Refusing a request from a senior colleague can be daunting but patient safety should always be the priority. Here’s how to navigate this tricky situation.

Working within the limits of your competence

Starting work as a junior doctor can raise some anxieties for many and it is inevitable for new doctors to feel out of their depth at times. While undertaking new tasks is a necessary part of your professional development, it is important that this is done in a structured and supported manner. The priority is always patient safety.

It can be particularly difficult to speak up when a senior colleague asks you to perform a procedure or do something where you feel out of your depth. However, the overriding principle is laid out in the GMC’s Good medical practice (paragraph 14):

14. You must recognise and work within the limits of your competence.

Therefore, if you feel like you’re being asked to do something that is outside your level of expertise or experience, you should explain this rather than attempt to undertake the task.

How to say no

How to say no can be as important as actually saying it. It might feel awkward to decline a request from a senior, especially if they seem dismissive of your valid concerns. You may feel embarrassed admitting you do not feel competent to undertake the task they are requesting. Instead of refusing the request, consider the following:

  • Explain that you are willing, but you do not have the requisite experience to agree to the request. This can frame the refusal in a collaborative way.
  • Follow up with confirmation that you are keen to learn and therefore would like to assist or observe so you can perform what is requested of you in future.
How to say no can be as important as actually saying it.

It is worth bearing in mind that the landscape current medicine is practised in is very different from how it was even a decade ago. There have been significant shifts in the medico-legal and regulatory aspects of medicine and an increasing emphasis on patient safety.

The old adage of see one, do one, teach one (SODOTO) is sometimes used to reference the fact that previous generations of junior doctors just ‘got on with it’ even if they had minimal training. The principle of observing a procedure before attempting it under appropriate supervision is not necessarily problematic, but it can push juniors to complete procedures they do not feel safe to do – which is problematic. If your concerns are met with a SODOTO type response, remember that just because something was common practice in the past, does not mean that it’s acceptable now.