Medico-legal fellow Dr Rachel Stewart explains what she learnt about ethics while working as an FY1 and offers tips for those starting their foundation training.

I graduated in 2019 and moved to South Thames for my foundation training. After this, I worked in plastic and burns surgery in London, where I re-ignited my interest in medico-legal and ethical issues. I was one of the coordinators for our quarterly morbidity and mortality meetings, and I enjoyed reviewing the cases and considering how the team could learn from them. 

I was struck by how often these cases had come not from clinical errors or incidents, but from navigating sometimes complex medico-legal issues in a busy clinical environment. This prompted me to apply for a medico-legal fellow post at the MDU so I could learn more about managing these difficult issues. 

I’m currently working a few days a week with the MDU’s advisory team providing advice to members, while also working as a locum plastics doctor, so I can keep my hand in clinical practice. 

Quick tips: documentation

When I started as an FY1, I soon realised that a significant part of my day was spent typing. Many trusts have adopted paperless notes, which, when coupled with the almost constant battle to find a (working!) computer on the ward, can make it challenging to document effectively and quickly. 

Here a few things I learnt about keeping on top of documentation.

  • If you have paperless notes, create saved templates for common situations such as ward rounds and patient reviews. This will save you time when documenting, but also acts as a memory aid to make sure you don’t forget anything important.
  • It can be tempting during a busy shift to see the next patient and write all your notes at the end, but you’re more likely to forget important information if you delay documenting or there’s a danger you may write down information in the wrong notes. 
  • Whenever you have a conversation with someone, be it a staff member or a patient’s relative, document the full name of the person, their role/relationship to the patient and what was said. This maintains the completeness of the patient record, and is helpful to colleagues who take over from you as they can easily see who has said what, and to whom.
  • If you’re writing notes on behalf of a senior colleague, and something isn’t clear to you, don’t be afraid to ask them to clarify it. The notes are a legal document, and your colleagues would rather you took the extra time to make sure what you’ve written is correct.
  • If you’re documenting your assessment of a patient’s capacity to consent, make it clear which decision this relates to, and when the assessment needs to be reviewed.
Good communication is at the heart of medicine, and many of the complaints we see at the MDU stem from communication breakdown.

Quick tips: communication

If your medical school was anything like mine, then I’m sure you had at least one session about communication skills a year. It’s easy to dismiss the importance of these sessions, especially if cringe-inducing role plays were involved. 

However, good communication is at the heart of medicine, and many of the complaints we see at the MDU stem from communication breakdown. When speaking to patients:

  • make sure you choose an appropriate location to speak to patients or relatives, which offers privacy and confidentiality
  • always make time to explore your patient’s (or colleague’s) ideas, concerns, and expectations. You may be surprised at how they differ from your own
  • be aware of any medical jargon that you might use without noticing. Make sure you give the patient plenty of time to ask you questions at the end to clarify things that might not have been clear
  • don’t be afraid to admit if you’re not sure of something; honesty is crucial when consulting with patients. You can always ask for help from a colleague
  • if something does go wrong, make sure you speak to a senior colleague as soon as possible, fully document what has happened and be open and honest with the patient. Mistakes happen, but it’s essential to manage them properly.

Quick tips: confidentiality and technology

Technology is another aspect of communication that needs careful consideration. Mobile phones make it easier than ever to keep in touch with your colleagues, especially when you can take a quick picture of a patient’s wound or X-ray. But you need to be sure that you’re still respecting patient confidentiality.

  • Find out if your trust has any specific tools that allow you to message colleagues securely. There are increasingly specific apps designed for healthcare professionals, such as one which lets you upload photos directly into a patient record for safe storage. 
  • Don’t be tempted to post photos of interesting cases on social media. Even if you think the patient is not identifiable in the photo, you don’t have control over where those photos could end up, or who may see them. 
  • If you’re asking a colleague for advice about a patient via WhatsApp, avoid including patient identifiable information like names, hospital numbers or dates of birth. 
  • Check with your employer to make sure the forms of communication you’re using are acceptable.

Browse our seminars

We offer a series of free seminars for our foundation members covering all the foundation professional capabilities that touch on medico-legal aspects of clinical practice - including communication, good record-keeping and more.

Find out more about our seminars and how to book.

Good ethical practice

Medical school is busy, and often the focus is on clinical knowledge. However, helping patients is at the heart of medicine, and this extends beyond simply treating their illness. 

As an FY1, you may well be the predominant doctor a patient on the ward sees every day, and doing your best to be empathetic and respectful to patients through good medico-legal and ethical practice will set you up with good habits for the future.

This page was correct at publication on 08/09/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.