A fifth-year medical student was shadowing a FY1 doctor on a surgical ward as part of the team looking after patients waiting for surgery. The student had been asked by the consultant to summarise the discussions that had taken place in the notes, including the management plan and any investigations. The consultant dictated what she wanted written in the notes to the student, so that there would be no misunderstandings.
For one patient, the student wrote down a list of haematology investigations that were needed and asked one of the nurses to complete the blood request form so that the phlebotomist could take the samples the next morning prior to the patient’s operation that day.
The results came back but the INR result was missing. As the patient was due to go for surgery that day, the INR result was urgently needed. The student wasn’t aware that the INR hadn’t been taken until about a week later and went back to look in the notes and realised that they’d not written down an INR in the notes but remembered a discussion about it and that the consultant specifically asked for it. Concerned they’d get into trouble for not recording it, the student added the INR to the list making it look like they’d recorded it during the ward round as requested, and that the nurse had simply forgotten to tick the correct box on the form.
Learning from your mistakes and those made by others is an important part of learning and developing and is essential for safe patient care.
The patient’s surgery was delayed until the following week, so the patient made a complaint. As part of the complaint investigation, the notes the student had recorded at the time were photocopied. It was noted that the initial photocopy didn’t have the INR recorded but the original notes now did. The consultant asked the student if they could explain what had happened.
The student was very upset and remorseful and explained they had been worried about getting into trouble for delaying the patient’s operation. They apologised both to the nurse and for their lack of judgement. Their clinical supervisor felt they had no choice but to report the matter to the deanery who opened a Fitness to Practise investigation. The student contacted the MDU for advice.
The student was advised to reflect on what they’d done and write a report for their portfolio. They were advised to review the GMC’s Good medical practice and the guidance produced by the GMC and Medical Schools Council about professional behaviour and fitness to practise. The student was especially encouraged to think about the importance of honesty and trust as a doctor to avoid bringing the profession into disrepute.
The student produced an insightful and reflective report referring to the GMC’s guidance and made an appropriate apology for their actions. While the fitness to practise panel accepted their report and apology, due to the serious nature of the allegations and the fact that the case related to dishonesty, the student was given a final written warning and was made aware that the GMC would know about the incident when it was time for them to apply for preregistration. As such, it was important that the student had an exemplary record going forward.
Learning from mistakes
The GMC and medical schools take allegations about a student or doctor’s probity very seriously.
It’s often more difficult to take remedial action and reassure the GMC or medical school that the student or doctor won’t act dishonestly again – unlike when clinical concerns are raised, where a doctor can engage in further training or professional development to improve their skills or knowledge.
It’s also important to be open and honest when things went wrong. Errors or wrong decisions can happen from time to time as medical professionals. Learning from your mistakes and those made by others is an important part of learning and developing and is essential for safe patient care.
If errors or near misses aren’t reported, there’s no opportunity to learn or, if necessary, change systems that are in place. Therefore, there’s a risk that those same errors could happen again and again.
You can always contact us for advice at any time.
Dr Kathryn Leask
Dr Kathryn Leask
BSc (Hons) MBChB (Hons) LLB MA MRCPCH FFFLM RCPathME DMedEth
Kathryn has been a medico-legal adviser with the MDU since 2007 and is a team leader, trainer and mentor in the medical advisory department. Before joining the MDU, she worked in paediatrics gaining her MRCPCH in 2002 and did her specialty training in clinical genetics. She has an MA in Health Care Ethics and Law, a Bachelor of Law and a Professional Doctorate in Medical Ethics. She is also a fellow of the Faculty of Forensic and Legal Medicine and has previously been an examiner and deputy chief examiner for the faculty. Kathryn is currently a member of the faculty’s training and education subcommittee and a member of the Royal College of Pathologists (medical examiner).
See more by Dr Kathryn Leask