Dr Sally Old

The Francis Report into the standards of care provided at Mid-Staffordshire hospital recommended, among other things, that "proactive steps need to be taken to encourage openness on the part of trainees and to protect them from any adverse consequences in relation to raising concerns."

Junior doctors on the wards are often well-placed to notice something is amiss as they move between different hospital placements. For example, a trainee who has recent experience of excellent practice at one post could be acutely aware of incidents of poor care they might encounter at another hospital. Trainees are also less likely to be influenced by the prevailing culture within their new department, which might inhibit some long-standing employees from speaking out.

While knowing when you need to raise concerns is central to ethical practice, it's equally important to know how to do this effectively. In our experience, there are several pitfalls doctors fall into when raising a concern – the most common are using the incorrect channels; not keeping a record of the action taken; and conflating a concern with a grievance against a colleague. Equally damaging is choosing the 'nuclear option' of going public without giving the hospital trust the opportunity to carry out a proper investigation, a course which can bring the hospital and profession into disrepute, as well as leaving the doctor vulnerable to a complaint.

We encourage all doctors who want to raise concerns to follow their employer's existing policy in the first instance. In the light of media horror stories about victimised 'whistleblowers', it's understandable for trainees to be nervous about the implications for their career. However, be reassured that there are many more unreported cases of doctors who successfully raise concerns. You may even gain recognition and respect if you bring a serious threat to patient safety to the attention of your employer.

If you are unsure whether your concerns are well-founded or how best to raise your concern, the MDU is on hand to provide specific medico-legal advice. Just call our 24-hour helpline on 0800 716 646.

Dr Sally Old
Medical editor

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