red-carded. The choice is mine.

Kindness is being clear with people and holding each other to account. Where we see wrong-doing, it’s showing a warning, with a yellow card before anyone is harmed. It is necessary when learning from each other for uncomfortable conversations, just to achieve the very low bar of keeping people safe and carries the aspiration of excellence through preventing exclusion2. Good people can be wrong, or make bad choices. Separate the behaviour from the person you know: it takes courage to do that, but you know it is right.

I might deflect the ball so it misses its target, but in so doing it may still hurt me or someone else in its path.

I might throw the ball back gently to someone who needs to learn the basic ball skills: a stressed patient who in their distress, perhaps, says something they might not say at another time.

I might just ignore the ball that drops to the floor and walk on by, too bored or tired to bend down and pick it up. This is, however, a form of disrespect to a colleague who could and should do better. At the team talk where the conversation includes colleagues joking about rape, it may be easy to ignore, but that is not responsible behaviour. Chatter with sexism and disrespect promotes an environment where sexual assault is more likely. Don’t ignore or drop this ball – improve your skills in dealing with the awkward pass. Learning is more effective when challenging real statements, in the moment, in proportion. It is more difficult when witnessing and being excluded from ‘banter,’ but not impossible. If we reflect on common problems, or even practice responses, we may be better equipped to challenge in a way where we can grow.

To paraphrase Norman Shidle: “A group becomes a team when each member is sure enough of themselves and their contribution to praise (and critique) the skills of others3.”

Some examples of awkward tackles:

1. Where are you from? No, I mean where are you from originally? No seriously, I just want to know…

For people who look different, this is a tedious, repetitive question. In the professional environment, we want to focus on what’s relevant or fun and to have an exchange which is of value to each of us. Please do not follow up with further throws of the ball; this persistence and a denial of someone’s choice to remain silent, or to change the subject lands somewhere between irritating and racist.  

Development of our skill set in handling this particular thrown ball might include one of several responses:


“I work in...  how about you?”

“That’s a long story, where do you work?”


“Originally? Do you mean my ancestors’ country of birth? I’m not sure we have time for that!”

“Do you mean my ethnicity? That’s quite a personal question to start off with.”


“Now look, people used to talk like that a lot, but it’s just ‘not on’ these days. You have to put your curiosity to one side and start off with something more appropriate.”

"There is work being done at the College and at the BOA about how to come across well. All the bright youngsters need role models who are well-informed. The problem is, sometimes people ask that question because they want to stereotype someone who has a different demographic. It’s so boring. The association you don’t want is that some of those people are racist (while acknowledging denials of racism)."

2. Let me make it sexual… Shall we have some sex talk?

Losing an earring, taking the train, being hit on the arm by a colleague – these are all incidents which have been pounced on and sexualised with a supplementary, unnecessary and often somewhat disturbing and disgusting imaginative story; often delivered by a surgeon with a beer for his own entertainment. This is rape culture, where a simple act of misfortune or jostling a woman going about her business is transformed, alarmingly, into a sexual context. How can this not raise a comment from bystanders? On the field of play, how can you ignore a red card offence? People who turn a blind eye share the mindset of perpetrators where another person’s discomfort is for their entertainment.


“Why would YOU say that to ME?”


“Are you deliberately sabotaging my ability to belong here, or just being a twit?”


(Feigning surprise)

“Ah, this is what people mean when they talk about rape culture. This isn’t a good look for you or anyone associated with you.”

It takes time to learn new skills or to practice the ones we have already. We learn together and when we practice together, the team achieves. We can be most effective if we assert ourselves in a way which is not unkind or disproportionate, but it can feel relentless. For the more privileged, these expectations can feel like an assault. After all, everything was fine before. Be prepared also for awkwardness; it might be helpful to change the subject entirely, or to focus on someone else in a group to allow recovery and moving forward. Good luck to all of us!


  1. Abbasi K. The GMC has lost the profession’s trust and respect BMJ 2022;377:o1374.
  2. RCS England Diversity Report. www.rcseng.ac.uk/about-the-rcs/about-our-mission/diversity-review-2021/ accessed 19 February 2023.
  3. Adapted from Norman Shidle. https://twitter.com/CoachMotto/status/1286093681401921537?s=20.