One of the universal truths of being a medical student is that no matter where you position yourself in the operating theatre, you will always be in the way.
On this occasion – a minor surgery during my first clinical placement – I found a spot against the wall to be the most unobtrusive, and retreated there after I'd introduced myself to the theatre staff and the patient, who was undergoing the operation under local anaesthetic. He was very nervous, and a healthcare assistant stood by his head keeping up a steady comforting patter of smalltalk.
Suddenly, a senior doctor burst into the theatre. He loomed over the registrar's shoulder, observing his suturing.
'Well, that's not how I'd do it at all,' he said brusquely.
The patient sort of coughed in a manner that suggested he did not need to clear his throat but rather wanted to know who this person was, exactly, and what was wrong about the operation underway.
The senior doctor smoothly slid onto the stool to take the registrar's place. He snapped on some surgical gloves and proceeded to finish the operation speedily and, no doubt, skilfully.
As I watched, however, I kept waiting for the scrub nurse, or the theatre sister, or the registrar, or anyone present to point out that the senior doctor had neither scrubbed nor gowned before taking over. Meaningful glances exchanged over his bowed head suggested that everyone was aware of and uncomfortable with the breach in policy, yet not a word was said.
The senior doctor finished, stood up, and walked back out of the theatre, leaving the registrar to dress the wound and the patient even more anxious about whether the operation had been botched and then fixed, or simply tweaked.
I turned the matter over in my head for a few days, unsure of what to do. I didn't want a reputation as a 'difficult' student or to be fobbed off for sticking my nose where it didn't belong. At first I told the story to my fellow medical students as a sort of amusing anecdote. But then I remembered the patient and how nervous he had been, and how much more nervous the senior doctor's behaviour had made him, and how much more at risk of infection he'd been.
It didn't seem as funny then, and I decided to speak to the undergraduate placement supervisor, who emailed my year director, who informed the clinical placement lead, who spoke to me in person. She in turn emailed the clinical director of the theatre's department, who said he would follow up with the doctor in question. I never found out what happened after that.
I didn't want a reputation as a 'difficult' student or to be fobbed off for sticking my nose where it didn't belong.
This kind of scenario could have been ripped from the pages of a situational judgement test: 'You're a medical student on placement and you see someone more senior blatantly flaunt infection control policy. What do you do?'
Of course you say something, of course you challenge the behaviour, of course you raise a concern. But in practice the path was not so clear, and much more strewn with obstacles both psychological and practical.
First of all, the power of the medical hierarchy is real; there might as well have been Super Glue on my lips that day in theatre, so utterly unable was I to formulate an 'appropriate' way to challenge what was going on.
Secondly, the stigma against whistleblowing is strong; my impression of the NHS is that it has a very specific culture, an aspect of which is that staff look out for each other and 'have each other's back'. In most cases this fosters support among staff, but in some cases it can foster an 'us vs. them' attitude, where the 'them', perhaps, are particularly litigious patients.
Thirdly, there was not a policy I was aware of for students to raise concerns that was clear, easily accessible, anonymous, and well-advertised. In contrast, NHS staff have numerous avenues open to them for reporting incidents, almost all of which are clear, easily accessible, anonymous, and well-advertised. In the same hospital where this incident occurred, for example, flyers were posted in all the wards that informed staff of five different avenues for raising concerns, including text, email, and voicemail options.
As medical students, we have the great privilege of being privy to patients' consultations, operations and therapies without having to shoulder any of the responsibility when something goes wrong.
Perhaps because of this special position, we sometimes notice things others do not – for example, in the infamous case of the surgeon who removed the wrong kidney, it was a medical student who first realised the mistake after spending time studying the patient's X-rays. Yet also because of our position, we sometimes feel unable to point these things out.
An extra pair of eyes should be a positive thing, especially in an NHS that is more and more stretched to capacity. Medical students need a system for raising concerns that matches that already in place for NHS staff – we should feel confident, empowered and safe in our ability to point out when something isn't right.
After all, as the 'how to raise a concern' flyers in the wards proclaimed, 'excellent care is everybody's business'.
The views expressed in this article are those of the member concerned, and do not necessarily reflect the views and policy of the MDU.
See the MDU website for more information on your options and responsibilities when raising a concern.