It might not be the easiest thing to do, but raising a concern when patient safety is at stake is your duty as a doctor. Kathryn Leask gives an overview of how to tackle this sensitive subject.

Medical students are in a unique and privileged position. You're provided with an opportunity to witness patient care first hand and to engage with members of the public at their most vulnerable.

This position isn't without its own responsibilities, however. Whether it's down to the systems in place in the hospital or practice you work in, or because of the actions of an individual, unfortunately you may witness situations where you feel that patient care has been lacking. If you found yourself in this position, what would you do?

Why would you raise a concern?

All doctors have a duty to raise concerns if they believe that patient safety or care is being compromised, and this applies to medical students too. The General Medical Council (GMC) and the Medical Schools Council (MSC) has recently produced a report called 'First, do no harm', about enhancing patient safety teaching in undergraduate medical education. It's well named, as the reason for raising a concern should always be to make sure the patient comes first.

If you came across a situation where a patient was at risk and opted not to speak out, you could be vulnerable to criticism and asked to justify your decision.

What's stopping you?

The thought of pointing out that something - or someone - is wrong can be intimidating, especially if you're the most junior member of the medical team. Lacking the skills and knowledge of your seniors, you're obviously in a very difficult position. It's easy to assume that someone else will raise concerns and that you can just keep your head down and carry on. But it's important to know what your responsibilities are as a qualified doctor, and also to recognise that you have responsibilities while you're still a medical student.

One aspect of developing learning in patient safety is considering the importance of challenging unsafe practice. However, the 'First, do no harm' report says that in an electronic voting report from the GMC's 2015 conference workshop, 33% of students disagreed, and a further 29% strongly disagreed, that their education and training took place in an open and fair safety culture where they felt able to draw attention to concerns about patient safety.

It's easy to assume that someone else will raise concerns

This would inevitably have an impact on students speaking up if they saw patients receiving poor care, and delegates at the GMC conference were also asked to suggest changes that could improve patient safety. Not surprisingly, one suggestion was better support for those speaking out, emphasising the fact that raising concerns does make students - and doctors - feel vulnerable.

Cause for concern

Concerns about a colleague's behaviour may come in many forms. It's not just their clinical ability or performance that can have an impact on patient safety, but also their conduct or personal behaviour. You may have noticed a change in their behaviour that raises concerns about their mental health, or you may be worried that a colleague is abusing alcohol. This doesn't only have an impact on patient care, but also raises the need for that colleague to receive appropriate support before something goes wrong, which could affect their entire career.

Whilst raising concerns for any reason makes us feel uncomfortable, providing it's done in good faith and for the right reasons, you are unlikely to be criticised. You could, however, be criticised and asked to justify yourself if you were aware of concerns but chose to ignore them.

MDU advice - how to raise a concern

  • Don't be afraid to speak up.
  • Consider whether any of your colleagues have also raised concerns and consider speaking up as a group.
  • Speak to a senior member of staff as soon as possible.
  • Explain what has happened, with examples if available.
  • Keep notes of any incidents that concern you, ensuring you don't breach patient confidentiality.
  • Be honest, open, objective and able to support your concerns.
  • Don't make it personal if it concerns a colleague you don't get on with.
  • Be prepared to make a statement to support your concerns or be interviewed if the colleague is investigated under the Trust's disciplinary procedures.