The scene

A medical student witnessed a specialist registrar being rude to a patient and was not sure what to do.

What the GMC expects

It is important to speak up if you know something isn’t right. Sometimes we hold back because we feel nothing will change or we are simply too busy. But we have a moral obligation to protect patients and our colleagues, we can’t leave it for someone else to do the right thing.  Once you qualify as a doctor you will have a professional obligation to raise concerns.

The GMC’s guidance for medical students, Achieving good medical practice (paragraphs 18 -22) recognises you may witness or be involved in something in training which impacts on patient safety, dignity or comfort. The GMC advises you to raise such concerns promptly, usually following your medical school’s procedures, and contribute honestly and openly to the process.

Speaking up with the help of others

If you are unsure about whether your concern is justified, speaking to your colleagues can sometimes help. They may have experienced similar things and not feel able to say anything alone.  Raising concerns together is more powerful, and you may feel less vulnerable as part of a group.

You may feel uncomfortable speaking to senior clinicians and it can be difficult to raise a concern about your supervisor, who may be responsible for making assessments of your own performance.  In that case you may find it helpful to speak to someone you have an ongoing relationship with, such as your personal tutor, or seek advice from us at the MDU. In 2013, we received about 30 calls a week from members seeking help about raising a concern.

Alternatively, every NHS Trust in England has a Freedom to Speak up Guardian (FtSUG). This role was developed based on recommendations made by Sir Robert Francis after the failings in care delivered at the Mid-Staffordshire Trust. The FtSUGs form part of the NHS whistleblowing policy. As well as supporting people to raise concerns, the FtSUGs work to identify and break down the barriers to raising concerns within organisations. 

Can I speak up anonymously?

It is sometimes possible to raise concerns anonymously, but this can then make it difficult to investigate the issue fully. Although the organisation knows you raised the concern, they may not need to identify you when they investigate. Be willing to identify yourself if possible.

Submitting formal statements

Once you have let someone know about the problem, the organisation may need to investigate formally. This may involve you writing a formal statement about what you have witnessed. We’ve published general guidance on writing formal statements and we can help by reviewing a draft for you.

Cite specific examples of what you have observed or experienced, giving relevant dates and times where you can. You may need to refer back to the clinical records but it’s always important to bear patient confidentiality in mind. An investigator may want to interview you instead to obtain your evidence. 

Within the NHS and universities, there are formal procedures for investigating and managing the performance, conduct and health of employees. Investigators will usually have had formal training in their role. Whether you give your evidence in person or in written form, you have the same responsibility to make sure what you say is accurate and honest.

MDU advice

The student contacted us for advice on raising concerns about the inappropriate and rude comments her specialist registrar had made to the patient on the ward. We advised her that she should raise this concern about the patient’s comfort and dignity, just as she would a patient safety issue.

As we advised, the student spoke to the patient to let him know that she intended to tell her consultant about it. The patient thanked her as he felt he would not have been believed if he said anything himself. With the patient’s consent, the student then informed her consultant about the specialist registrar’s actions.

The consultant was able to speak to the patient about his experience and apologised for what had happened. The consultant thanked the student for letting him know and assured her that he would speak to the specialist registrar about his behaviour. The consultant’s report at the end of the placement praised the student for speaking up.